Enhancing Breastfeeding in NICU: Comprehensive Quality Improvement

This report examines a quality improvement initiative aimed at enhancing breastfeeding rates among mothers of preterm neonates in the Neonatal Intensive Care Unit (NICU). The intervention involves a Comprehensive Postnatal Breastfeeding Counseling (CPNC) package designed to promote early breast milk expression and increase the proportion of neonates receiving maternal milk. The study evaluates the impact of the CPNC platform, implemented using a team methodology, on the timing of milk expression and the overall quantity of expressed breast milk (EBM). Results indicate a significant increase in the proportion of mothers expressing milk and a reduction in the need for formula milk. The report emphasizes the crucial role of NICU nurses in providing lactation-based support and care, advocating for evidence-based lactation teaching for all nurses. The initiative underscores the importance of teamwork and continuous feedback in achieving positive outcomes and promoting exclusive maternal milk feeding in the NICU. The report concludes that implementing a simple quality improvement method, such as the CNPC package, can substantially improve breastfeeding practices and enhance maternity care quality.

Breast
Feeding

Introduction
• Most operative protective policy for under-five
mortality.
• Breach in current evidence based application
strategies are introduced.
• Reduce time of first milk appearance and upsurge
regularity of expression.
• Aim to establish effective milk expression
techniques (LM Grummer-Strawn, 2013).
• Augments the amount of breast milk
consumption.

• Problem is overdue breast milk appearance by
mothers of preterm neonates whose infants were
admitted in the “neonatal intensive care unit
(NICU)”.
• “Comprehensive postnatal breast feeding
counseling (CPNC)" to endorse early breast milk
manifestation (E Froh, 2017).
• Proportion of neonates receiving mother
increased.

three forms of nursing
inquiry
• Researchers evaluated amount of mothers stating
milk on day 1.
• Amount of neonates on occupied EBM on day 7
• After 1 year introducing quality improvement (QI)
job in two periods.
• Similar QI increasing initial milk expression in
mothers of preterm infants published.
• First stated QI project connected to elevation of
appearance for EBP (A Sethi, 2017)

• Articles have demonstrated effectiveness of
program.
• Support and direct care related with training and
education.
• Nurses provides effective lactation based support
care to mothers.
• NICU plays a critical role to ensure evidence
based education (LM Grummer-Strawn, 2013)
• NANN revised position statement for the usage of
maternal milk and encourages NICU for
evaluation.

• CPNC platform application using team
methodology.
• Managing timing of milk expression.
• Advancement of appearance breast milk in NICU
without obligation of outside provision.
• Extra breast pump assumed to maternity division
ensuring breast milk appearance (E Froh, 2017)
• Education regarding breast feeding, pumping and
human oral care.
• Checking milk in the refrigerator for proper
labeling and expiration.

Analysis of the
evidence presented
• Studies recommends humble and possible CPNC
platform leads to enhanced milk production.
• Decrease in the requirement of formula milk by
50%.
• Single center small quality improvement initiative
utilized the caregivers.
• Recommends the significance of a feasible and
simple CPNC package application using team
method (LM Grummer-Strawn, 2013)
• The difficulty of abridged sleep was achieved by
appearance of milk after both breasts.

• NICU has different policies to promote and protect
breastfeeding.
• The policies are easily accessible for nurses and
caregivers.
• The IIFAS designed to elicit the participants by
overall attitude toward infant feeding options.
• Through this, various nurses and care providers
acknowledged numerous methods for effective
breastfeeding (A Sethi, 2017)
• Support and direct care must be related with
schooling and preparation delivered to the NICU.

• The quality improvement initiated directed in a
level 3 NICU.
• Fish bone examination was performed to classify
the probable issues.
• Lack of knowledge and sensitization was
identified as the limitation.
• The nurse instructor and staff encountered the
on-duty NICU nursing staff each third daytime.
• Continuous feedback for nursing staff and
resident doctors.

• Effect of teamwork and CPNC discussed everyday
with team members to incorporate adjustments.
• Team of faculty in charge, two resident
physicians, nurse educator, and two senior staff
nurses were evaluated for effective team working
(E Froh, 2017)
• As a teamwork, the team measured an
anticipated reduced sleep time for the mothers.
• Daily meeting with the staff for effective team
working.
• Using teamwork approach, CNPC package was
implemented.

• Total quantity of EBM was negligible.
• Proportion of mother expressed milk increased to
86.66%.
• Total EBM and proportion of neonates increased.
• Between 50.7% and 72.9% nurses described in
proving lactation grounded provision.
• IIFAS resulted in overall marking of 69.1.
• Achieved “positive to breastfeeding” attitude
among mothers.
• Evidence based support teach and education was
also achieved.

Conclusion
• A simple excellence improvement method was
used.
• CNPC package helped upsurge exclusive MOM
feeding amongst NICU.
• NICU nurses provides significant lactation based
support and care.
• All nurses must obtain evidence grounded
lactation teaching.
• Evidence based practice approach should be used
to improve breast feeding in the nation.
• The aim is to promote normal breast feeding.