Enhancing Early Colostrum Administration and Sustained Breastfeeding Practices in Preterm Neonates: A Quality Improvement Initiative with Long-term Implications

Background Preterm neonates admitted to neonatal intensive care units (NICUs) frequently encounter challenges with breast milk feeding, which compromises their nutrition and immunity. This study aimed to improve colostrum availability for administration from a baseline of 10%-50% among preterm infants using some low-cost, quality improvement (QI) interventions. Methods A quasi-experimental pre- and post-test QI study was conducted between June 2023 and May 2024 in a Level III NICU in Northern India. After the initial baseline assessment, interventions including lactation counseling, posters, breast pumps, wrist tags, and tailored educational materials were cyclically implemented in four phases after an initial baseline phase. The study followed four Plan-Do-Study-Act (PDSA) cycles, including a sustenance phase involving a total of 432 participants. Key outcomes were colostrum expression within 6 h and exclusive breastfeeding rates at discharge. Results The overall frequency of colostrum expression within the first 6 h increased significantly from 15.57% to 56.63% ( P < .001) post-intervention, was further sustained at 75.67% during the sustainability phase, and the exclusive breastfeeding rates at discharge improved from 49.63% to 85.68% ( P < .001). Subgroup analyzes further showed the absence of any disparities in outcomes based on either mode of delivery or maternal background, being rural or urban, highlighting the interventions’ adaptability and effectiveness. Conclusion Structured, low-cost QI strategies for proper implementation can significantly enhance early colostrum expression and exclusive breastfeeding rates in NICU settings. These findings highlight the need for such cost-effective interventions to improve neonatal outcomes in diverse healthcare setups, thereby providing a practical framework for improving neonatal outcomes in resource-limited environments.