P2C027: Improving the Rate of Human Milk Feeding for African American Infants at Discharge from a Level IV NICU

Purpose/Objectives:

Background: There are myriad benefits to human milk feeds for neonates that impact several systems reducing the rate of complications such as necrotizing enterocolitis, sepsis, and retinopathy of prematurity. Neonates fed with their own mothers’ milk have better neurodevelopment and shorter lengths of neonatal intensive care unit (NICU) stay, improving overall health while reducing costs. SMART AIM/objective: a) To increase the rate of neonates discharged from the NICU on human milk by 10% by December 2022, b) To identify differences between races and ethnicities.

Design/Methods: Methods: We used the IHI model of improvement and developed a key driver diagram. The multidisciplinary team composed of lactation consultants, dietitians, QI analysts and physicians met monthly. We looked at baseline data and stratified by race and ethnicity in 2020. We were able to individualize interventions to groups that needed more attention. In 2022, we listened to and consulted African American caregivers on lactation rounds, focusing on infants with a stay of 7- 14 days. Identified needs such as home pump rentals and emotional support were addressed. Following the adage “if you can see it, you can be it,” the team increased and improved visual representation; for example, showcasing Black Breastfeeding Week on unit posters and handouts.

Results:

Results: The overall human milk feeding rates for all races/ethnicities did not increase to goal. Using a Funnel plot (Figure 1) we were able to identify African American infants as a group below the control limits in 2021. In 2021, 57% of African American infants admitted within the first week of life were discharged on breast milk compared to 82% of Caucasian infants (p < 0.01). After targeting and tailoring our interventions we increased the percentage of African American patients discharged on BM from 57% to 72%$ (Figure 2), without significant decrease in rates for other groups. Two out of three points were in the outer third of limits showing a center line shift in February 2022.

Conclusion/Discussion:

Conclusion: Rational subgrouping by race and ethnicity can help increase the visibility of groups within the cohort. In our case, those who self-identified as African Americans and had a short length of stay had the lowest rates of human milk feeding at discharge. Although the specific aim wasn’t achieved for the whole group, tailored interventions decreased disparities. More work is needed to sustain this change such as building partnerships with community resources to maintain breastmilk feeding after discharge.