PRIME (preterm infants need milk early) - Success of a multidisciplinary quality improvement project in a tertiary neonatal unit

Abstract Background Maternal milk (MM) protects against necrotising enterocolitis and other morbidities in preterm infants. Guidelines advise the early initiation of enteral feeds after birth using MM. Objective PReterm Infants need Milk Early (PRIME) is a multidisciplinary initiative introduced to improve the early provision of MM among preterm infants. Methods Setting and inclusion criteria: Inborn infants, born Design Quality Improvement Project (QIP) following Plan Do Study Act cycle methodology. We conducted a cross-sectional survey amongst staff (n = 100) to evaluate knowledge and attitudes towards MM for preterm infants at baseline. The survey findings informed the initiative which included development of guidelines and a multidisciplinary staff teaching programme. A pre-intervention cohort provided baseline data for comparison. Study outcomes were clinical and knowledge based pre- and post-intervention. Results The pre-intervention cohort included 121 infants born in 2016, GA 30 (27, 31) weeks, BW 1230 (915, 1440) g. The post-intervention cohort included 197 infants born May 2018–December 2019, GA 29 (27, 31) weeks, BW 1180 (855, 1490) g. Pre-intervention, the time to 1st MM was 35 (18, 55) hours and 34% (n = 41) received MM within 24 h of birth. Post-intervention, the time to 1st MM was 19 (10, 37) hours and 60% (n = 119) received MM within 24 h. The follow-up survey amongst staff (n = 91) found improvements in knowledge and attitudes. Conclusion We improved the time to first MM and staff knowledge and attitudes following the introduction of our QIP.