Wee Nuzzle: A QI Initiative to Promote Nonnutritive Breastfeeding for Preterm Infants.

Objectives: Nonnutritive breastfeeding (NNBF) benefits preterm infants younger than 34 weeks' gestational age (GA), but it is often delayed in those on noninvasive respiratory support. Our primary aim was to reduce the mean number of days to NNBF by 50% in infants born at less than 34 weeks' and more than 30 weeks' corrected GA within a 12-month period. Our global aim was to increase provision of human milk at discharge.

Methods: This 1-year quality improvement (QI) initiative involved a multidisciplinary team employing a key driver diagram, fishbone analysis, and "Wee Nuzzle" guidelines, implemented through Plan-Do-Study-Act cycles. The first cycle focused on training health care providers, the second on integrating NNBF into medical progress notes, and the third on incorporating NNBF into the electronic medical record (EMR). Data were collected using EMR and the California Perinatal Quality Care Collaborative database.

Results: The initiative achieved its Specific, Measurable, Achievable, Realistic and Time bound (SMART) aim, reducing the mean time to first NNBF by 66%, from 12.0 to 4.1 days. Additionally, the global aim of increasing human milk provision at discharge improved from 59% to 72%.

Conclusion: This QI initiative effectively reduced the time to first NNBF attempt and increased human milk provision at discharge. Ongoing assessment of human milk exposure post-neonatal intensive care unit discharge is needed.