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Improving Time to First Feeding for Preterm Infants: A Quality Improvement Approach.
Molly F May1,2,3, Melissa L McKinney2, Danielle Cestare1
1From the Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa.
Pediatric Quality & Safety
|February 21, 2025
Summary
Early enteral feeding for preterm infants (<35 weeks, <2000g) increased from 49% to 80% within 24 hours. This quality improvement project successfully enhanced feeding initiation without raising rates of necrotizing enterocolitis (NEC).
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Quality Improvement Science
Background:
- Early enteral feeding in preterm infants (<35 weeks gestational age, <2,000g) is linked to reduced sepsis and mortality.
- At the center, less than half of eligible infants received enteral feeding within 24 hours of birth.
Purpose of the Study:
- To increase the initiation of enteral feeding within 24 hours of birth from a baseline of 49% to a target of 75% for preterm infants.
- To address barriers to early feeding, specifically the unavailability of mother's own milk.
Main Methods:
- Implemented interventions: antenatal lactation consultation, patient-dedicated breast pumps, standardized feeding orders, and multidisciplinary education.
- Monitored time to first enteral feeding as the primary outcome.
- Tracked necrotizing enterocolitis (NEC) incidence and formula use as balancing measures.
Main Results:
- The proportion of infants receiving enteral feeding within 24 hours increased significantly from 49% to 80%.
- The incidence of NEC remained stable at 1.9% before and during the project.
- Pasteurized donor human milk was the most common initial feeding source, followed by mother's own milk and formula.
Conclusions:
- The quality improvement project successfully increased early enteral feeding rates in eligible preterm infants.
- The interventions did not lead to an increase in NEC or formula use for initial feedings.
- Early enteral feeding can be effectively promoted through targeted quality improvement initiatives.
