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191 An audit of the time from birth to first milk feed in preterm infants less than 32 weeks gestation and of low-birth-weight infants under 1500g
  1. Natasha Ramsden
  1. UK


Background There are many benefits to starting breast milk feeds early for both preterm and low-birth-weight infants including: the immunological benefits of receiving breast milk, potential to establish full enteral feeds earlier and lowering the risk of necrotising enterocolitis.

Objectives Trust guidelines state that all infants should receive colostrum in the first day of life, preferably within the first 6 hours. The objectives of this audit were to evaluate whether this is achieved in infants <32 weeks gestation or with birth weights <1500g and to look at the impact of gestation on the time from birth to first milk feed.

Methods Inclusion criteria were infants born <32 weeks gestation or with a birthweight of <1500g. The length of time from birth to first milk feed in hours (including either colostrum mouth care or first enteral feed) was evaluated on a total of 52 inpatients on the neonatal unit. Data was initially collected in December 2018 on 24 infants. This was followed by interventions including: education of parents and the multidisciplinary team about the importance of the early colostrum administration and collaboration between the neonatal and maternity teams to provide expressing packs to mother’s pre-delivery. Further data was then collected on 28 infants in July 2020, all born during the first wave of the COVID-19 pandemic. The data from 2018 and 2020 were compared and the impact of gestation was analysed by comparing infants born <27 weeks and ≥27 weeks.

Results In 100% of infants in the study the first milk received was human milk (either mother’s own milk or donor breast milk) and all infants received their first milk within 96 hours of birth. Overall, 19.2% of infants received their first milk within 6 hours of birth and 63.5% within 24 hours. When comparing the 2018 and 2020 data, a similar percentage of infants received their first milk feed in <24 hours: 62.5% in 2018 and 64.3% in 2020, and at <6 hours: 20.8% in 2018 and 17.9% in 2020. Infants ≥27 weeks received their first milk feed sooner than infants <27 weeks. In extreme preterm infants <27 weeks, 10% received their first milk feed in <6 hours and 55% in <24 hours. Comparably in preterm infants ≥27 weeks, 25% received their first milk feed in <6 hours and 68.8% in <24 hours. In both groups, 90% of infants received their first milk feed within 48 hours of birth.

Conclusions The results in 2018 and 2020 were similar, suggesting that the interventions made during this audit cycle had no observed increase in delivery efficiency of the first milk feed. The second cycle of the audit was carried out during the COVID-19 pandemic but even with many restrictions there has been no observed adverse impact on the delivery of the first milk to this group of neonates. Future focus should improve the prompt delivery of the first milk feed for extreme preterm neonates through discussing expressing colostrum with mother’s pre-delivery and giving colostrum mouthcare early to these infants.

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