While most infants already leave the neonatal intensive care units at Children’s Minnesota on their mother’s milk, the goal is to get the numbers even higher – and specifically, to increase the percentage of infants of color and infants with hospital stays greater than 3 months receiving human milk at discharge. That’s the focus of a quality improvement (QI) project in Children’s Minnesota’s neonatal department called Project HOME (Home on Milk Every Time), which is developing strategies to integrate tools and additional support to provide milk to babies that need it most.
Project HOME is an ongoing, multi-institution QI project with the Children’s Hospitals Neonatal Consortium (CHNC) and 36 Level IV NICUs across the United States and Canada to increase rates of breastfeeding at discharge. Children’s Minnesota is the only health care system in the Twin Cities metro area participating in CHNC.
“Human milk is important for babies, especially our smallest and sickest patients in the NICU,” said Dr. Leah Jordan, neonatologist and one of the leaders of Project HOME at Children’s Minnesota. “It protects against infection, it’s the easiest for babies to digest, it reduces length of hospital stay, and it promotes optimal development across a lifetime.”
Barriers to providing human milk
There are many reasons parents might have difficulty or concerns about feeding their newborn human milk, ranging from physical and psychological challenges to cultural norms and social influences. The demand of expressing milk can be exhausting and parents may also feel emotionally separated from their infant if they are in the NICU due to a medical condition. Bottle feeding is very common for infants in the NICU to ensure adequate nutrition and this can become time consuming and stressful for the parent.
Additionally, societal barriers including unsupportive work environments and insufficient childcare options disproportionately affect certain cultures and ethnicities such as African American women, where human milk feed rates are notably lower. The Project HOME program seeks to tailor breastfeeding support and tools around these barriers.
Project HOME at Children’s Minnesota
Project HOME is a quality improvement project happening in every neonatal department at Children’s Minnesota, as well as the Midwest Fetal Care Center (MWFCC) and The Mother Baby Center (TMBC). The project’s leadership team also includes Dr. Ann Downey, director of neonatal quality, Jennifer Rivera, neonatal clinical nurse specialist, and Kimberly Johnson, CHNC data coordinator. The full multi-disciplinary Project HOME team at Children’s Minnesota includes nurses, lactation consultants, nurse managers, pediatric nurse practitioners, neonatal nurse practitioners, dietitians, speech therapists, neonatologists, and others. Tristessa Johnson, a health equity coach at Children’s Minnesota, is advising the project to ensure it promotes equitable support for lactation.
“We feel strongly about approaching this project with an equity-focused quality improvement framework,” said Dr. Jordan. “The goal of the project is to increase the number of patients who go home on their [own] milk. These are families that need additional support to provide milk to the babies that need it the most.”
One of the first organizing steps of Project HOME at Children’s Minnesota has been to stratify all process and outcome measures by race and insurance type. The team reviews these measures and identifies opportunities to promote equitable breastfeeding support, including translating all written resources for Project HOME into Spanish, Hmong, and Somali. An example is noticing disparities in skin-to-skin rates for Black and non-English speaking families. Although the project is early in its implementation process, the team wants to ensure that interventions improve disparities, rather than maintaining or worsening them.
About the neonatology program at Children’s Minnesota
Children’s Minnesota neonatology department encompasses the largest high-risk neonatal care program in the Upper Midwest. We care for more than 2,300 newborns each year. Our fetal intervention program is also nationally recognized for exceptional clinical outcomes. Children’s Minnesota neonatology provides everything from consults to air and ground transportation for babies in need. We are committed to consistent care across the community, limiting unnecessary variation, identifying, and spreading best practices, and rapidly addressing opportunities for improvement.
Alexandra Rothstein