The Effect of Restricted Parental Movement During the COVID-19 Pandemic on the Utilization of Pasteurized Donor Breastmilk in the NICU: A Quality Improvement Project

Abstract

The COVID-19 pandemic presented as a major health crisis that caused shutdowns and restricted access to healthcare facilities globally. Not only did this have an immeasurable impact on adult critical care units, but also on neonatal intensive care units (NICUs). One impact of COVID-19 was restricted access and movement to Providence Alaska Medical Center’s (PAMC’s) NICU, affecting both families and designated caregivers. This movement restriction caused families to choose whether to stay at the bedside or leave the NICU without the ability to re-enter for an undefined or restricted period of time. The purpose of this retrospective chart review was to evaluate how restricted access affected donor breast milk (DBM) usage in the NICU for infants <35 weeks according to their respective feeding protocols. DBM was used as a surrogate marker for mothers own milk (MOM) as this is routinely supplemented when MOM is unavailable. Yearly averages of DBM (in mLs) per infant in their respective feeding protocol from 2019-2020 were collected and sorted according to episode (monthly for 2019 data versus monthly or restricted access period for 2020). A survey was provided to NICU staff to obtain qualitative data on barriers and facilitators to MOM during COVID-19. An ANOVA test was planned to interpret results for average DBM usage per infant in their respective feeding protocol and descriptive statistics and trends in the qualitative data were reported from the NICU staff survey. Incomplete data collection occurred due to unforeseeable issues with the electronic healthcare record (EHR) report. The staff survey provided a small sample size of data (n = 10) for perceived barriers to utilizing MOM (restricted access, stress, and childcare concerns) and facilitators (more time in the NICU and more access to lactation) during COVID-19. Considering the inability to interpret average DBM mLs per infant accurately, this study demonstrates a need for a more consistent and accurate EHR report to carry out the methods for this study. Overall, this study provides strong methodology to conduct and analyze DBM as a surrogate marker for MOM during the COVID-19 pandemic for future studies at PAMC or other NICUs.