Purpose for the program: Benefits of human milk for term babies outweigh formula.  Human milk is even a greater benefit to the preterm infant (infection prevention and improved neurodevelopment).  In 2006, UCSD Medical Center was designated “Baby Friendly”.  The “SPIN” (Supporting Premature Infant Nutrition) program was launched in 2007.  The goal was to improve the growth and nutrition of preterm infants.   It was noted, that following hospital discharge, most premature infants were not competent breastfeeders.  These infants continued to require fortifiers but we did not know how much or for how long.  Mothers continued to need to pump but supply was decreasing.  Both parents were exhausted and overwhelmed. 

Proposed change: In August 2008, the Premature Infant Nutrition Clinic (PINC) was established by a pediatrician and registered nurse.  Utilizing a team approach, visits included infant’s growth and development assessments and discussions of  the mother's concerns.  Then the RN performs a lactation consult and assesses an infant feeding, looking for ways to improve milk transfer, increase milk supply and increase breast/less pumping.  At the end of the 45-60 minute session, a plan is developed to help mother reach the desired goal.  Visits are individualized-one time only to several (1-3 weeks apart).  A follow-up letter is sent to the primary provider with appointment highlights and recommendations.

Implementation, outcomes and evaluation: It was noted during the first year, 97 patients/ 183 visits occurred; the second year, 83 new patients and the third year, 130 new patients/ 637 visits occurred.  During the 3 years, the gestational age breakdown  included:  46 newborns <30 weeks, 90 newborns 30-33 6/7 weeks, 104 newborns 34-36 6/7 weeks, and 40 newborns > 37 weeks.  Multiples data included 215 singletons, 83 sets of twins and 12 sets of triplets.  Currently, the team sees 7-8 patients in a 4 hour session, one day a week.  There is a need to expand to two days to manage the increase in consultations.  Outcomes have improved such as increased breast milk for longer duration of time, more breastfeeding, decreased/no breast pumping, and increased exclusively breastfeeding. 

Implications for nursing practice: Assuring best practice and performing research is exemplified by the projects in progress including a PINC Quality Assurance project, liquid fortification of mother’s milk at discharge research and an International multicenter validation of a pre-term growth chart. Both providers and nurses are involved in every aspect leading to increases in patient and staff satisfaction.

Keywords: Human milk, Premature Infant Nutrition, Lactation Consultant