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Optimizing human milk provision: Review of QI best practices.

Anthony J Piazza1, Christine Bixby2, Allison Black3

  • 1Emory University Division of Neonatal-Perinatal Medicine, Atlanta, GA 30309, United States.

Seminars in Perinatology
|April 21, 2026
PubMed
Summary

Quality Improvement (QI) methodology enhances human milk provision for NICU infants, improving clinical outcomes. Systematic QI efforts address barriers to ensure optimal nutrition for vulnerable newborns.

Keywords:
Breast milkCollaborativeLactationMom's own milkNICUPDSAQuality improvement

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Area of Science:

  • Neonatal Medicine
  • Public Health
  • Healthcare Quality Improvement

Background:

  • Human milk provision in Neonatal Intensive Care Units (NICUs) is linked to improved clinical outcomes, neurodevelopment, and reduced comorbidities.
  • Despite evidence, significant variation exists in breast milk utilization and discharge rates among NICU patients.
  • Bridging the gap between evidence-based research and bedside practice for human milk provision remains a challenge.

Purpose of the Study:

  • To examine the role of Quality Improvement (QI) methodology in optimizing human milk provision for NICU infants.
  • To identify key interventions and strategies for successful implementation of human milk initiatives.
  • To highlight the impact of QI efforts on clinical outcomes and resource utilization.

Main Methods:

  • Review of successful Quality Improvement (QI) initiatives in human milk provision.
  • Application of the QI framework, including multidisciplinary stakeholder engagement and plan-do-study-act cycles.
  • Analysis of interventions across the neonatal care continuum: antenatal, peripartum, and postpartum.

Main Results:

  • Successful QI initiatives demonstrate improved breast milk utilization and clinical outcomes in NICU populations.
  • Key interventions such as early pumping, oral immune therapy, skin-to-skin care, and standardized protocols are effective.
  • QI efforts have shown positive impacts on clinical outcomes and hospital resource utilization, particularly in diverse populations.

Conclusions:

  • Quality Improvement (QI) methodology is crucial for optimizing human milk provision in the NICU.
  • Systematic QI efforts addressing cultural barriers and provider roles are essential to reduce institutional variation.
  • Ensuring optimal nutrition for vulnerable infants requires sustained and targeted QI initiatives.