The First 28 Days of Live:

1. The First 28 Days of Live: Exclusive breast milk feedings for babies less than 1500 grams to decrease our NEC rates. Promote and use human milk as the preferred nutritional substrate for VLBW Infant NICU Climate Changers Committee, NICU Nutrition Improvement Process Committee, Katie Pope, Nutrition Tech., Olivia Collins, Nutrition Tech. If breast milk was marketed as an Rx It would be ordered for every premature infant . • Why did we start? • Over the last decade our historically low NEC rates have risen despite implementation of recommended nutritional practices including: • Early initiation of TPN • Feeding Protocol • Early trophic feeds • An algorithm for managing intolerance • A systematic advancement of feedings for infants <1500 gms. • Strong NICU lactation program. What did we find? • What does our experience mean? • Balancing act to provide adequate nutrition to high risk infants • with immature guts but good nutrition post birth is mandatory • to provide good brain maturation and survival • Adopting new practices changes can be difficult to implement • and embrace by staff. This was especially true for beginning • banked breast milk feeding protocol. Pre-education, several • rounds and communication over a year prior to • implementation, was key to successfully changing culture. • Mother’s receptivity to their babies receiving banked milk • helped staff embrace this change. • Goal: NEC rate < 4 percent incidence (Top VON Quartile) • Kangaroo Care (Skin to Skin) has been an initiative for past 5 • years, however consistent implementation has not occurred. • The role of skin to skin in improving milk supply is an important • motivator. • Future Action Plan: • Track Feeding tolerance & Selected Outcomes: • Duration of human milk use • Days to full feedings • Days of TPN use • Incidence of feeding intolerance • Incidence of NEC • Successful establishment of breast feeding by • discharge • Unanswered Questions: • What is the best use of cow’s milk fortifiers (when to add, • which products, powder vs. liquid)? • Is human milk fortifier (Prolacta) worth the cost? • Will parent log and parent involvement improve our skin to skin • rates? • What did we do? • Continued ongoing assessment of VON data with implementation/revision of NICU • feeding protocol. • Joined Perinatal Quality Collaborative of North Carolina – Goals include: • Promote and use mother’s milk as the preferred nutritional substrate for • infants • Implement feeding guidelines • Assure safety in the use of expressed human milk. • Joined VON Nutrition Improvement Collaborative (Jan’ 11 – Dec ‘12) • Two NICU committees joined forces to work on PDSA cycles toward this aim over the next • two years. May 2011