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Section on Breastfeeding Program | January 01 2018
Improving Vitamin D Administration to Breastfeeding Newborns Using a Quality Improvement Model*
Suhagi Kadakia, MD;
(1)Jersey Shore University Medical Center K. Hovnanian Children's Hospital, Department of Pediatrics, Ocean, NJ
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Alan Cabasso, MD, FAAP;
(2)Jersey Shore University Medical Center K. Hovnanian Children's Hospital, Department of Pediatrics, Neptune, NJ
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Anita Siu, PharmD, BCPPS;
(3)Jersey Shore University Medical Center Department of Pharmacy, Ernest Mario School of Pharmacy, Rutgers University, Neptune, NJ
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Rose St. Fleur, MD, FAAP
(4)K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, Neptune City, NJ
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Pediatrics (2018) 141 (1_MeetingAbstract): 290.
Introduction: In November 2008, the American Academy of Pediatrics (AAP) doubled the recommended daily intake of vitamin D for infants and children, from 200 IU/day (2003 recommendation) to 400 IU/day. Vitamin D should also be offered to any mother giving less than 500 mL of breast milk per day. Although breast milk is the best source of food for infants, it only contains 25 to 50 IU/L of vitamin D and, thus, is insufficient by itself. Vitamin D deficiency can cause nutritional rickets in severe cases but can also cause impaired growth, developmental delays, lethargy, and hypocalcemic seizures. Many pediatricians are unaware of the new recommendations for Vitamin D administration. Purpose: The purpose of this project is to identify rates of vitamin D administration in our resident clinic and develop a strategy for optimizing these rates by utilizing a quality improvement model. All of the newborn infants seen at our clinic were born at Jersey Shore University Medical Center. We theorized that initiating vitamin D supplement administration in the Nursery Unit to any newborn receiving breast milk as per the AAP guidelines will improve rates of vitamin D administration in our outpatient resident clinic. Method: Pre-intervention, a retrospective chart review of 60 outpatient clinic visits for 2-week-old newborns during October 2014 to November 2014 was performed. Documentation based on maternal report was recorded for all visits during this time period. In July 2015, we added Tri-vi-sol (vitamins A, C, and D) 1 mL orally once a day as an admission order set for newborn infants who will be fed breast milk. Tri-vi-sol contains 400 units of vitamin D, satisfying the current AAP recommendation. No intervention or change was made in the resident clinic regarding vitamin D administration. Post-intervention, another chart review of outpatient clinic visits for 2-week-old newborns was performed from August 2015 to October 2015. Results: The pre-intervention results showed that exclusive breastfeeding mothers were offered vitamin D supplements 93% of the time. However, combination feeding (breast milk and infant formula) mothers reported being offered vitamin D only 30% of the time. All of the combination feeding newborns were consuming less than 500 mL of infant formula per day. The post-intervention chart review remained consistent in the exclusive breastfeeding mothers; 93% of them reported being offered vitamin D. However, there was a vast improvement among the combination feeding mothers. They reported being offered vitamin D 86% of the time within the first 2 weeks of life Conclusion: Using our quality improvement model, we discovered that compared to exclusively breastfeeding mothers, giving a combination of breast milk and infant formula were 63% less likely to report being offered vitamin D. We were able to demonstrate improvement in reported vitamin D administration rates for combination feeding infants by 56%. This intervention could be utilized in other hospital settings to improve evidence-based breastfeeding care practices.
Pre and Post Intervention Statistics
Pre and Post Intervention Statistics
Copyright © 2018 by the American Academy of Pediatrics
2018
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Source: https://pediatrics.aappublications.org/content/141/1_MeetingAbstract/290
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