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  • Quality Improvement Article
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Increasing usage of mother’s own milk in neonates at risk of neonatal abstinence syndrome: MOM-NAS quality improvement initiative



To increase the usage rate of mothers’ own milk (MOM) among neonates with prenatal opioid exposure from a baseline average of 47% to an average of 75% over two years.

Study design

Between October 2018 and December 2020, we implemented various Plan-Do-Study-Act cycles that involved engaging providers in postpartum counseling for mothers with opioid dependence, using electronic medical records to track the rate of counseling, providing NAS educational materials to parents, and establishing a rooming-in unit. Our outcome measure was the provision of MOM to eligible neonates, while our process measure was the rate of postpartum counseling.


During this initiative, we witnessed a special cause variation with an increase in the usage rate of MOM from a baseline of 47% to a 27-month average of 85% by December 2020.


A series of quality improvement efforts resulted in increased usage of MOM among infants at risk of NAS.

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Fig. 1
Fig. 2: Annotated SPC p-chart of MOM usage rate among eligible neonates.
Fig. 3: Annotated monthly p-chart of postpartum parental counseling for neonates at risk of NAS.

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The authors did not receive any funding for this work. Financial support was obtained from CMN and Walmart to establish private rooms in the NAS unit.

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Authors and Affiliations



IH, SS, JC, MM, AE, PS helped design and implement the study. AA, JM collected data on MOM usage. JV helped to implement the study and educate the staff members. IH, SS, JC helped to write the manuscript. MLH provided guidance, mentorship, and reviewed and critically revised the manuscript.

Corresponding author

Correspondence to Samarth Shukla.

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The authors declare no competing interests.

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Shukla, S., Hanna, I., Cortez, J. et al. Increasing usage of mother’s own milk in neonates at risk of neonatal abstinence syndrome: MOM-NAS quality improvement initiative. J Perinatol 41, 2684–2689 (2021).

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