Dose of own mother's milk (OMM) – Effective initiation results

High dose and long exposure to OMM are low cost interventions that reduce the incidence of chronic co-morbidities such as NEC, late onset sepsis and BPD in vulnerable NICU infants. These can be achieved by evidence-based interventions that support effective initiation.

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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 hospitalization
• 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 hospitalization.^13,14

How to optimize 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 optimizing 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 while 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.

Downloads

Dose of OMM (pdf)

Value of human milk in the NICU (pdf)

Value of OMM (pdf)

Why choose OMM over donor’s milk (pdf)

Clinical & economic impact of OMM (pdf)