Purpose for the Program
There is overwhelming evidence in the literature that human milk is superior to any form of nutrition for the neonate. It contains immunological, nutritional, and developmental properties that prevent infection, provide individualized nutrition, and optimize brain growth and visual development. Recent studies have proven that the protective factors in colostrum are even more concentrated in the colostrum of women who deliver low birth weight infants. This population of patients in the neonatal intensive care unit (NICU) is most vulnerable to morbidities, including necrotizing enteral colitis and nosocomial infections. Human milk decreases the incidence and severity of nosocomial infections and necrotizing enteral colitis. It also has been proven to protect against gastrointestinal and respiratory infections. Its perfect combination of protein, carbohydrates, and plasma proteins improves gastric emptying, which promotes feeding tolerance. The purpose of this project is to promote buccal application of mother's colostrum for low birth weight infants in the NICU.
The nursing intervention of buccal application of a mother's colostrum potentially decreases the incidence of certain morbidities and decreases the length of stay of these fragile infants. The proposed change in practice is to institute a policy of buccal application of colostrum in the NICU. The infants are being followed longitudinally for outcomes related to this care.
Implementation, Outcomes, and Evaluation
A protocol for the buccal application of a mother's colostrum as well as banked breast milk for all low birth weight infants (weighing less than 1,500 grams) was developed and implemented in January 2011. Staff education was completed at staff meetings via slide presentations. The completed policy also includes an education sheet for parents as a means of encouraging their participation in this bedside practice.
Implications for Nursing Practice
Due to the limited availability of colostrum, mothers are being encouraged to begin pumping within 6 hours of delivery and pump on a prescribed schedule. We created syringe kits with detailed instructions for the collection of a mother's breast milk to avoid waste. The initial review of charts since the start of this policy revealed that access to colostrum takes several days and adherence to the policy is varied. Currently, longitudinal data are being collected on the infant outcomes posttreatment. Ongoing education of staff and parents is imperative to the successful implementation of this policy.