Background: Hospitalized infants often need fortified human milk and formulas for growth in the neonatal intensive care unit and postdischarge. Parents must learn how to properly mix infant feedings. At the initial Children's Hospital Colorado follow-up visit, baseline data revealed a 50% rate of mixing inaccuracy of discharge feeding recipes and identified the readmission of 2 infants with life-threatening hypernatremia. A gap in discharge teaching was identified. A quality improvement project was implemented at 2 affiliated neonatal intensive care units. Purpose/Aim: The aim of this study was to improve parental comfort and efficacy in infant feeding preparation during hospitalization, reduce mixing inaccuracy postdischarge, and prevent readmission. The primary aim was to improve the accuracy rate at follow-up to 75% within 12 months and the sustain mixing accuracy rate at follow-up to above 95% for an additional 24 months. Methods/Interventions: A literature review was conducted; potential barriers were identified and strategies developed to recognize the relationships between the aim and the changes to be tested. Implementation of standardized teaching focused on the teach-back technique. Education included mixing demonstration and written instructions. Parents were expected to correctly mix the recipe 3 times before discharge. Results: Mixing accuracy at the initial clinic follow-up visit improved to 97%. No readmissions were reported from inaccurately prepared feedings. Implications for Practice: Collaborative quality improvement project with standardized teaching provided improved feeding safety and parental comfort with accuracy of discharge instructions. Primary care providers need to be aware of the importance of accurate formula or fortified human milk preparation and verify accuracy of the specific discharge recipes at the initial visit.
Background: Benefits of mother's own milk (MOM) for infants in neonatal intensive care units (NICUs) are well known. Many mothers provide for their infant's feedings during their entire hospitalization while others are unable. Knowledge is limited about which infant and maternal factors may contribute most to cessation of MOM feedings. Purpose: Study aims were to (1) identify which maternal and infant risk factors or combination of factors are associated with cessation of provision of MOM during hospitalization, (2) develop a lactation risk tool to identify neonatal intensive care unit infants at higher risk of not receiving MOM during hospitalization, and (3) identify when infants stop receiving MOM during hospitalization. Methods: A data set of 797 infants admitted into a level IV neonatal intensive care unit before 7 days of age, whose mothers chose to provide MOM, was created from analysis of data from the Children's Hospital Neonatal Database. Maternal and infant factors of 701 dyads who received MOM at discharge were compared with 87 dyads who discontinued use of MOM by discharge using χ2, t tests, and Wilcoxon rank tests. Logistic regression was used to build a risk-scoring model. Results: The probability of cessation of MOM increased significantly with the number of maternal–infant risk factors. A Risk Calculator was developed to identify dyads at higher risk for cessation of MOM by discharge. Implications for Practice: Identifying mothers at risk for cessation of MOM can enable the healthcare team to provide optimal lactation management and outcomes. Implications for Research: Although the Risk Calculator has potential to identify dyads at risk of early MOM cessation, further research is needed to validate these results.
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