P2.I169: Documentation of Pump Initiation and Coming to Volume for Mothers of VLBW Infants

Purpose/Objectives: Breastmilk is important for the health and development of very low birth weight (VLBW) infants. Mothers of VLBW infants struggle with delayed lactogenesis II and coming to volume (CTV). Literature suggests the time of pump initiation contributes to breastmilk volume after 7 days. Due to suboptimal rates of breastmilk intake in infants >7 days of age, we wanted to look at timing of first pump and CTV within the first month.

Design/Methods: A retrospective chart review of infants born < 33 weeks gestation at our institution. Mothers’ charts were reviewed for documentation of feeding plan, pump time initiation, and volume of breastmilk produced in the first 30 days after delivery. Demographic data collected included self-reported race (on birth certificate), time of birth, and gestational age of the infant. Lactation reports were analyzed to determine if mothers achieved coming to volume (CTV) which is defined as >500 mL in a 24-hour period. Exclusion criteria were drug use or maternal medications that were contraindicated to breastfeeding.

Results: 94 charts were reviewed between 1/2023 and 9/2023: 10 charts were excluded. The results are shown in Table 1. 29% (24/84) had recorded time to first pump. Mothers with a documented pump initiation < 6 hours were more likely to achieve CTV although not statistically significant. Secondary analysis by race (Table 2), showed that white mothers achieved CTV more often than non-white mothers, but numbers are too small to detect statistical significance.

Conclusion/Discussion: Our data supports prior research that earlier initiation of pumping improves achieving CTV during the first month after birth. Ongoing QI initiatives are focused on L&D staff awareness of the importance of pumping initiation (and documentation) and the benefits of breastmilk for preterm infants. Further research into potential causes for disparities in time to pumping initiation between races is warranted.