Quality Initiative Program to Improve the Percentage of Very Preterm Neonates Receiving Expressed Breast Milk Within 24 Hours of Birth in a Tertiary Care (Level III-B) NICU

Abstract

Background There is often a delay in the initiation of feeding in preterm babies and more dependence on PDHM milk due to the non-availability of the mother’s own milk. This study aimed to increase the percentage of very preterm neonates receiving expressed breast milk (EBM) within 24 hours of birth. Methods A quality improvement (QI) initiative study was conducted from May 2022 to August 2022 in a tertiary care (Level III-B) NICU. A QI support team was formed. The reasons for the delay in the initiation of expression of breastmilk were evaluated. We included preterm neonates (<32 weeks gestation) born within the study period. Antenatal and postnatal counseling regarding the expression of breast milk, using leaflets and video, frequent visits, telephonic reminders, and emphasizing Kangaroo Mother Care through various Plan-Do-Study-Act cycles were done. Results A total of 17 very preterm babies were studied over a period of 3 months. The percentage of preterm receiving EBM within 24 hours of birth, increased from 20% (observation phase) to 83.3% (initiation phase) and maintained to 90% in the continuation phase. The time of receiving the first EBM reduced from a median of 32.5 hours (1.35 days) in the retrospective phase to 17 hours (0.7 days) during the initiation phase and it was sustained later on. Mothers were able to express as early as within 4.5 hours. Conclusion A simple QI intervention showed early expression and sustenance of breast milk in mothers of preterm neonates.