Development, Implementation and Evaluation of a Pilot Intervention: Promoting Breast Milk Expression in a Neonatal Intensive Care Unit

Background: Very preterm infants receiving breast milk experience better health outcomes compared to formula fed infants. However, these infants often lack the ability to coordinate sucking and swallowing and are unable to breastfeed at delivery. Consequently, mothers of very preterm infants must initiate milk expression. While these mothers demonstrate high milk expression initiation rates, continuation of this behavior until infant discharge from the Neonatal Intensive Care Unit (NICU) is a significant challenge.Therefore, the primary aim of this study was to gain an understanding of mothers’ experiences expressing milk for their very preterm infants in a Level III NICU and to develop, implement and evaluate a pilot intervention to promote milk expression. Methods: This study was conducted in three phases: 1) using a phenomenological approach, mothers were interviewed about their experiences expressing milk, 2) PumpMed, a web-based application, was developed in response to these interviews and a developmental evaluation (DE) was conducted to assess usability and acceptability by members of the target population, 3) PumpMed was piloted using a randomized design in a Level III NICU, with mothers of very preterm infants to assess feasibility and efficacy. Mothers of very preterm infants were randomized to one of three study groups: 1) Control Group (Resources), 2) Partial Intervention (Resources + Logs), and 3) Full Intervention (Resources + Logs + Questions + Feedback). Results: Five global themes emerged, which informed the prototype of PumpMed. PumpMed scored significantly above the benchmark average in usability and the majority of participants reported they would have used PumpMed. Recruitment and retention rates for the pilot intervention were high. However, actual usage of PumpMed among participants was low. There were no significant differences between groups and milk expression outcomes, however the small sample size was a limitation. Conclusions: This study provides insight into the complex experience mothers undergo when expressing milk for their preterm infants. A DE of PumpMed demonstrated it was useable and allowed for iterative changes to further tailor PumpMed to the unique needs of the target population. Future iterations of PumpMed may benefit from alternative strategies to increase usage.