Prolonged Oropharyngeal Mother's Own Milk Administration to Extremely Preterm Infants: The POP-MOM Study – A Quasiexperimental Study

Abstract

Background: Previous studies have assessed the safety of short-term application of oropharyngeal colostrum to preterm infants for 5-7 days. These studies revealed no differences in necrotizing enterocolitis (NEC) rates, infection, death, or feeding at discharge. Research aims: This study aimed to investigate the association between prolonged oropharyngeal mother's own milk (POP-MOM) administration (from birth to oral transition) and the prevalence of receiving mothers’ own milk and head growth at discharge or survival without morbidities in extremely preterm (EPT < 30 weeks) infants. Methods: The study design is quasiexperimental, with an intervention group using POP-MOM administration and a historical control group before implementing this practice. The intervention group received POP-MOM as soon as it became available and continued until the oral transition of feedings was achieved. All EPT infants admitted to the NICU without contraindications to human milk were included. The main outcome measured was receiving any volume of the mother's own milk (MOM) at discharge. The secondary outcomes assessed were insufficient head growth (head circumference < P3) at discharge and preterm-related morbidities, including severe intraventricular hemorrhage (IVH≥3), chronic lung disease (CLD), necrotizing enterocolitis (NEC), sepsis, and cystic periventricular leukomalacia (PVL). Results: The study included 217 EPT infants, 120 patients in the control group, and 97 in the intervention group. No antenatal or clinical differences were observed between the two groups. Of the total number of infants, 189 (87.0%) survived in the NICU, and at the time of discharge, 171 (90.4%) were breastfed at least once a day. After implementing the POP-MOM protocol, there was an increased likelihood of receiving any volume of MOM at discharge in extremely preterm infants (RR=1.10, 95% CI=1.02-1.21; p=0.01). The intervention group also had lower rates of insufficient head growth (RR=0.47; 95% CI 0.23-0.98; p=.04). We did not observe complications as a result of implementing this practice. Conclusions: Prolonged administration of the oropharyngeal mother's milk protocol was associated with an increased frequency of infants receiving any MOM volume and improved head growth at NICU discharge. Study registration: This study is registered under the number 61359516.1.0000.5330 at the Brazilian Federal Research Registration Platform.