Dose of OMM | NICU Lactation Quality Improvement

What is dose of OMM?

Dose of OMM refers to the proportion (%) or amount (ml/kg/day) of oral feeds that is comprised of own mother’s milk (OMM).¹

For prematurely-born infants the dose (ml/kg/day) should be calculated for specific periods:

Each day of hospitalisation

Critical periods of: First 0–14 days, Days 0–28 post-birth¹

In the NICU, dose of OMM is a more accurate quality measure for human milk use than breastfeeding rates at discharge.¹

Why is dose of OMM important?

Own mother's milk (OMM) is a NICU medical intervention that offers superior benefits over pasteurised donor human milk (DHM) and bovine formula.^2,3

A dose-response relationship exists between the amount of OMM received by prematurely-born infants and the risk of clinical morbidities.⁴

High doses of OMM feeds are low-cost interventions that reduce the risk of necrotising enterocolitis (NEC),^5-8 late-onset sepsis,{9,10} bronchopulmonary dysplasia (BPD),¹¹ retinopathy of prematurity (ROP)^12,13 and prolonged hospitalisation.^13,14

How to optimise dose of OMM

Ensure NICU infant feeding charts/logs define the composition and volume of each feed OMM:DHM:Formula

Document the daily volume of OMM / DHM / formula and the method of administration (e.g. enteral) for first 28 days of infant life

Regularly educate staff on the value of optimising the dose and exposure to OMM for NICU infants and the significant impact this has on reducing neonatal co-morbidities. For more information, watch 'Healthy Brain, Healthy Body, Wealthy Society' video by Professor Paula Meier.

Provide staff with education on the value and use of donor human milk as a bridge to avoid bovine formula whilst lactation support for effective initiation is provided to mothers of NICU infants

Support parental discussions on the importance of the dose of OMM for their infant so that NICU mothers are informed and empowered to pump early and often

How to monitor dose of OMM

Collect and review infant feeding data from electronic records or feeding charts for the first 28 days post-birth:

total volume per day and proportion of feed OMM / DHM / formula.

Include data for at-breast feeds and use test weighing pre and post feed to record accurate volume of OMM transfer

Upload infant feeding logs to data collection tool to measure the

% proportion of daily feeds that are OMM / DHM / formula

% proportion of NICU infants receiving 100% human milk (OMM/DHM)

Integrate monthly monitoring and evaluation meetings to review the data, identify areas of compliance and specific timepoints for areas of improvement to increase infant daily OMM feed volume and dose.

Share findings with maternity and delivery suite to adopt behaviour and practice change to support effective initiation of lactation and coming to volume.

References

1. Bigger HR et al. Quality indicators for human milk use in very low-birthweight infants: are we measuring what we should be measuring? J Perinatol. 2014; 34(4):287–291.

2. Meier PP et al. Evidence-based methods that promote human milk feeding of preterm infants: An expert review. Clin Perinatol. 2017; 44(1):1–22.

3. Meier P et al. Donor human milk update: evidence, mechanisms, and priorities for research and practice. J Pediatr. 2017; 180:15–21.

4. Meier PP et al. Human milk in the neonatal intensive care unit. In: Family Larsson-Rosenquist Foundation, editor. Breastfeeding and breast milk - From biochemistry to impact: A multidisciplinary introduction. 1st ed. Stuttgart: Thieme; 2018.

5. Sisk PM et al. Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J Perinatol. 2007; 27(7):428–433.

6. Johnson TJ et al. Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants. Neonatology. 2015; 107(4):271–276.

7. Sullivan S et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010; 156(4):562–567.

8. Alshaikh B et al. Effect of a Quality Improvement Project to Use Exclusive Mother's Own Milk on Rate of Necrotizing Enterocolitis in Preterm Infants. Breastfeed Med. 2015; 10(7):355–361.

9. Patel AL et al. Impact of early human milk on sepsis and health-care costs in very low birth weight infants. J Perinatol. 2013; 33(7):514–519.

10. Hylander MA et al. Human milk feedings and infection among very low birth weight infants. Pediatrics. 1998; 102(3):E38.

11. Patel AL et al. Influence of own mother's milk on bronchopulmonary dysplasia and costs. Arch Dis Child Fetal Neonatal Ed. 2017; 102(3):F256-F261.

12. Hylander MA et al. Association of human milk feedings with a reduction in retinopathy of prematurity among very low birthweight infants. J Perinatol. 2001; 21(6):356–362.

13. Johnson TJ et al. Economic benefits and costs of human milk feedings: a strategy to reduce the risk of prematurity-related morbidities in very-low-birth-weight infants. Adv Nutr. 2014; 5(2):207–212.

14. Hair AB et al. Beyond Necrotizing Enterocolitis Prevention: Improving Outcomes with an Exclusive Human Milk-Based Diet. Breastfeed Med. 2016; 11(2):70–74.