The First 28 Days of Live:

1
The First 28 Days of Live Exclusive breast milk
feedings for babies less than 1500 grams to
decrease our NEC rates. Promote and use human
milk as the preferred nutritional substrate for
VLBW Infant NICU Climate Changers Committee, NICU
Nutrition Improvement Process Committee, Katie
Pope, Nutrition Tech., Olivia Collins, Nutrition
Tech.
If breast milk was marketed as an Rx It would be
ordered for every premature infant .

• Why did we start?
• Over the last decade our historically low NEC
  rates have risen despite implementation of
  recommended nutritional practices including
• Early initiation of TPN
• Feeding Protocol
• Early trophic feeds
• An algorithm for managing intolerance
• A systematic advancement of feedings for infants
  lt1500 gms.
• Strong NICU lactation program.

What did we find?

• What does our experience mean?
• Balancing act to provide adequate nutrition to
  high risk infants
• with immature guts but good nutrition post
  birth is mandatory
• to provide good brain maturation and survival
• Adopting new practices changes can be difficult
  to implement
• and embrace by staff. This was especially
  true for beginning
• banked breast milk feeding protocol.
  Pre-education, several
• rounds and communication over a year prior to
• implementation, was key to successfully
  changing culture.
• Mothers receptivity to their babies receiving
  banked milk
• helped staff embrace this change.
• Goal NEC rate lt 4 percent incidence (Top VON
  Quartile)
• Kangaroo Care (Skin to Skin) has been an
  initiative for past 5
• years, however consistent implementation has
  not occurred.
• The role of skin to skin in improving milk
  supply is an important
• motivator.
• 
  

• What did we do?
• Continued ongoing assessment of VON data with
  implementation/revision of NICU
• feeding protocol.
• Joined Perinatal Quality Collaborative of North
  Carolina Goals include
• Promote and use mothers milk as the preferred
  nutritional substrate for
• infants
• Implement feeding guidelines
• Assure safety in the use of expressed human
  milk.
• Joined VON Nutrition Improvement Collaborative
  (Jan 11 Dec 12)
• Two NICU committees joined forces to work on
  PDSA cycles toward this aim over the next
• two years.

May 2011