Background: 

The opportunity to establish a direct breastfeeding (DBF) relationship with a preterm infant, if desired by the mother or lactating parent, is a known driver of positive healthcare experiences. Preterm birth is an independent risk factor for early human milk (HM) cessation, and DBF at the first oral meal promotes continued DBF during hospitalization and HM duration beyond discharge. While the Spatz 10-step model for protecting and promoting HM and breastfeeding in vulnerable infants provides best practices, lack of standardized implementation results in missed opportunities to meet parents' DBF goals.

Purpose: 

To standardize clinical practices to increase DBF at the first oral meal, total DBF meals during hospitalization, and use of test weighing to measure milk transfer for preterm infants.

Methods: 

Quality improvement methods were used to develop and implement Encourage, Assess, Transition (EAT): a DBF protocol for infants less than 37 weeks gestation at birth, in a level II neonatal intensive care unit.

Results: 

Thirty-eight (45%) infants from 27.7 to 36.7 weeks of gestation initiated the protocol. The proportion of infants' DBF at first oral meal increased from 22% to 54%; mean DBF meals during hospitalization increased from 13.3 to 20.3; and use of test weighing increased by 166%.

Implications for Practice and Research: 

Standardizing DBF practices with the EAT protocol increased DBF during hospitalization—a known driver of patient experience—and HM duration beyond discharge, in hospitalized preterm infants. Researchers should validate the reported benefits of EAT (increased DBF during hospitalization, use of test weighing, and improved patient experience), methods to promote passive dissemination of evidence, and sustain change.

https://journals.lww.com/advancesinneonatalcare/pages/video.aspx?v=61.

中文翻译：

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鼓励、评估、过渡 (EAT)：一项质量改进项目，为早产儿住院婴儿实施直接母乳喂养方案

背景： 

如果母亲或哺乳期父母愿意，与早产儿建立直接母乳喂养(DBF) 关系的机会是积极的医疗保健体验的已知驱动因素。早产是早期母乳(HM) 停止的独立危险因素，第一顿口服膳食的 DBF 促进住院期间的持续 DBF 以及出院后的 HM 持续时间。虽然用于保护和促进弱势婴儿母乳喂养和母乳喂养的Spatz 10 步模型提供了最佳实践，但缺乏标准化实施会导致父母错失实现 DBF 目标的机会。

目的： 

标准化临床实践，增加第一顿口服膳食的 DBF、住院期间总 DBF 膳食，以及使用测试称重来测量早产儿的乳汁转移。

方法： 

使用质量改进方法来制定和实施鼓励、评估、过渡 (EAT)：针对出生时妊娠 37 周以下婴儿的 DBF 方案，在二级新生儿重症监护病房中使用。

结果： 

妊娠 27.7 至 36.7 周的 38 名 (45%) 婴儿启动了该方案。婴儿第一次经口进餐时的 DBF 比例从 22% 增加至 54%；住院期间平均 DBF 膳食从 13.3 份增加至 20.3 份；测试称重的使用增加了 166%。

对实践和研究的影响： 

通过 EAT 方案标准化 DBF 实践可以增加住院早产儿住院期间的 DBF（已知的患者体验驱动因素）以及出院后的 HM 持续时间。研究人员应验证 EAT 报告的益处（住院期间增加 DBF、使用测试称重以及改善患者体验）、促进被动传播证据和维持变革的方法。

https://journals.lww.com/advancesinneonatalcare/pages/video.aspx?v=61。