Providing Breast Milk for Neonates with Birth Weight Less Than 1500 Grams

Purpose for the program:

A retrospective review of very low birth weight (VLBW) infants’ records revealed only 50.6% of VLBW infants had breast milk in their feeding plan at discharge.  Our aim was to increase the number of VLBW infants receiving breast milk. 

A review of the literature was conducted which established the benefits of breast milk for VLBW infants, including reduced incidence of necrotizing enterocolitis, bacteremia, sepsis, and less retinopathy of prematurity. Barriers to providing milk and tested interventions for success were also identified. Literature established that an adequate milk supply is dependant on the education and commitment of the baby’s mother and bedside nurses.

Proposed change:

To increase the number of VLBW neonates receiving breast milk, we utilized a two step approach. We created a specialized task force of neonatal intensive care unit (NICU) nurses and we provided education about lactation and VLBW infants to the entire NICU nursing staff.  Both steps were done within a framework to create a paradigm shift in the way NICU nurses support mothers of VLBW infants to implement and sustain lactation. 

Implementation, outcomes and evaluation:

We used Watson’s “Caring Science” and associated caritas processes to organize this project .  We  educated our team of 12 RNs as Certified Lactation Educators (CLEs).    Through their indepth knowledge, the CLEs create a series of caring moments where lactation is the focus.  Data collection includes: maternal tracking of pumping, CLE collection of demographics, tracking of milk output, problems, and feeding at discharge.  A second focus was the provision of education about the lactation and feeding strategies for the rest of the NICU staff.  This enables continual support for mother’s endeavors and early problem identification.

This is an ongoing project.  We started by measuring how many infants, upon discharge, had breast milk as part of their feeding plan. Our first year (2007) showed a 60% increase in VLBW infants feeding any breast milk at discharge. We have maintained this level of success since that time.  In 2010, we’ve added two more data points - number of infants receiving only breast milk at 30 days of age, and number of infants breastfeeding at least once a day at discharge. 

Implications for nursing practice:

The data we collected shows that mothers are more likely to provide breast milk for their VLBW infant with education and support from specially trained neonatal nurses.  It also supports the use of Watson's Caring Science and caring moments.

Keywords: Breast milk for VLBW neonates; Lactation initiation in mothers of VLBW neonates; use of caritas to organize care;