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Perinatal Quality Collaborative of North CarolinaNCCC Collaborative Action PlanExclusive Human Milk in Newborn Critical Care CentersPrimary Drivers Secondary Drivers
Relates directly to getting the desired results ANDoutside the focus of this collaborative action plan
 
Action:
1. Create supportive and family-centeredenvironmenta. Perform self assessment and implement family centeredcare practicesb. Welcome 24 hour parent care in nurseryc. Develop family support programsd. Provide pumps and pumping rooms for mothers beforeand after discharge2. Optimize nutrition and nutritional monitoring ofall infants.a. Monitor daily intake and multiple parameters of growthb. Utilize a multidisciplinary team, including neonatalnutritionist and pharmacist
c.
Early initiation of TPN (protein within 2 hours, lipids infirst 24 hours)
 
3. Support the mom & baby to breastfeed a. Evaluation for oral feeding (baby readiness)b. Teach infant cuesc. When transitioning to exclusive breastfeeding considermeasuring milk transfer, and use Supplemental NursingSystem (SNS) and/or nipple shields as neededd. In preparation for discharge establish feeding regimen tomeet growth requirements and developmental needs,identify and connect to community resources, considerrooming in prior to discharge and consider baby weightscales for use at home to measure milk intake4. Promote Breastfeeding support in thecommunitya. Emphasize breastfeeding in group prenatal patienteducationb. Collaborate to assure breastfeeding support groups foroutpatientsc. Promote breastfeeding support in the greatercommunity, with special attention to underserved groups
A. Promote and use mother’s milk as thepreferred nutritional substrate
 
for infants
 
Actions:
1. Assess feeding intention and establishexpectations related to premature birth uponadmissiona. Inform all mothers at time of birth of benefits of their milkfor their baby including mother’s milk “as medicine”b. Use language that distinguishes providing milk frombreastfeedingc. Encourage early initial visit to facilitate communicationand assistance to obtain colostrum and milk2. Provide early and continuous support to obtainmother’s colostrum and milka. Provide mother with access to appropriate pump(hospital-grade with double pumping kit) and providenecessary suppliesb. Teach breast massage and relaxation techniquesc. Teach hand expression & pumping techniques usingmechanical pumpd. Provide support from lactation consultant or otherbreastfeeding experte. Provide daily review of mothers records of pumping andvolume expressed3. Promote regular maternal skin to skin contact a. Provide staff & parent education to promote skin to skin b. Encourage early maternal visits to include touch andskin to skin as soon as possiblec. Encourage breast pumping immediately after each skinto skin interaction with momd. Encourage non-nutritive sucking at the breast
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