The purpose of this Learning Collaborative is to increase the number of very low birth weight infants that will receive human milk, preferably their mother’s milk, as their primary source of nutrition to assist with their immune and gastrointestinal tract development. More specifically, this project will focus on helping participating hospitals identify barriers to establishing maternal milk supply, barriers to supporting breastfeeding in the NICU, and overcome system barriers impeding breast milk use. 

This learning collaborative is designed to enable teams to share, test, and implement ideas for improving rates of human milk and breastfeeding among very low birth weight babies. This project will require that teams engage with energy and skill to try new ways of delivering care. Together, we can arrive at and spread ideas that will improve outcomes for very low birth weight infants and serve as a model of how to improve care more broadly.

This learning collaborative will work to increase the use of human milk and breastfeeding by focusing on components of a “NICU Breast Milk Feeding Bundle.” This bundle was developed through discussion with several hospitals throughout the state who have all been working to increase breastfeeding and the use of human milk in the NICU and informed by the extensive literature on breastmilk utilization in the NICU. Improvement on different components of the bundle can help improve rates of breastfeeding, human milk use, and the health of infants in the NICU. 

NICU Breast Milk Feeding Bundle: 
    Begin hand expressing or pumping breastmilk within 6 hours of birth
    Provide electric, hospital-grade breast pumps to breastfeeding mothers before discharge
    Administer colostrum as it is produced, either through oral care or feeding
    Track breast milk volumes daily, to assist with the establishment and maintenance of milk supply
    Utilize skin-to-skin care (kangaroo care) daily and facilitate non-nutritive breastfeeding
    Facilitate the transition from breast milk feeding to direct breastfeeding prior to discharge
    Provide human donor milk for infants <1500g birth weight whose mother’s milk is not available
    Establish and utilize a written Infant Feeding Protocol for all infants in the NICU
    Conduct unit-wide education for nursing and medical staff in lactation support
    Provide education for parents on the importance of mother’s milk

Each hospital is NOT expected to work on every component of the bundle, rather it is expected that each hospital will focus on the type of change needed in their NICU. To facilitate the hospital’s choice of focus, each team will complete a self-assessment that will help guide this decision.

It is expected that each hospital will participate in monthly hour long calls. These calls will provide an opportunity for each group to share their challenges implementing change, share how they successfully impacted one of the bundle components, and share what did not work for them. The common goal that is shared by all participants is the want to increase human milk use and breastfeeding in the NICU; therefore, it is also expected that all participating hospitals will share data within the learning collaborative. Data sharing will be necessary to assess the impact each group is having on rates in their NICU, as well as to assess the collective impact the collaborative is having on the health and well-being of infants in Texas.