Increased Human Milk Exposure In The NICU Through The Development Of A Premature Infant Nutrition And Lactation Team
Lisa Stellwagen, MD, Charles W. Sauer, DO, Jae H. Kim, MD, PhD
Department of Pediatrics, University of California, San Diego, California USA
Background: Human milk feeding rates for preterm infants in neonatal intensive care units (NICU) at discharge lag behind breastfeeding rates for term infants reflecting a gap between maternal intention and success in producing adequate milk for the preterm infant. Nutrition, lactation, nursing and medical teams traditionally work in parallel in the NICU, which may lead to suboptimal quality improvement.
Objective: The aim of this study was to demonstrate that a collaborative nutrition team can improve human milk intake in the NICU.
Design/Methods: Starting in mid‐2007 we designed a collaborative nutrition health care team to improve the nutrition of very low birth weight infants (VLBW). The team, comprised of pediatricians, neonatologists, nurses, nurse practitioners, nurse educators, dietitians, and occupational therapists conducted a needs assessment, developed educational materials, organized program focus, and created a timeline. Roll out included a structured education program for nursing and physicians, updated feeding protocols, additional lactation support, improved milk handling policies, and research study implementation. Benchmark measures of human milk intake were compared between VLBW infants before and after the formation of the team.
Results: Baseline demographics including gestational age, birth weight, and hospital stay were similar for all groups. Significant changes in human milk intake such as full (100%) and mean human milk intake at discharge and time to regain birth weight were seen after the institution of the program.
Conclusions: integration of an interdisciplinary nutrition team in the NICU can markedly improve human milk exposure. The impact of this team is likely to lead to short and long‐term health benefits to the NICU population based on the established dose effects of exposure to human milk.
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Addressing the Nutritional Emergency of the Very Low Birth Weight Infant: Establishing a SPIN Program
Lisa Stellwagen, Yvonne Vaucher, Amy Yates, Alison Wolf, Laurel Lee, Donna Posin, Liz Zborowski, Corey Anaka, Terry Lawson, Colleen Philpot, Diana Stanford, Eyla Boies, Neil Finer, Jae Kim