Increasing Breast Milk Availability at Neonatal Intensive Care Unit Discharge

Abstract

Problem: Breast milk confers health benefits to preterm infants, but they are less likely than term counterparts to receive breast milk at hospital discharge. In a tertiary neonatal intensive care unit within a suburban delivery hospital, 40% of infants born at 35 weeks’ gestation or younger were discharged on exclusive formula diets despite 100% of this cohort of mothers desiring breastfeeding. A literature review identified coming to volume as the strongest predictor of the availability of breast milk at neonatal intensive care unit discharge. Assessment of coming to volume was not routinely performed on mothers of preterm infants. Purpose: The purpose of this quality improvement initiative was to implement and standardize coming to volume assessments among qualifying mothers to identify mothers at risk of not coming to volume. Methods: Nurses were educated on the coming to volume assessment tool and monitored pumped breast milk volume daily through the first 14 days postpartum, or less if the mother came to volume sooner. Assessment responses were evaluated, and specific interventions were initiated if maternal milk volumes were not progressing. Results: Nine infants were eligible and received the intervention during the implementation phase. All (100%) received exclusive maternal milk diets plus caloric supplementation on the day of discharge. Five mothers (71%) came to volume by day 7 postpartum, one mother (14%) came to volume by day 14 postpartum, and one mother never came to volume. Compliance with coming to volume assessments was 33%. The average dose of human breast milk on day of life 7 was 126 ml/kg/day and 119 ml/kg/day on the day of hospital discharge. One third (33%) of infants received donor breast milk during their hospitalization. Conclusions: The implementation of coming to volume assessments may lead to an increased availability of breast milk on the day of hospital discharge.