P3.044: A quality improvement intervention to increase mothers’ own milk intake and reduce dependence on pasteurized donor human milk in the Neonatal Intensive Care Unit.

Purpose/Objectives: Mother’s Own Milk (MOM) is the optimal source of nutrition for preterm neonates. It provides immune support and protection against conditions like necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. Despite these benefits, barriers to MOM initiation and maintenance often lead to increased reliance on Pasteurized Donor Human Milk (PDHM). This study evaluates quality improvement (QI) intervention at our institution, aimed at increasing MOM use and reducing dependence on PDHM.

Design/Methods: A collaborative QI team conducted a root cause analysis to identify factors contributing to PDHM dependence. Interventions included multilingual educational materials for parents, daily tracking charts for milk expression, staff training for pediatric residents and NICU nurses, and strengthened lactation service support. Data were collected from neonates born < 32 weeks’ gestation or < 1500g. Newborns who were deceased before reaching 34 weeks, had major congenital anomalies and gastrointestinal surgeries, or critical maternal illness leading to inability to breastfeed, were excluded from the study. Outcomes measured pre- and post-intervention included feeding type at initiation and 34 weeks post-menstrual age (PMA), time to regain birth weight, and time to achieve full feeds. Statistical analysis was performed using chi-square and t-tests

Results: Of 70 NICU admissions, 64 neonates met inclusion criteria (31 pre-intervention, 33 post-intervention). MOM use as first milk improved significantly, increasing from 12:21 to 20:11 (MOM: PDHM) (p = 0.024). At 34 weeks PMA, the MOM: PDHM ratio shifted from 19:14 to 23:8, though not statistically significant (p = 0.163). Notably, five infants in the post-intervention PDHM group were receiving mixed MOM and PDHM. The mean time to regain birth weight improved modestly from 10.75 days (SD=4.04) to 9.61 days (SD=5.42) (p = 0.346), and the time to achieve full feeds decreased slightly from 19.03 days (SD=14.11) to 17.93 days (SD=9.6) (p = 0.715)

Conclusion/Discussion: PDHM is an essential alternative when MOM is unavailable; however, it cannot fully substitute for the immunological and nutritional benefits of MOM. This study demonstrates that addressing lactation barriers and implementing structured, culturally sensitive interventions can significantly improve MOM initiation rates. Our next goal is to focus on sustaining MOM intake beyond 34 weeks PMA and explore further strategies to overcome ongoing challenges in MOM provision