title: Quality indicators for human milk use in very low-birthweight infants: are we measuring what we should be measuring?
abstract: OBJECTIVE
  The objective of this study was to compare the currently used human milk (HM) quality indicators that measure whether very low-birthweight (VLBW; <1500 g birthweight) infants 'ever' received HM and whether they were still receiving HM at discharge from the neonatal intensive care unit (NICU) to the actual amount and timing of HM received.
  
  
  METHODS
  This study used data from a large NIH-funded cohort study and calculated whether VLBW infants ever received HM (HM-Ever) and of these infants, the percentage who were still receiving HM at NICU discharge (HM-DC). Then, the HM-DC indicator (exclusive, partial and none) was compared with the amount and timing of HM feedings received by these same infants.
  
  
  RESULTS
  Of the 291 VLBW infants who met inclusion criteria, 285 received some HM (HM-Ever=98%). At NICU discharge (HM-DC), 24.2, 15.1 and 60.7% were receiving exclusive, partial and no HM, respectively. Of the 60.7% infants with no HM-DC, some had received higher amounts of HM during the NICU hospitalization than infants categorized as exclusive and partial for HM-DC. Of the infants with no HM-DC, 76.8 and 59.7% had received exclusive HM during the days 1-14 and days 1-28 exposure periods, respectively.
  
  
  CONCLUSIONS
  The average daily dose (HM-DD; in ml kg(-1) d(-1)) and cumulative percentage (HM-PCT; as % of cumulative enteral intake) of HM feedings were sufficient to significantly reduce the risk of multiple morbidities, including late-onset sepsis, necrotizing enterocolitis, neurocognitive delay and rehospitalization, in the majority of the VLBW infants who were discharged with no HM-DC. Quality indicators that focus on the amount and timing of HM feedings in the NICU should be added to the HM-Ever and HM-DC measures.
authors: Rush University Medical Center, Chicago, IL, USA.
authors: H R
authors: HR
authors: Bigger
authors: Rush University Medical Center, Chicago, IL, USA.
authors: L J
authors: LJ
authors: Fogg
authors: Rush University Medical Center, Chicago, IL, USA.
authors: A
authors: A
authors: Patel
authors: Rush University Medical Center, Chicago, IL, USA.
authors: T
authors: T
authors: Johnson
authors: Rush University Medical Center, Chicago, IL, USA.
authors: J L
authors: JL
authors: Engstrom
authors: Rush University Medical Center, Chicago, IL, USA.
authors: P P
authors: PP
authors: Meier
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000592:standards; D015931:Intensive Care, Neonatal / Q000592:standards; D008297:Male; D008895:Milk, Human; D017283:Neonatal Nursing; D019984:Quality Indicators, Health Care