Proactive Lactation Care is Associated With Improved Outcomes in a Referral NICU.

This was a retrospective before-and-after study at one referral NICU, not a randomized trial, so the care model was not tested against a concurrent control group and the results cannot prove causation. The proactive period changed several things at once, including extra IBCLC staffing, automatic consults, nurse education, screen-saver prompts, follow-up visits, pump access, and daily volume reporting, so the contribution of any single component cannot be separated. Milk-room bottle and volume data were pooled for all NICU admissions, not only infants admitted in the first 7 days, and could not be linked to individual mothers or infants. The milk-room data excluded fresh unfortified milk fed the same day as pumped and did not record preparation/storage volumes when no excess milk was stored. Prior lactation support and resources at the birth hospitals varied widely and were not measured, including whether mothers used hospital-grade pumps before NICU admission. The study could not assess very early pumping, including the first hours of life, because many mothers were still inpatients elsewhere and infants were transported. Exclusive mother's own milk was defined as 100% mother's own milk during the NICU stay, so one early formula or donor milk feed classified an infant as non-exclusive even if most feeds were mother's own milk. No power analysis or sample size calculation was performed; sample size was determined by the timing of the practice change. Weekend admissions and transport delays meant the 24-hour IBCLC visit goal was not always met, and first visits were often by phone or indirect contact rather than in person.

No funding source is stated. The authors declared potential conflicts of interest, but the supplied text does not list them.

Do not conclude that extra IBCLC staffing alone caused better lactation outcomes. This was a before-and-after comparison of a bundled care model, and stored milk volume did not increase significantly, so the study shows association, not proof of cause.