Increasing Pasteurized Donor Human Milk Use in a Level 1 Newborn Nursery

Supplementation with pasteurized donor human milk (PDHM) instead of formula can help to preserve breastfeeding exclusivity. At our institution, up to 50% of term breastfeeding newborns admitted to the well nursery used formula supplementation during birth admission, impacting our discharge breastfeeding exclusivity and potentially long-term breastfeeding success. The primary outcome measure of our project was to increase by at least 10% the number of well newborns receiving PDHM instead of formula each month. Our secondary outcome measure was to increase overall breastfeeding exclusivity at hospital discharge.

We conducted a process analysis and nursing and newborn provider surveys to better understand barriers to PDHM use in our level 1 nursery. Interventions included staff and provider education, discussion of supplementation options with families on admission, and improvement of access to PDHM within our unit. Using cycles of plan-do-study-act, we refined our PDHM use plan to a standard workflow.

We observed a 70% increase in PDHM use in our level 1 nursery, which was sustained over a 12-month period. Breastfeeding exclusivity also demonstrated a sustained increase from 49.2% to 57.2%. In addition, 54.5% of babies receiving PDHM during the birth hospitalization for whom we could obtain follow-up information remained exclusively breastfed at 2 months.

Understanding and addressing the local barriers to providing PDHM in the level 1 nursery and including the main stakeholders in designing solutions was key to our practice change. As shown in prior studies, PDHM use during birth hospitalization can improve longer breastfeeding exclusivity.