Background: 
There are many short and long-term benefits of breastfeeding or providing expressed breast milk (EBM). Colostrum, the first milk produced after birth, has the highest concentration of immune-protective biofactors. When born < 34 weeks gestational age (GA), infant’s oral motor skills limit their ability to orally feed. To overcome this barrier and promote exposure to EBM, oral colostrum care (OCC) allows for the administration of EBM in preterm infants. Promoting OCC may lead to an increase in EBM feedings with earlier establishment of lactogenesis. In April 2019, our neonatal intensive care unit (NICU) initiated a policy for OCC use for all inborn infants < 32 weeks GA for the first 7 days of life (DOL).

Objective: 
Describe OCC practice after implementation of policy in the Children’s Memorial Hermann Hospital (CMHH) level 4 NICU and quantify the impact of OCC on use of EBM at discharge.

Methods:
A three-year retrospective cohort study from January 2019 through May 2022 included inborn infants < 32 weeks GA. During this period, n=1184 qualified for OCC, 25 infants were randomly sampled per year. The infants were divided into two groups: those who received OCC and those who received no OCC. Categorical and continuous variables were compared using Fisher's exact test and the Mann-Whitney U test, respectively. 

Results:
Included in the analysis were OCC infants (n= 92) and non-OCC infants (n=8). Both groups were comparable in baseline characteristics except OCC infants were an average of 16 days younger than non-OCC infants (p=0.031). Length of stay was more than double in OCC infants compared to non-OCC infants (52.5 vs 25.0 days, p=0.072). No difference appreciated between groups in feeding outcomes within 72 hours of discharge (p=0.157). 1.1% OCC infants received exclusive human milk (either donor human milk ((DHM) or EBM), compared to 12.5% non-OCC infants received exclusive human milk. 58.7% OCC infants received formula, compared to 37.5% non-OCC infants received formula. 38% OCC infants received fortified human milk (either DHM or EBM) and formula, compared to 50% of non-OCC infants (p=0.157). No difference in hours after birth the infant received first EBM (66 vs 52 hours, p=0.434) or for documented EBM volume throughout hospitalization (2332.5 mL vs 2573 mL, p=0.722) between OCC infants and non-OCC infants. 

Conclusions: 
OCC use occurred in 92% of our sample. Non-OCC infants had greater exclusive human milk volume within 72 hours of discharge, greater parental visits, received first EBM sooner, and had greater EBM volume received throughout hospitalization.

Oral Colostrum Care to Predict Expressed Breast Milk at Discharge

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