Immune Boost: a collaborative initiative between maternity and neonatal services to improve early access to maternal breast milk for infants born <34 weeks' gestation

Tricklebank, V.; Miller, G.; Kilburn, E.; Shaw, E.

Immune Boost: a collaborative initiative between maternity and neonatal services to improve early access to maternal breast milk for infants born <34 weeks' gestation

All Authors

Tricklebank, V.

Miller, G.

Kilburn, E.

Shaw, E.

LTHT Author

Tricklebank, Victoria
Miller, Gemma
Kilburn, Elizabeth
Shaw, Emily

LTHT Department

Leeds Children's Hospital
Neonatology
Women's Services
Obstetrics & Gynaecology
Midwifery
Community Midwifery

Contributor Profession (Non Medical)

Advanced Nurse Practitioner
Midwifery

Publication Date

2025

Item Type

Article

Abstract

Evidence consistently demonstrates that access to early maternal breast milk (MBM) significantly improves outcomes in preterm infants. MBM is particularly beneficial for this vulnerable population, contributing to a reduction in mortality and morbidity. Prematurity affects approximately eight in every 100 births, with complications varying by gestational age and often including respiratory distress, neurological impairment, sepsis, and feeding intolerance. MBM is associated with reduced incidence of sepsis, gastrointestinal and respiratory infections (Patel et al 2013), retinopathy of prematurity (Zhou et al 2015) and bronchopulmonary dysplasia (Kim et al 2019). Its easily digestible fatty acids, protective enzymes and hormones support intestinal growth, reduce permeability and promote maturation (Taylor et al 2009). Furthermore, MBM improves gastric emptying and reduces the risk of necrotising enterocolitis (NEC) (Patel et al 2013). Infants who receive MBM also experience fewer hospital readmissions in their first year of life compared to those who are formula fed (Vohr et al 2006). The documented evidence of the overwhelming benefits of MBM reinforces the need to support mothers in initiating and sustaining milk expression following preterm delivery. The World Health Organization (WHO) and numerous professional guidelines advocate for the early and sustained use of MBM in preterm and unwell infants. However, mothers of very preterm infants often encounter substantial barriers to breastfeeding. As neonatal care advances and the threshold of viability shifts, it is increasingly vital that maternity and neonatal clinicians provide robust support for mothers in initiating and maintaining lactation. This includes accessible education, emotional reassurance, and appropriate tools within an unfamiliar and stressful clinical environment. Despite well-documented benefits, many very preterm infants in the UK are not fed an exclusive MBM diet. According to the 2019 National Neonatal Audit Programme (NNAP), only 55 per cent of very preterm infants received any MBM at discharge, a figure that has remained stagnant over the past five years. At Leeds Teaching Hospitals Trust, a local monthly audit of infants born <34 weeks' gestation was introduced to monitor compliance with NHS England's (2019) Saving babies' lives version 2 (SBLv2) and the British Association of Perinatal Medicine (BAPM) recommendations (BAPM 2021). In February 2022, the audit revealed that 0 per cent of eligible infants received MBM within six hours of birth, and only 37.5 per cent received it within 24 hours. This highlighted a critical gap in care, prompting the need for a quality improvement (QI) initiative. The Immune Boost QI project aimed to increase the proportion of infants <34 weeks receiving MBM within 24 hours of birth