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A Regional Care Bundle Approach to Increasing Maternal Breast Milk Use in Preterm Infants: Outcomes of the East of England Network Quality Improvement Project

Presented at the Neonatal Society 2013 Autumn Meeting.

Battersby C1, Santhakumaran S1, Upton M2, Radbone L2, Birch J3, Modi N1

1 Neonatal Data Analysis Unit, Imperial College London
2 East of England Operational Delivery Network
3 Neonatal Data Analysis Unit, Imperial College London

Background: Maternal breast milk (MBM) has been shown to improve neurodevelopmental outcomes, and reduce late-onset sepsis and NEC in the preterm infant (1). The EoE perinatal network introduced a care bundle to increase the use of MBM in the hope that this would lead to a reduction in NEC, and other longer-term benefits. Here we present an evaluation of the impact of the care bundle on the proportion of preterm babies receiving MBM at discharge (exclusive or any) and percentage of care days where any MBM was received.

Methods: Data were extracted from the National Neonatal Research Database (NNRD) for 17 neonatal units in the East of England (EoE) perinatal network and 144 neonatal units in the rest of the UK Neonatal Collaborative (UKNC) for babies born ≤32+6 weeks gestation admitted to neonatal specialised care between 2009 and 2012. An interrupted time series approach was used to compare feeding outcomes between the 25-month period pre-implementation (Jan 2009-Jan 2011) and the 23-month period post-implementation (Feb 2011 to Dec 2012). Results were compared against the rest of the UK NC, where the care bundle was not implemented.

Results: Data were included for 3,680 babies in EoE and 29,492 in the rest of UKNC. Improvements in exclusive and any MBM at discharge were seen in EoE over the 4-year evaluation period. There was no evidence of a step change or trend change in MBM at discharge in relation to the introduction of the care bundle but the rate of exclusive MBM at discharge improved significantly faster in EoE than the rest of the UKNC (0.22% (95% CI 0.11, 0.34) increase per month vs 0.05% (95% CI 0.01, 0.09), p=0.007 for difference). The rate of any MBM at discharge increased by 0.23% (95% CI 0.1, 0.36, p<0.001) per month though this was not significantly different to the UKNC trend. In EoE the percentage of care days where babies received MBM was in decline prior to the introduction of the bundle (-0.3% per month, 95% CI (-0.6, -0.06) p=0.02) but showed a significant improvement post introduction (difference in trends 0.5% (0.04, 1.0) p=0.03).

Conclusion: We highlight the importance of examining pre-existing trends prior to the introduction of quality improvement interventions and including population-based comparator data where possible. In employing the NNRD, we illustrate the strength of using operational electronic clinical records to evaluate health service interventions.

Corresponding author: n.modi@imperial.ac.uk

References
1. Vohr, B.R., et al., Persistent Beneficial Effects of Breast Milk Ingested in the Neonatal Intensive Care Unit on Outcomes of Extremely Low Birth Weight Infants at 30 Months of Age. Pediatrics, 2007. 120(4): p. e953-e959

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