PURPOSE: The purpose of this study was to explore the use of mothers' own milk (colostrums, transitional milk, and mature milk) as oral care in the ventilator-associated pneumonia (VAP)–prevention bundle of mechanically ventilated preterm infants weighing 1500 g or less.
SUBJECTS: Mechanically ventilated preterm infants weighing 1500 g or less admitted to a regional level III NICU in the Gulf South between January 1, 2006, and December 31, 2009.
DESIGN: Retrospective descriptive.
METHODS: Oral care with mothers' own milk was implemented as part of the VAP-prevention bundle in the neonatal intensive care unit in the fourth quarter of 2007. Using retrospective deidentified data retrieved from the electronic medical record, the primary and secondary outcome variables were collected among eligible infants (≤1500 g) admitted January 1, 2006, to December 31, 2007 (before implementation) and January 1, 2008, to December 31, 2009 (after implementation). Sample characteristics, including infant gestational age, birth weight, and gender, as well as maternal age, type of delivery, and incidence of maternal chorioamnionitis, were also collected. Data analysis included frequencies and distributions to summarize sample characteristics and variables of interest. Appropriate tests for differences were conducted on outcome variables between the before and after groups of the human milk oral care intervention.
MAIN OUTCOME MEASURES: The feasibility outcome variable included nursing compliance with the oral care procedure. The safety outcome variable included record of any adverse events associated with the oral care procedure. The efficacy health outcomes included the rate of positive tracheal aspirates, positive blood cultures, the number of ventilator days, and length of stay.
RESULTS: Infant age (26.1–26.6 weeks) and weight (840–863 g) were similar in the before (n = 70) and after (n = 68) sample subjects. There were no statistically significant differences in ventilator days, χ² (46, n = 115) = 46.22, P = .46, and length of stay, χ2 (75, n = 115) = 78.78, P = .36, between groups. Although the rate of positive tracheal aspirates and positive blood cultures reduced after implementation of oral care with mothers' own milk, these differences were not statistically significant (U(47) = 250, z = −7.1, P = .48; U(47) = 217.5, z = −1.44, P = .15).
CONCLUSIONS: There were no statistically significant differences in the rates of positive tracheal aspirates and blood cultures after implementation of oral care with mothers' own milk. The findings of this study suggest that using mothers' own milk as part of the VAP-prevention bundle is a feasible and safe practice; however, further research is needed to determine the immunological benefits of this practice.
Center for Nursing Research, Ochsner Health System (Ms Thibeau), and Women's Services, Ochsner Medical Center (Ms Boudreaux), New Orleans, Louisiana.
Correspondence: Shelley Thibeau, PhD(c), RNC-NIC, Center for Nursing Research, Ochsner Health System, 1514 Jefferson Hwy, New Orleans, LA 70122 (firstname.lastname@example.org).
The authors thank Dr Harley Ginsberg, medical director; Dawn Ricouard, unit director; staff (nurses, neonatal nurse practitioners, lactation consultants, occupational therapists, and respiratory therapists); and the parents of their preterm infants for their cooperation and enthusiasm. They also wish to thank Andrea Gallagher and Jennifer Routte, Tulane University undergraduate research interns, for participating in data collection and Dr Richard Ashmore for statistical support.
The authors declare no funding or conflict of interest.