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Breast Milk for Babies

Thursday, February 21, 2019 - 10:45

Colostrum Kits Increase Early Breast Milk Feeding in Very Low Birth Weight Infants

Infants weighing less than 1500 grams (3 lb. 5 oz.) at birth typically spend six weeks or more in neonatal intensive care units (NICUs) before going home with their families. Yet the benefits of receiving their mother’s breast milk soon after birth are well-documented and potentially lifesaving. And early expression of colostrum has been shown to increase a mother’s milk supply six weeks later.1

However, despite the short-term and long-term benefits for these very low birth weight (VLBW) infants, early and prolonged separation of mother and baby, combined with the mother’s own recovery from what may have been a complicated pregnancy or delivery, often hinders the ability of mothers to provide colostrum to their newborns or to provide it within the infant’s first day of life.

Dr. Lynn IwamotoLynn Iwamoto, MD, a neonatologist at Kapi’olani Medical Center for Women and Children and Associate Professor of Pediatrics at the University of Hawaii, found inspiration to address this issue at Kapi’olani when one of her own medical students had a VLBW infant in the NICU.

“I was creating a quality improvement (QI) project to improve maternal breast milk feedings for VLBW infants when my student, Nohea Leatherman (pictured below), came up with an idea: a colostrum collection kit that gives new mothers test tubes, time-and-date labels, and instructions to begin expressing colostrum soon after birth,” she says. “Then Dad or Grandma or a partner can bring the tubes to the NICU.”

Dr. Nohea Leatherman-Arkus

The kits also include a link to the online Stanford Medicine Newborn Nursery, a website with videos about the importance of breast milk, including one about hand expressing milk.

Within three months of creating the kits and implementing the process to deliver them to mothers, the average time between birth and first feeding of VLBW infants dropped from 27 hours to 13 hours and the percentage receiving their mother’s colostrum within 12 hours of birth increased from 20 percent to 40 percent. One-hundred percent of VLBW infants at Kapi’olani Medical Center now receive their mother’s colostrum as their first food, nearly 80 percent receive it within 24 hours of birth, and the rate of infants receiving breast milk at discharge has increased, too.

Because of their success in the NICU — and the minimal cost to create the kits — the kits are now distributed to all mothers of NICU-admitted infants and available to all new mothers throughout the medical center, regardless of the infant’s birth weight or gestational age. 

“A challenge and benefit simultaneously for us was getting all the nursing units — NICU, postpartum, and labor and delivery — to participate,” says Dr. Iwamoto. “But it was one of the best things that happened because it helped get the units to collaborate together.”

1Parker LA, Sullivan S, Krueger C, Kelechi T, Mueller M. Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study. J Perinatol. 2012;32(3):205-209.doi: 10.1038/jp.2011.78.


Would you like to improve breast milk use in your hospital's newborn nursery? Check out our Improving Breast Milk Use in the Nursery Performance in Improvement Module/PIM (login required), an MOC Part 4 activity that has no additional cost for pediatricians already enrolled in Maintenance of Certification (MOC).