Proactive Lactation Care is Associated With Improved Outcomes in a Referral NICU

Background Mother's milk improves outcomes. Referral neonatal intensive care units face unique lactation challenges with maternal-infant separation and maternal pump dependency. Little is known about lactation resource allocation in this high-risk population. Research Aims To determine differences in human milk outcomes, (1) the proportion of infants fed exclusive or any mother's milk and (2) recorded number and volume of pumped mothers' milk bottles, between two models of lactation care in a referral neonatal intensive care unit. Methods This retrospective, longitudinal, two-group comparison study utilized medical record individual feeding data for infants admitted at <= Day 7 of age and milk room storage records from reactive and proactive care model time periods (April, 2017-March, 2018; May, 2018-April, 2019). The reactive care model (n = 509 infants, 58% male, median birth weight and gestational age of 37 weeks,) involved International Board Certified Lactation Consultant referral for identified lactation problems; whereas, the proactive model (n = 472 infants, 56% male, median birth weight and gestational age 37 weeks) increased International Board Certified Lactation Consultant staffing, who then saw all admissions. Comparisons were performed using chi square, Mann Whitney, and t-tests. Results A proactive lactation approach was associated with an increase in the receipt of any mother's milk from 74.3% to 80.2% (p = .03) among participants in the proactive model group. Additionally, their milk room mean monthly bottle storage increased from 5153 (SD 788) to 6620 (SD 1314) bottles (p < .01). Conclusions In this retrospective study at a tertiary referral neonatal intensive care unit, significant improvement inhuman milk outcomes suggests that increased resources for proactive lactation care may improve mother's milk provision for a high-risk population.