Promoting Human Milk Use in the Pediatric Cardiac Intensive Care Unit

Abstract

Problem & Purpose: The nutritional benefits of human milk are particularly important for infants with congenital heart disease (CHD). While not all infants with CHD are able to breastfeed directly, the provision of human milk for this population can be supported by utilizing expressed milk for enteral feeds or oral immune therapy. Evaluation of human milk utilization in the cardiac intensive care unit at a children’s hospital revealed suboptimal human milk use. Pre-implementation data from unit audits showed that 27% of infants under 1 year old were receiving any amount of human milk. Lactation consultations and oral immune therapy were not regularly ordered, and no formal lactation education was being delivered. Using quality improvement methodology, this project aimed to implement a lactation bundle to increase the percentage of infants in the pediatric cardiac intensive care unit receiving any human milk within the first 30 days of life. Methods: The bundle included pre and postnatal lactation education, lactation support bag, and revision of the newborn admission order set to specify human milk oral immune therapy and a lactation consultation. Implementation occurred over 15 weeks. Infants less than 30 days old were eligible. During implementation, parents enrolled in the Prenatal Cardiology Program were given access to online lactation education. On admission, the electronic medical record order set specified that infants with CHD receive oral immune therapy and a lactation consultation. Lactating parents received a lactation support bag and lactation education. Data collection occurred through electronic medical record audits. Order set use, lactation consultations, bag delivery, education delivery, human milk use, and oral immune therapy were tracked. Results: Of the 26 eligible infants, 96% received some amount of human milk; 65% of eligible infants received oral immune therapy. Conclusion: Findings demonstrate that lactation bundle components support maternal lactation efforts and improve the use of human milk.