Barbara O’Rourke, NICU RN, read my post on pacifier dips in the NICU, and is sharing the infant-guided neuroprotective “milk drop intervention” being used in her intensive care unit, and its positive outcomes. Thank you, Barbara!
Three years ago, our NICU launched an approved IRB research project of giving milk drops to our infants. The project was initiated due to an increase in our VLBW and LBW of oral aversion and the inability to take full oral feedings at 40-44 weeks CGA. We sought the guidance of our medical team, who requested that the project focus on 23 week to 33+6 week gestational age at birth infants. Although our only hypothesis was that “the infants who received milk drops would have a shorter length of stay (LOS) than infants who did not”, we also assessed and collected data for our knowledge regarding their HR, RR, oxygenation, color, state, tone, respiratory support, and response to the milk drops. The intervention would start at 3 days of age, and the infants were to be given normal bedside care except after they had been nested in, we would give a droplet or two of milk – if the infant licked their lips we would offer a swab or pacifier – if the infant accepted we would give more – a droplet at a time – based on the infant’s cues. The swab or pacifier remained in place as the droplets were given. The volume was limited by gestational age, and just like a feeding, sometimes the infants would not respond, however most of the time the infant did respond. As they matured they would often awaken before cares, sucking their fingers, looking around, and “waiting” for their milk drops. The process often took 10-15 minutes as we paced the infant allowing the infant to guide us. We only gave milk drops with cares or gavage feedings as oral attempts were considered the oral enjoyment for that set of cares. 100 subject infants were matched with 100 control infants who were discharged from our NICU before the study began. The data of the one 23 week infant in the project was pulled since the infant was transferred to another facility. The remaining 99 subject infants were matched only on gender and gestational age at birth with control infants. The average LOS for the subject group was 44.11 days versus the control group 49.30 days. The most significant difference in LOS being seen in the infants 24-30weeks. When costs were assessed, it saved our unit over $660,000.00 on these 99 infants. Our medical team requested the milk drop intervention become a standard of care for all infants in our NICU. The nurses document the infant’s response to milk drops in EPIC with the therapists and neonatologists often including the infant’s response to milk drops when they are assessing for oral feeding readiness. It is not unusual for our VLBW and LBW infants to go home at 35-36 weeks, some exclusively breastfeeding.