Impact of Neonatal Intensive Care Unit (NICU) Environment on Maternal Breast Milk Utilization: : A Retrospective...

Prematurity remains a significant cause of infant and childhood morbidity and mortality. Infants who are exclusively breastfed during the first 6 months of life have improved outcomes. A majority of premature infants are discharged home on formula. Neonatal Intensive Care Unit (NICU) design may influence parental involvement and, in turn, affect breast milk utilization. This study assesses breast milk utilization at discharge, before, and after transitioning from a traditional open-bay NICU to a private, single-family room (SFR) NICU.

This is a retrospective observational study of infants born at <32 weeks gestation admitted to a level III NICU before and after a transition from a traditional open-bay to a SFR NICU. Infants who received care in both NICU environments were excluded. The primary outcome was breast milk utilization at discharge. Standard descriptive statistics were used.

A total of 276 infants were included in the analysis. Demographic and clinical variables did not differ except for increased socioeconomic disadvantage and eligibility for donor breast milk. There was a significant increase in overall breast milk utilization (p=.04) but not maternal breast milk (p=0.61) in the SFR. Infants admitted to the traditional open-bay unit were younger at first oral feeding attempt (34.2 weeks (2.9)) compared to infants in the SFR room (35.2 weeks (2.4), p=0.007).

Transition from a traditional open-bay model to a single-family room (SFR) model affected the time of oral feeding initiation but did not significantly impact breast milk exposure, breastfeeding attempts, or parental involvement in feeding. Breastfeeding outcomes may be more strongly influenced by clinical practices and support systems rather than by the physical environment. Understanding the impact of the NICU environment on feeding practices can inform institutional policies aimed at optimizing breast milk utilization.