September 30, 2010

Initiative encourages breast-feeding in state NICUs

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Ashley Childs said it was easy to breast-feed her son, Beau, in Vanderbilt’s NICU because of the presence of a lactation specialist, the proper equipment and the encouragement of the unit’s staff members. (Photo by Susan Urmy)

Initiative encourages breast-feeding in state NICUs

Last week, about 70 staff and faculty from hospitals across Tennessee came to the Monroe Carell Jr. Children's Hospital at Vanderbilt to begin a new push to provide the tiniest premature infants with human breast milk.

The Human Breast Milk project is part of the Tennessee Initiative for Perinatal Quality Care (TIPQC). The NICU at Children's Hospital, along with the NICU at The Med in Memphis, led efforts to draw up guidelines in the form of a tool kit that could be used by any NICU to make providing breast milk to critically ill infants a priority.

“When we began in 2007, less than 15 percent of mothers whose babies were in our NICU provided breast milk for their babies, but last year our breast-feeding rate was up to 65 percent,” said project co-leader Ramasubbareddy Dhanireddy, M.D., chief of Neonatology at the University of Tennessee Health Science Center at Memphis.

Dhanireddy and Steve McElroy, M.D., assistant professor of Pediatrics at Vanderbilt, are the state co-leaders of the project. Vanderbilt and The Med have been working with TIPQC members in East Tennessee Children's and Parkridge Medical Center in Chattanooga to pilot the toolkit over the last several months.

Ashley Childs was already planning to breast-feed her baby boy, but baby Beau's arrival by emergency C-section two months early made it difficult. The hospital where she delivered was more concerned with making sure mother and baby were safe and medically stable.

“You had to know which nurses would agree to stop what they were doing and go find storage bottles so I could pump. I was pumping every two hours so it was difficult to keep up using our home supplies,” Childs said.

Childs said she was grateful when Beau was transferred to Vanderbilt's NICU because a lactation specialist was there to ensure she had a pump, plenty of storage bottles and the encouragement of all staff.

“We put up educational posters about the benefits of breast-feeding and tips to do it successfully. We are also holding regular educational sessions to train all 300-plus nursing staff to use the toolkit so breast milk is made a priority for these babies,” said Carol Huber, R.N., an International Board Certified Lactation Consultant at Children's Hospital’s NICU.

Huber says evidence clearly shows low birth weight babies do better and recover faster if they are fed breast milk as opposed to formula. The evidence is so strong there is a growing push to set up a human milk bank in Tennessee, where donated breast milk can be pasteurized and provided to infants whose own mothers cannot or will not provide it. Other states have such banks, but they are rare.

Huber was hired this summer to work fulltime in Vanderbilt's NICU as part of the TIPQC Human Milk initiative. Project co-leader McElroy says there are three more goals to accomplish:

• Determine human milk initiation rate and human milk use at discharge rate for the NICU population;
• Increase awareness and knowledge base among staff and faculty; and
• Decrease the rate of formula-fed infants by 50 percent by December 2011.

“The challenge is that many new mothers didn't intend to breast-feed at all, so you have to let them know that it is even more important for a premature or low birth weight baby. It's like medicine,” said Huber.

Dhanireddy said the excellent show from Tennessee NICUs hoping to learn to use the TIPQC toolkit is very exciting.

“One of the unique things about this effort is hospitals are putting aside any competitive concerns to work together to do the right thing: help all babies across the state, and reduce infant mortality in Tennessee,” he said.