376 - Improving Mother's Own Milk Volume Provided to Very Low Birth Weight Infants by Targeting Perinatal Health Disparities

Mother’s own milk (MOM) is of particular importance to very low birth weight (VLBW, < 1,500 g) infants. Many modifiable and non-modifiable factors affect MOM volume, and in turn, determine the proportion of infants discharged from the neonatal intensive care unit (NICU) with MOM. Disparities exist among United States regions and by race and ethnicity.

Objective:

The objective of this study is to evaluate an ongoing quality improvement initiative designed to increase MOM volumes for VLBW infants admitted to the level IV NICU at the Medical University of South Carolina Shawn Jenkins Children’s Hospital.

Design/Methods:

A multidisciplinary quality improvement group was formed to improve rates of VLBW infants receiving MOM. Multiple interventions were implemented through antenatal lactation and neonatal consults. Improved lactation support included a 12-week daily pumping log, 14-day virtual lactation support and partnering with the local Women Infant and Children Clinic to offer services on site to eliminate transportation barriers. Overall coming to volume (CTV) at 14 days postpartum (≥ 500 ml of MOM per day) was measured before (October 2021-February 2022) and after intervention (March 2022-November 2022). Secondary outcome measures included pumping within six hours postpartum, CTV in relation to pumping initiation times, and CTV based on insurance.

Results:

Milk expression initiation within six hours increased from baseline (57%) to intervention period (63%; p = 0.22). Mothers who initiated pumping within six hours postpartum produced more MOM at 14 days (446 ml) compared to mothers who initiated pumping after 6 hours (332 ml; p = 0.03). Overall CTV at 14 days improved from baseline (321 ml) to intervention period (430 ml; p = 0.047). Medicaid patient CTV increased slightly without statistically significant change while patients with non-Medicaid payer sources improved from baseline mean (265 ml) to intervention period (531 ml; p = 0.01).

Conclusion(s):

Quality improvement efforts resulted in an increase in mothers who pump within six hours postpartum. CTV based on pumping initiation time was statistically significant though it is not a sole indicator that a mother will achieve goal CTV at 14 days postpartum. Medicaid insurance status was associated with fewer gains in CTV indicating that future efforts may be more effective by addressing perinatal health disparities and social determinants of health. The effect of resolving social barriers to providing MOM is currently being assessed.