A quality improvement intervention to improve lactation in mothers of hospitalized extreme preterm and very low birth weight infants in the first 2 weeks of life at a tertiary hospital in South India

Objectives: Early establishment of human milk (HM) feeding significantly decreases neonatal morbidity. There are barriers in establishing and maintaining lactation in mothers of hospitalized extreme preterm and very low birth weight (VLBW) infants, particularly during the first 2 weeks of life. Infant feeding policy modification was done to improve lactation as a quality initiative project and the effect of this modification was studied. Material and Methods: This study was done at SRIHER by analyzing retrospective data from the period before infant feeding policy modification (April 1, 2017–June 30, 2017) and prospective data from post-policy modification (July 1, 2017–December 31, 2017). All extreme preterm babies and VLBW babies both inborn and outborn were included in the study. The policy was approved by the institutional quality control cell. Fishbone analysis and “why” question pattern were implemented to identify pitfalls in establishing and maintaining lactation in mothers of extreme preterm and VLBW mothers. Prior antenatal counseling (for inborn deliveries), immediate postnatal assessment, constant surveillance, internal audits, and regular interprofessional team meets were done to carry out the implementation of the quality control program. Results: Daily milk output improved after intervention from baseline value in the pre-policy modification group to nearly 3 times after policy modification. The total duration of the requirement of parenteral nutrition decreased from 11 days to 7 days and time to reach birth weight decreased from 17 days to 11 days after quality improvement initiative. Conclusion: A simple quality improvement initiative was able to achieve increased lactation in mothers of extreme preterm and VLBW neonates.