Increasing Breastfeeding and Human Milk Use in the NICU

Project Overview

Increasing Breastfeeding and Human Milk Use in the NICU: An Initiative to Improve Infant Nutrition and Care in NICUs is a learning collaborative sponsored by the Texas Collaborative for Health Mothers and Babies (TCHMB) with support from University of Texas Health Science Center, Tyler (UT Health Northeast) and Population Health, Office of Health Affairs at University of Texas, System (UT System).


Intervention by:



To increase the number of very low birth weight infants that will receive human milk, preferably their mother’s milk, as their primary source of nutrition to assist with their immune and gastrointestinal tract development. More specifically, this project is focused on helping participating hospitals identify and overcome barriers to establishing maternal milk supply and barriers to supporting breastfeeding in the NICU.



Currently there are nine Level III & six Level IV hospitals participating in the project, as well as two observing hospitals. Approximately 800 NICU beds are covered by the project. 

9 Level III & 6 Level IV, + 2  observing hospitals  800 NICU beds covered by  the project  

9 Level III & 6 Level IV, + 2  observing hospitals  800 NICU beds covered by  the project


This learning collaborative is designed to enable teams to share, test, and implement ideas for improving rates of human milk and breastfeeding among very low birth weight babies. This project will require that teams engage with energy and skill to try new ways of delivering care. Together, we can arrive at and
spread ideas that will improve outcomes for very low birth weight infants and serve as a model of how to improve care more broadly.

NICU Breast Milk Feeding Bundle

This learning collaborative is working to increase the use of human milk and breastfeeding by focusing on components of a “NICU Breast Milk Feeding Bundle.” This bundle was developed through discussion through the participating hospitals throughout the state who have all been working to increase breastfeeding and the use of human milk in the NICU, and is informed by the extensive literature on
breastmilk utilization in the NICU. Improvement on different components of the bundle can help improve rates of breastfeeding, human milk use, and the health of infants in the NICU.

"VLBW infants were 1.4% of the births in Texas in 2013 and 2014, comprising 11,078 births in this two-year period"

Elements of the Bundle

• Begin hand expressing or pumping breastmilk within 6 hours of birth
• Provide electric, hospital-grade breast pumps to breastfeeding mothers before discharge
• Administer colostrum as it is produced, either through oral care or feeding
• Track breast milk volumes daily, to assist with the establishment and maintenance of milk supply
• Utilize skin-to-skin care (kangaroo care) daily and facilitate non-nutritive breastfeeding
• Facilitate the transition from breast milk feeding to direct breastfeeding prior to discharge
• Provide human donor milk for infants <1500g birth weight whose mother’s milk is not available
• Establish and utilize a written Infant Feeding Protocol for all infants in the NICU
• Conduct unit-wide education for nursing and medical staff in lactation support
• Provide education for parents on the importance of mother’s milk

Neonatal Subcommittee

TCHMB’s Neonatal Subcommittee focuses on improving health care for neonates and families. It promotes evidence-based practice through clinical quality improvement projects. 

Project Lead
Dorothy Mandell, PhD, University of Texas Health Science Center at Tyler & UT System

Charleta Guillory, MD, MPH, Baylor College of Medicine
Amy B. Hair, MD, Baylor College of Medicine
Alexander Kenton, MD, FAAP, Mednax & Methodist Health System
Nancy Hurst, RN, PhD, Texas Children’s Hospital