Innovations In Lactation Support for Infants Born with Complex Surgical Anomalies

Purpose for the program: Infants born with complex surgical anomalies require extensive intervention, treatment and have high medical care costs both during short term initial hospitalization.  In addition, these children may have long term health complications and on-going higher medical care costs related to their surgical anomaly.  Based on what is known regarding the health outcomes of human milk and the critical needs of these infants, lactation support of the maternal infant dyad must be a priority.  The American Academy of Pediatrics recommends that all infants receive exclusive human milk for the first 6 months of life, yet less than 13% of infants in the United States exclusive human milk for this duration.  Infants born with complex surgical anomalies require different and more intensive lactation support so that these infants receive the benefits of human milk.  Proposed change:  This presentation will cover the innovative programs developed to ensure breastfeeding success for these most vulnerable infants.   Nurses will be able to take away skills and evidence based practice measures to implement in their own clinical facilities to ensure all high risk mothers and infants achieve breastfeeding success.
 Implementation, outcomes and evaluation: The Breastfeeding Resource Nurse model will be presented as a nurse drive model to ensure positive lactation and breastfeeding outcomes.  The comprehensive prenatal lactation program will be described and strategies for implementation will be presented resulting in a 99.95 % pumping rate.  Strategies for early and frequent pumping will be presented.  In the Special Delivery Unit, mothers initiate pumping within 2 hours (vaginal deliveries) and 4 hours (cesarean deliveries). A continuous quality improvement project will be presented as a model that other institutions can replicate.  Furthermore the success of the ten step process for vulnerable infants and transition to breast pathway will be presented which led to 100% success in transition to at breast feeds.

Implications for nursing practice:  All nurses working with high risk mothers and infants can apply the principles presented in this specialty session.  Detailed prenatal consultation should be incorporated into prenatal care with a focus on informed decision and the provision of human milk.  Following delivery, nurses must prioritize that women initiate pumping within 2-4 hours post delivery.  Nurses are the first line of defense for assisting a mother with the initiation and maintenance of milk supply

•    Keywords: Lactation, neonatal intensive care, human milk, skin to skin care, transition to breast