Resident Physician Staten Island University Hospital Northwell Health Staten Island University Hospital Brooklyn, New York, United States
Background: In 2017 as the AAP published its first policy guidelines on DHM while the Level 3 NICU at Staten Island University Hospital launched its DHM program. As more NICUs launch DHM programs, it is unclear if this practice affects maternal pumping and exclusive EBM rates.
Objective: Compare the rates of EBM feeding among VLBW infants before and after the implementation of a DHM program in the Level 3 NICU at SIUH in 01/2017 Compare the rates of NEC pre and post-implementation of the DHM Program
Design/Methods: A retrospective chart review was conducted for newborns with GA ≤32 weeks and/or BW ≤1500 grams admitted to the NICU from 03/2014-06/2019. Demographics, neonatal morbidities, and nutritional data including type of enteral feeding were obtained on DOL # 7, 28 and day of discharge.
Results: Demographics of the pre and post intervention cohorts were similar, with a smaller incidence of singletons noted post-intervention. To account for this confounder in multiples, only the multiplewith longest LOS was included. Newborns who expired or were transferred to another institution before initiation of enteral feeds were excluded from analysis.
Higher, but statistically insignificant, use of EBM in the pre-intervention group on DOL 7 (74%) and 28 (66%) is compared to the post intervention group on DOL 7 (68%) and 28 (59%). At discharge, only 39% of mothers pre-intervention were providing EBM while 53% were post intervention, a statistically significant difference.
The increase in the incidence of NEC from pre to post intervention was not significant. Of note, a NEC cluster occurred in a two month period in 2018 which may have skewed the NEC data. Conclusion(s): After launching a DHM program, EBM rates declined by DOL 7 and 28 possibly due to decreased maternal pressure to pump, knowing that DHM is available. This could also reflect a subconscious drop in emphasis on maternal education by the NICU team. Further investigation of potential causes, and emphasis of maternal education, ensuring access to lactation and early breast pump access are ongoing. The noted increase in EBM use at discharge is reassuring, suggesting the DHM program has helped parents understand the importance of pumping.
Authors/Institutions: Smrithy Jacob, Staten Island University Hospital, Brooklyn, New York, United States; Jonathan Blau, Staten Island University Hospital - Northwell Health, Staten Island, New York, United States
