Publication:

Quality improvement initiative to improve the availability of mother’s own milk for feeding preterm babies admitted to NICU

Background Ensuring timely availability of mother’s own milk (MOM) for preterm infants admitted to neonatal intensive care units is challenging. We aimed to improve MOM availability for feeding preterm infants by postnatal day 5 (PND5) through a structured quality improvement approach.

Methods This prospective pre–post intervention QI study was conducted over 6 months in a tertiary-care NICU. Preterm infants <34 weeks with hospital stay ≥5 days were included. The QI phases were baseline (August 2023), three sequential monthly PDSA cycles (September–November 2023) and sustenance (December 2023–January 2024). The primary outcome was a unit-day metric: the mean proportion of prescribed enteral milk requirement met by MOM from PND1–PND5, with PND5 as the primary endpoint. Infant-days with nil per oral status or zero prescribed enteral volume were excluded. Process measures were proportion of mothers expressing milk within 4 hours of birth; and proportion of mothers expressing milk ≥8 times/day.

Results In all phases of the study, the expression of milk within 4 hours showed improvement and the availability of MOM increased from day 1 to day 5. Process measures improved. Expression within 4 hours and Expression ≥8 times/day also increased from baseline values.

Conclusions A phased package of counselling, family participatory care, reminder systems and lactation counsellor support were associated with improved MOM availability by PND5. This was accompanied by improved early and frequent milk expression and gains were maintained subsequently.