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  • Quality Improvement Article
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Increasing early exposure to mother’s own milk in premature newborns

Journal of Perinatology volume 42, pages 1126–1134 (2022)Cite this article

Subjects

Abstract

Objective

Increase the proportion of ≤33 weeks newborns exposed to mother’s own milk (MOM) oral care by 12 h of age by 20% over 2 years to support a healthier microbiome.

Study design

We implemented interventions to support early expression of colostrum and reliable delivery of resultant MOM to premature newborns. Statistical process control charts were used to track progress and provide feedback to staff. Proportions of newborns exposed to MOM by 12 h were compared relative to baseline.

Results

There were 46, 66, and 46 newborns in the baseline, implementation, and sustainability periods, respectively. The primary outcome improved from 48% to 61% in the implementation period (relative change 1.27, 95% CI 0.89, 1.81, p = 0.2), to 69% in sustainability period (relative to baseline 1.45, 95% CI 1.02, 2.08, p = 0.03).

Conclusion

An interdisciplinary team-based, multicycle, quality improvement intervention resulted in increased rates of early exposure to MOM.

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Fig. 1
Fig. 2
Fig. 3: Secondary Outcomes shown below in Fig. 3a-d.
Fig. 4: Process Improvement in Interventions 1 & 4 shown in Fig. 4a and 4b respectively.

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Acknowledgements

We would like to thank the following people for their contributions: Lactation consultant—Suzanne DeSandre, RN,IBCLC; L&D Champions: Amber Nicholls RN, Kim Hutchison RN, Naomi Har-El, RNC-OB, Sabrina Trevino RNC-OB, Paola Valenzuela BSN, RN; Post-Partum Unit Champions: Paige Whitney White BSN, CLE, RN, Jieyun Wan RN,CLE, Abigail Galang BSN RN IBCLC, Chung Ying Jamie Huang RN, BSN, CLE, Estephani Castro-Torres BSN, RN, IBCLC; NICU Champions: Arlene Fleming RNC-NIC, Cristina Canete BSN, RN, IBCLC, Laura Haselden, RNC Melissa Suarez RN; Oral Care Champions: Amanda Cooley RD, IBCLC, Georgette Aquilina RNC-NIC, Rebekah Babcock RNC-NIC, Lan Bui RNC-NIC, Terri Muench RNC-NIC; EPIC Report Developer: Gopal Vedartham NICU Nurse Manager: Jody Charles MSN, RN, NE-BC Nurse Educator: Ellen Keohane RN,MSN,RNC-OB, NICU CNS Student: Yingchun Chen, MSN, RNC-NIC; Family Advisory Board Members; El Camino Health NICU Staff and ECH Stanford Neonatologists, Dr. Jane Morton for providing the hand expression video. Dr. Joseph Schulman MD, MS.

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Author notes

  1. These authors contributed equally: Cody Arnold, Dharshi Sivakumar.

Authors and Affiliations

  1. Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

    Malathi Balasundaram, Rachel Land, Stephanie Miller, Jochen Profit, Cody Arnold & Dharshi Sivakumar

  2. Neonatal Intensive Care Unit, El Camino Health, Mountain View, CA, USA

    Malathi Balasundaram, Rachel Land, Stephanie Miller, Melinda Porter, Cody Arnold & Dharshi Sivakumar

  3. California Perinatal Quality Care Collaborative, Palo Alto, CA, USA

    Jochen Profit

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Contributions

MB conceptualized and designed the study, designed data collection instruments, collected and analyzed data, drafted the initial paper and revised the paper. SM conceptualized and designed the study, reviewed the paper. JP critically reviewed the paper and approved the final manuscript as submitted. MP developed and conducted staff education for this project, assisted with creation of the figures and tables, and reviewed the paper. DS and RL conceptualized and designed the study, designed data collection instruments and collected data, and critically reviewed the paper for important intellectual content. CA contributed to formulating the study questions, deciding how the data would be analyzed, performing and interpreting statistical analyses, and writing the paper.

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Correspondence to Malathi Balasundaram.

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Balasundaram, M., Land, R., Miller, S. et al. Increasing early exposure to mother’s own milk in premature newborns. J Perinatol 42, 1126–1134 (2022). https://doi.org/10.1038/s41372-022-01376-8

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