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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.
Insights
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.
Introduction:
Early initiation of enteral feeding is reported to reduce sepsis and mortality in preterm infants. Less than half of stable infants born <35 weeks gestational age with birth weight <2,000 g are fed within 24 hours of birth at our center.
Methods:
The Specific, measureable, achievable, relevant, timely aim of this quality improvement project was to increase the initiation of enteral feeding within 24 hours of birth from 49% (baseline) to 75% among infants born <35 weeks gestational age with birth weight <2,000 g between November 2022 and December 2023. We identified the unavailability of a mother's own milk as a major barrier to early feeding initiation. Project interventions included antenatal lactation consultation, patient-dedicated breast pumps, standardized feeding orders, and multidisciplinary education. The outcome measure was the time to first enteral feeding, and the balancing measures were the diagnosis of necrotizing enterocolitis (NEC) and the use of formula for first feeding.
Results:
The proportion of infants with feeding initiated within 24 hours of birth increased from 49% to 80% during the project period. The incidence of NEC was unchanged (1.9% before and during the project period). Both before and during the project, feedings were most frequently initiated with pasteurized donor human milk (49.7% versus 58.7%), followed by mother's own milk (37.8% versus 35.6%) and formula (12.5% versus 5.8%).
Conclusions:
This quality improvement project increased the proportion of eligible infants fed within 24 hours of birth without a change in the incidence of NEC or an increase in formula use as first feeding.
