Enhancing Mother’s Own Milk Volume in the First 14 Days Postpartum for Very Low Birth Weight Neonates: A Quality Improvement Initiative in a Predominantly Outborn NICU in India

Abstract

Background

Providing mother’s own milk (MOM) for very low birth weight (VLBW) neonates, especially in outborn settings, is challenging due to factors such as mother–infant separation, communication gaps and limited breastfeeding support at referring hospitals.

Methods

This quality improvement initiative used the Point of Care Quality Improvement (POCQI) framework, with sequential Plan–Do–Study–Act (PDSA) cycles to increase MOM volume in mothers of VLBW neonates. This study was conducted in three phases—baseline, intervention and sustenance—from August 2022 to July 2023. Each phase enrolled different mother–infant dyads (non-concurrent cohorts), and outcomes were compared across phases. We aimed to increase cumulative MOM over postnatal days 1-14 by 25% during a 1-year implementation period using sequential PDSA cycles. Interventions included lactation education, a standard operating procedure for lactation counselling, provision of free manual breast pumps and a short course of domperidone.

Results

Among 48 mother–infant dyads, cumulative MOM (median [IQR]) increased from 1,105 mL (281-2,680) at baseline to 2,847 mL (1,912-3,170) in the sustenance phase. This increase reflects between-phase cohort comparisons and does not represent within-mother longitudinal improvement. Across phases, median daily MOM approached the infant feeding volume by day 3 and exceeded it from day 7 onwards. Exclusive breastfeeding at discharge improved from 50% (5/10) at baseline to 87.5% (7/8) in the sustenance phase, though not statistically significant (P = .24).

Conclusion

Using the POCQI framework with sequential PDSA cycles, higher MOM volumes were observed across successive phases in our predominantly outborn VLBW population; interpretation of sustainability is limited by the small sustenance cohort (n = 8).