Quality improvement initiative: improving proportion of preterm infants on mothers only milk at the time of discharge

Authors

  • Sumandeep Kaur Department of Nursing, University College of Nursing, Baba Farid University of Health Sciences, Faridkot, Punjab, India
  • Gurmeet Kaur Department of Pediatrics, Guru Gobind Singh Medical College and hospital, Faridkot, Punjab, India
  • H. C. L. Rawat Department of Nursing, University College of Nursing, Baba Farid University of Health Sciences, Faridkot, Punjab, India
  • Prajjwal Bansal Department of Pediatrics, Guru Gobind Singh Medical College and hospital, Faridkot, Punjab, India
  • Amanpreet Sethi Department of Pediatrics, Guru Gobind Singh Medical College and hospital, Faridkot, Punjab, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20194613

Keywords:

Infants, Kangaroo mother care, Mothers only milk, Preterm, Quality Improvement

Abstract

Background: Availability of mothers only milk (MOM) for preterm infants is a boon for their growth and development. Authors found that in our Special Newborn Care Unit (SNCU), the availability of MOM was very less with excessive use of formula feed. So, authors planned a quality improvement (QI) study to improve availability of MOM for preterms in level 3 SNCU catering to both in-born and out-born neonates.

Methods: Authors aimed to improve availability of MOM to preterm infants admitted in SNCU from the current 10% to 80% at day 7 of admission over a period of 8 weeks. Authors included preterm and mother dyads with <34 weeks of gestation or having birth weight <1800 gm. and likely to stay in SNCU for at least a week. For this initiative a QI team was formed. Baseline data was collected for a period of 3 weeks and analysis was performed of various constrains in providing MOM to preterms was later an interventional package was implemented which included counselling to mothers, Kangaroo mother care (KMC), demonstration of milk expression techniques. Intervention phase was implemented for the period of 8 weeks followed by sustenance phase for 2 months.

Results: Proportion of preterm infants on MOM increased from 10% to 81% during intervention phase at day 7 of admission and remained 66% during sustenance phase.

Conclusion: QI initiative has the potential to bring a tremendous change in making mothers milk available to both inborn and out-born preterms. With existing resources simple interventions can increase availability of MOM to preterm infants.

References

Lucas A, Cole TJ. Breast milk and neonatal necrotising enterocolitis. Lancet 1990; 336:1519e23.

Lucas A, Morley R, Cole TJ, Lister G, Leeson-Payne C. Breast milk and subsequent intelligence quotient in children born preterm. Lancet 1992; 339:261e4.

Orlando S. The immunologic significance of breast milk. J Obstet Gynecol Neonatal Nurs. 1995; 24:678e83.

American Academy of Pediatrics. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatr. 2005;115(2):496-506.

Morrow AL, Ruiz-Palacios GM, Altaye M, Jiang X, Guerrero ML, Meinzen-Derr JK, et al. Human milk oligosaccharides are associated with protection against diarrhea in breast-fed infants. J Pediatr. 2004;145(3):297-303.

Sethi A, Joshi M, Thukral A, Singh Dalal J, Kumar Deorari A. A quality improvement initiative: improving exclusive breastfeeding rates of preterm neonates. Indian J Pediatr. 2017;84(4):322e5.

Alshaikh B, Kostecky L, Blachly N, Yee W. Effect of a quality improvement project to use exclusive mother's own milk on rate of necrotizing enterocolitis in preterm infants. Breastfeed Med 2015;10(7):355e61.

Merewood A, Phillipp BL, Chawla N, Cimo S. The Baby- Friendly Hospital Initiative increases breastfeeding rates in a US neonatal intensive care unit. J Hum Lact 2003;19(2):166-71.

Lowenstein LM, Brown K, Barrows D, Foti T, Scholer L, LeVant C, et al. Continuous quality improvement in a level IIIB NICU to increase human milk use at day of life 14, day of life 28, and discharge. ICAN: Infant, Child, & Adolescent Nutrit. 2014 Jun;6(3):137-43.

Sullivan S, Schanler RJ, Kim JH, Patel AL, Trawoger R, Kiechl- Kohlendorfer U, et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010;156(4):562-7.

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Published

2019-10-21

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Original Research Articles