Stanford researchers and several collaborating institutions have helped nearly a dozen hospitals in California significantly improve breast milk feeding rates for premature infants, a strategy that carries larger implications for assisting hospitals in adopting underused evidence-based practices.
A paper (subscription required) describing the researchers' findings was published this week in Pediatrics. Hospitals participating in the study received an information package detailing ten best practices for promoting breast milk feeding in premature infants in the NICU. Health-care providers were encouraged to implement the methods in any order they wished and were supported in making modifications to hospital practices. My colleague explains more in a release:
Over the 12-month study and subsequent six-month follow-up period, the 11 participating hospitals increased their rates of breast milk feeding for NICU babies at discharge from 55 percent to 64 percent, bringing these hospitals up to the average rates for the state. (Some participating hospitals had above-average rates before the study began, and enrolled to both learn and share their expertise with other institutions, [Paul Sharek, MD, the senior author of the new research] noted.) Participating hospitals also reduced the rate of a serious complication of prematurity — the bowel disease known as necrotizing enterocolitis — by two-thirds, from 7 percent to about 2 percent of all infants in their NICUs.
The fact that the hospitals continued to sustain, and even improve on, their gains after the 12-month intervention ended is “a really important quality statement,” said Sharek, who is also the medical director of the Center for Quality and Clinical Effectiveness at Packard Children’s. “In many quality-improvement projects, improvements decrease after the hospitals’ attention is transitioned to another project. Something about our approach, and the changes made at the participating hospitals, resulted in a lasting improvement.”
During the study, hospitals made two important changes: increasing babies’ skin-to-skin time with their mothers and improving the education of NICU staff about breast milk feeding. Before the study began, four of 11 hospitals reported that their staff had a comprehensive knowledge base and skill set in breast milk nutrition. After the study, the number rose to 10 of 11 hospitals. The number of hospitals providing daily skin-to-skin time for moms and babies increased from six to 11 during the study.