LAUSR

Aim Maternal milk (MM) protects against necrotizing enterocolitis and sepsis. PRIME is a multi-disciplinary initiative to improve the early provision of MM for preterm infants and enhance outcomes. Our aim was to increase the number of high-risk infants receiving MM in the first day life in our tertiary neonatal unit. Method We retrospectively reviewed time to first MM for infants born <32 weeks gestational age (GA) or with a birth weight (BW) <1500 g in 2016. We conducted a cross-sectional survey to evaluate the knowledge and attitudes of staff towards breast milk for preterm infants. Deficits in background knowledge and training informed a teaching programme. Education involved training sessions, development of guidelines, distribution of posters, and presentation at meetings. The first 5 infants per month born <32 weeks GA or BW <1500 g were included in the post-intervention analysis. The effect of the interventions were evaluated using a before and after study design. Time to first MM was our key performance indicator. Results We reviewed 123 infants born in 2016 [Median (IQR) GA 29 (26, 31) weeks, BW 1140 (820, 1410) g]. Many infants didn’t start feeds in 1st24 hours as MM was not available; median (IQR) time to 1st MM 35 (17, 55) hours, 34% of infants received MM in the 1st24 hours of life. Prospective data was collected from 25 infants, born May – October 2018, following interventions [Median (IQR) GA 30 (26, 31) weeks, BW 997 (890, 1560) g]. The median (IQR) time to 1st MM was 17 (8, 25) hours and 76% of infants received MM in the 1st24 hours. Conclusion The initial results of this hospital-wide QI initiative are promising. The median time to first MM has halved in the 5 months since this initiative commenced. Further PDSA cycles are indicated to ensure ongoing improvement.