The Neuroprotection of Oral Enjoyment with Milk Drops

We are so grateful to our Synapse Care Community for contributing to our blog. This post was submitted by Barbara O’Rourke, a NICU Nurse from Mercy One Hospital in Des Moines, IA.

Background of our problem and project

Three years ago, our NICU launched an approved IRB research project of giving milk drops to our infants. The project was initiated due to an increase in oral aversion in our VLBW (very low birth weight) and LBW (low birth weight) infants and their inability to take full oral feedings at 40-44 weeks CGA (corrected gestational age). We sought the guidance of our medical team, who requested that the project focus on those infants born between 23 week and 33+6 weeks gestation. Although our only hypothesis was that “the infants who received milk drops would have a shorter length of stay (LOS) than infants who did not”, we also assessed and collected data on their HR (heart rate), RR, (respiratory rate) oxygenation, color, state, tone, respiratory support, and response to the milk drops.

Our Plan

The study intervention would start at 3 days of age and the infants were to be given normal bedside care except after they had been nested in, we would give a drop or two of milk – if the infant licked their lips we would offer a swab or pacifier – if the infant accepted we would give more – a droplet at a time – based on the infant’s cues. The swab or pacifier remained in place as the droplets were given. The volume was limited by gestational age, and just like feeding, sometimes the infants would not respond, however most of the time the infant did respond. As they matured they would often awaken before cares, sucking their fingers, looking around, and “waiting” for their milk drops. The process often took 10-15 minutes as we paced the infant allowing the infant to guide us. We only gave milk drops with cares or gavage feedings since when we did give an infant an attempt at oral feeding were considered the oral enjoyment for that set of cares.

Our Results

100 preterm subject infants were matched with 100 control infants who were discharged from our NICU before the study began. One infant (a 23 week) was excluded from the study analysis since this infant was transferred to another facility before discharge. The remaining 99 infants were matched by gender and gestational age at birth with control infants.

The average LOS for the subject group was 44.11 days versus the control group 49.30 days. The most significant difference in LOS being seen in the infants 24-30 weeks. When costs were assessed, it saved our unit over $660,000.00 on these 99 infants.

After seeing these results, our medical team requested the milk drop intervention become a standard of care for all infants in our NICU. The nurses document the infant’s response to milk drops in our electronic medical record. The therapists and neonatologists often including the infant’s response to milk drops when they are assessing for oral feeding readiness. It is not unusual for our VLBW and LBW infants to go home at 35-36 weeks, some exclusively breastfeeding.

Table 2. Major Findings : Length of stay (LOS)

Gestational Age	Number of subject infants	Mean LOS subject infants	Number of control infants	Mean LOS control infants
24	2	90.0	2	135.0
25	3	86.0	3	127.7
26	6	88.8	6	90.8
27	5	83.4	5	98.2
28	5	53.0	5	64.8
29	6	56.8	6	65.8
30	9	47.2	9	55.4
31	20	41.5	20	38.5
32	16	30.1	16	34.6
33	27	23.6	27	24.1
	Average LOS	44.11	Average LOS	49.30
P = .007 paired t test with 98df

We continue to see unbelievable results. I just podium presented our study at the ANN conference and was able to talk about one of our very sick infants – born at 23 weeks that we had sent to a Level IV NICU at 35 weeks. This little one had received milk drops since DOL 3, and when we transferred her the mother requested and the hospital did continue the milk drops, although the mother stated not as consistent as our unit.

I attached the slide of her progression. It was unbelievable. The hospital staff and the family were so happy.

Feeding can be accomplished in many ways – but the neuroprotection of oral enjoyment is more than just feeding – it’s the joy of eating Grandma’s apple pie, loving pizza, looking forward to get-togethers, etc. Our joy is watching these tiny micro-preemies enjoy breastfeeding and bottling the first time they are able to orally attempt. They have been practicing and enjoying a long time.

Our future plans

We have presented our study and its results at the 3rd World Congress on Neonatology & Neonatal Nursing last fall and were accepted to the NANT and NANN conference this year as poster presenters. We are also planning to submit our abstract to other conferences in the future. Our hope is that this project will be replicated. It has truly made a huge difference in helping our micro preemies be more successful with feeding.

Written by:

Barbara O’Rourke RN NICU

UnityPoint Hospital

Blank Children’s Hospital

Mercy One Hospital

Des Moines, IA 50309

email: borourke53@gmail.com

Many Thanks!

We are so grateful to our Synapse Care Community for contributing to our blog. This post was written by Barbara O’Rourke, NICU Nurse from Mercy One Hospital in Des Moines, Iowa. If you’d like to contact Barbara about this study, she has provided her contact details below.

Do you have a story, a QI project, or an article that you’d like to contribute to our blog or maybe present at the next ONE Conference? Please reach out to us and let us know.

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