Improving the Odds of Breast Milk for Preemies
“There was a sixfold difference between the lowest- and highest-performing sites in California in rates of breast milk feeding for premature infants,” said Paul Sharek, MD, MPH, medical director of the Center for Quality and Clinical Effectiveness at Lucile Packard Children's Hospital and senior author of the new research, published online Nov. 5 in Pediatrics. “We saw a great opportunity there.”
Sharek is also the chief clinical patient safety officer at Packard Children's and the director of quality for the California Perinatal Quality Care Collaborative, a Stanford-based organization that tracks and seeks to improve the performance of neonatal intensive care units throughout the state. The research team included experts from several California research institutions. Because Packard Children's neonatal intensive care unit already had one of the highest rates of breast milk feeding at discharge in California (84 percent), it did not participate in the study.
Establishing and maintaining a breast milk supply for a premature infant too small to routinely breastfeed is difficult, Sharek noted. “We want every NICU to give state-of-the-art support to women who choose to provide breast milk for their infants in this challenging situation,” he said.
During the study, the 11 participating hospitals increased their rates of breast milk feeding at discharge for small and early-born NICU babies from 55 percent to 64 percent. The hospitals also reduced a serious complication of prematurity — the bowel disease known as necrotizing enterocolitis — by two-thirds, from 7 percent to about 2 percent of all infants in their NICUs.
Each participating hospital began the study with an information package detailing 10 best practices, culled from scientific evidence, for encouraging breast milk feeding in babies in the NICU. Hospital teams were supported in making the changes via a structured process that the CPQCC has used to modify hospital practices in the past.
Two important changes hospitals made were increasing babies’ skin-to-skin time with their mothers and improving the education of NICU staff about the importance of, and how to promote, breast milk feeding.
“Providing families and staff with the skill sets to support breast milk feeding in very low birth weight infants makes a big difference,” Sharek said. “These babies are so small, and people are understandably worried that they’re fragile.”
The payoffs associated with increased breast milk feeding in premature babies are potentially wide-ranging, Sharek said. "We're really pleased that our approach, and the changes made at participating hospitals, resulted in a lasting improvement for moms and babies."