Quality Improvement Initiative: Identifying Barriers to Reducing Time to First Feed With Human Milk in Low Birth...

Area of Science:

• Neonatalogy
• Quality Improvement Science
• Pediatric Nutrition

Background:

• Early human milk (HM) exposure and trophic feeding in low birth weight (LBW) infants (<2 kg) is linked to reduced mortality, sepsis, and shorter hospital stays.
• Initiating timely first feeds is crucial for LBW infant outcomes, yet barriers often delay this process.

Purpose of the Study:

• To determine the mean time to first trophic feed in LBW infants.
• To identify barriers hindering the initiation of first feeds.
• To achieve a target of 90% of LBW infants receiving their first feed within 6 hours of birth.

Main Methods:

• A 29-month quality improvement (QI) project in a level III NICU utilizing two Plan-Do-Study-Act (PDSA) cycles.
• Implementation of a first-feed audit tool and a comprehensive, multidisciplinary educational plan for all involved healthcare teams.
• Targeted interventions for staff in Labor and Delivery, NICU, and the Child Health Transport Team.

Main Results:

• Post-QI project, 91.3% of inborn and 27.5% of outborn LBW infants received their first feed by 6 hours, up from 78.8% and 12.5% respectively.
• The mean time to first feed for inborn infants decreased by 80 minutes, reaching 4.4 hours.
• Achieved the target of >90% of inborn infants receiving their first feed within the critical 6-hour window.

Conclusions:

• A multidisciplinary approach and enhanced staff education are vital for reducing first feed times in LBW infants.
• Improving clinical practice guidelines on early human milk exposure positively impacts timely initiation of nutrition.
• Successful QI initiatives can significantly improve early feeding practices for vulnerable low birth weight neonates.