Increasing Breastfeeding Rates in the NICU via Utilization of the Neonatal Transport Team
Enhancing Breastfeeding Rates in the NICU: The Impact of Colostrum Kits
Beth C. Diehl, DNP, NNP-BC, CCRN
The benefits of human milk and colostrum are well recognized, especially for infants requiring admission to the Neonatal Intensive Care Unit (NICU). Human milk provides optimized defense against co-morbidities such as necrotizing enterocolitis (NEC), sepsis, respiratory infections, chronic lung disease, and retinopathy of prematurity (ROP). Enteral feedings are better tolerated, feeding progression is enhanced, and cognitive development is fostered when mother's milk is utilized. Despite strong evidence supporting human milk feeding, studies show that many NICU infants are not discharged home receiving human milk due to factors like maternal-infant separation, geographical challenges, educational deficits, and inadequate lactation support.
Challenges of Maternal-Infant Separation
The birth of a premature or critically ill neonate is a crisis for the family. Neonatal transport and transfer to a higher-level NICU often separate the mother from her infant during the immediate postpartum period, overlapping with the highest colostrum production time.
Quality Improvement Study: Colostrum Kits
A quality improvement study was conducted to determine if providing direct education and a colostrum kit by the neonatal transport team to mothers of infants requiring transfer would increase breastfeeding rates. This initiative was a joint venture between Johns Hopkins Hospital (JHH) and the University of Maryland Medical System (UMMS), utilizing the Maryland Regional Neonatal Transport Team (MRNTP).
Colostrum Kit Components
The colostrum kit, housed in a washable vinyl tote, included two small colostrum collection bottles, a refrigerator magnet with human milk storage instructions, educational materials on colostrum benefits and breast pumping, a reusable cold pack, and a picture frame for a baby photo during pumping sessions.
Funding and Implementation
Funded by a March of Dimes Community grant, the colostrum kit was offered to mothers when the neonatal transport team brought the infant to the mother's room before departure. Mothers could decline the kit, which would then be left with hospital staff for later use. Mothers were encouraged to pump for the first one to two postpartum weeks, even if they initially chose bottle feeding.
Study Results
Retrospective data was collected for neonates transported before (N=290) and after (N=307) the program's implementation. Pre-protocol, 39% of neonates received breast milk as their first feed, and 37% were discharged on breast milk. Post-protocol, 75% received breast milk during admission, 67% as their first feed, and 66% were discharged receiving at least half of their feeds from breast milk. There was a 28% increase in infants receiving maternal breast milk as their first feeding and a 29% increase in those discharged on human milk.
Conclusion
The quality improvement project successfully increased breastfeeding rates in the NICU by providing direct education and colostrum kits. Preliminary findings suggest that utilizing the neonatal transport team for education and kit distribution can improve outcomes by reducing co-morbidities and optimizing feeding progression. Further studies are needed to confirm the long-term impact of this practice change.
About the Author
Beth C. Diehl, DNP, NNP-BC, CCRN, is a Neonatal Nurse Practitioner/Transport Nurse at Johns Hopkins Hospital in Baltimore, MD. With extensive experience in neonatal nursing care, she has published and lectured nationally. Beth also runs an independent legal nurse consulting business and serves as a nurse surveyor for the American Academy of Pediatrics NICU Verification Program.