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Increasing the Percentage of Neonates Consuming Human Milk in a Pediatric Cardiothoracic Intensive Care Unit: A
Jennifer Gauntt1, Ahquilah Tucker1, Kevin Dolan2
1The Heart Center, Nationwide Children's Hospital, Columbus, OH.
Insights
This quality improvement initiative successfully increased human milk consumption in critically ill infants in the cardiothoracic intensive care unit (CTICU). The percentage of neonates consuming human milk rose significantly without a rise in feeding errors.
Area of Science:
- Neonatal nutrition
- Quality improvement initiatives
- Clinical outcomes
Background:
- Critically ill neonates often have nutritional deficits.
- Human milk is crucial for infant health, especially in intensive care settings.
- Previous rates of human milk consumption in the CTICU were suboptimal.
Purpose of the Study:
- To increase human milk consumption among neonates in the cardiothoracic intensive care unit (CTICU).
- To improve nutritional status and overall health of critically ill infants.
- To achieve a target of 75% by December 2020 and 90% by December 2021.
Main Methods:
- A quality improvement initiative was implemented in the CTICU.
- Eleven interventions focused on parent/provider education, environment/equipment, and process optimization.
- Statistical process control p-charts tracked monthly human milk feeding rates; critical errors were monitored.
Main Results:
- Human milk consumption increased from a baseline of 55% to 73% by end of 2020 and 92% by end of 2021.
- The majority of infants received mother's own milk, with some receiving donor milk.
- Critical human milk administration errors decreased during the intervention period.
Conclusions:
- The quality improvement initiative successfully increased human milk consumption in CTICU neonates.
- No increase in critical feeding errors was observed.
- Interventions simplifying milk provision and storage for mothers were likely most effective.
Objective:
To address a known nutritional deficit and enhance the overall health of critically ill babies, this project sought to increase the percentage of cardiothoracic intensive care unit (CTICU) neonates consuming human milk from a 2019 baseline of 55% to 75% by December 2020 and 90% by December 2021.
Study Design:
This was a quality improvement initiative targeted to all neonates admitted to the CTICU, with baseline data obtained from January 2019 through February 2020. We implemented 11 interventions from March 2020 to January 2022 to address the key drivers of "education of parents and providers," "environment/equipment," and "process." We tracked the monthly percentage of neonates who were human milk fed with a statistical process control p-chart. The balancing measure of critical human milk feeding errors was also monitored.
Results:
The baseline percentage of CTICU neonates consuming human milk was 55%. This percentage increased to 73% by the end of 2020 and 92% by the year end 2021. Most neonates who received human milk were fed mother's milk with a minority receiving donor human milk. The number of aborted, critical human milk administration errors decreased during the intervention period.
Conclusions:
In this quality improvement initiative, we significantly increased the percentage of CTICU neonates consuming human milk without an increase in critical human milk errors. Interventions directly increasing the ease with which lactating mothers can provide/store their milk were likely the most effective.
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