Exclusive Breast Milk Feeding

PC-05 Exclusive breast milk feeding during the newborn's entire hospitalization.

The measure is reported as an overall rate which includes all newborns that were exclusively fed breast milk during the entire hospitalization.

Measure specifications are in the Public Domain.

LOINC(R) copyright 2004-2020 Regenstrief Institute, Inc. 

This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2020 International Health Terminology Standards Development Organization. ICD-10 copyright 2020 World Health Organization. All Rights Reserved.

These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.

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Exclusive breast milk feeding for the first 6 months of neonatal life has long been the expressed goal of World Health Organization (WHO), Department of Health and Human Services (DHHS), American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). ACOG has recently reiterated its position (ACOG, 2007). A recent Cochrane review substantiates the benefits (Kramer & Kakuma, 2002). Much evidence has now focused on the prenatal and intrapartum period as critical for the success of exclusive (or any) BF (Centers for Disease Control and Prevention [CDC], 2007; Petrova, Hegyi, & Mehta, 2007; Shealy et al., 2005; Taveras et al., 2004). Exclusive breast milk feeding rate during birth hospital stay has been calculated by the California Department of Public Health for the last several years using newborn genetic disease testing data. Healthy People 2010 and the CDC have also been active in promoting this goal.

Exclusive breast milk feeding for the first 6 months of neonatal life can result in numerous long-term health benefits for both mother and newborn and is recommended by a number of national and international organizations. Evidence suggests that the prenatal and intrapartum period is critical for the success of exclusive (or any) breast feeding. Therefore, it is recommended that newborns are fed breast milk only from birth to discharge.

Improvement noted as an increase in the rate

Reference Type: CITATION

Reference Text: 'American Academy of Pediatrics. (2005). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 115, 496-506.'

Reference Type: CITATION

Reference Text: 'American College of Obstetricians and Gynecologists, Committee on Obstetric Practice and Committee on Health Care for Underserved Women. (2007). Breastfeeding: ACOG committee opinion 361—Maternal and infant aspects. Washington, DC: American College of Obstetricians and Gynecologists.'

Reference Type: CITATION

Reference Text: 'California Department of Public Health. (2017). In-hospital breastfeeding initiation data: Hospital of occurrence. Retrieved from https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/BFP/BFP-Data-InHospital-Hospitals-2017.pdf'

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2007, August 3). Breastfeeding trends and updated national health objectives for exclusive breastfeeding—United States birth years 2000–2004. Morbidity and Mortality Weekly Report, 56(30), 760-763.'

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity, and Obesity. (2017). Breastfeeding report card. Retrieved from https://www.cdc.gov/breastfeeding/data/reportcard.htm'

Reference Type: CITATION

Reference Text: 'Ip, S., Chung, M., Raman, G., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: U.S. Department of Health and Human Services. Retrieved from https://archive.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf'

Reference Type: CITATION

Reference Text: 'Kramer, M. S., & Kakuma, R. (2002). Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews, (1). DOI: 10.1002/14651858.CD003517.'

Reference Type: CITATION

Reference Text: 'Petrova, A., Hegyi, T., & Mehta, R. (2007). Maternal race/ethnicity and one-month exclusive breastfeeding in association with the in-hospital feeding modality. Breastfeeding Medicine, 2(2), 92-98.'

Reference Type: CITATION

Reference Text: 'Shealy, K. R., Li, R., Benton-Davis, S., et al. (2005). The CDC guide to breastfeeding interventions. Atlanta, GA: U.S. Department of Health and Human Services, CDC. Retrieved from http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf'

Reference Type: CITATION

Reference Text: 'Taveras, E. M., Li, R., Grummer-Strawn, L., et al. (2004). Opinions and practices of clinicians associated with continuation of exclusive breastfeeding. Pediatrics, 113(4), e283-e290.'

Reference Type: CITATION

Reference Text: 'U.S. Department of Health and Human Services. (2007). Healthy People 2010 midcourse review. Washington, DC: U.S. Department of Health and Human Services. Retrieved from https://www.healthypeople.gov/2010/Data/midcourse/default.htm'

Reference Type: CITATION

Reference Text: 'World Health Organization. (2007). Indicators for assessing infant and young child feeding practices. Washington, DC, USA: World Health Organization. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/43895/9789241596664_eng.pdf'

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A discharge to a designated cancer center or children's hospital should be captured as a discharge to an acute care facility.

Data shows that the majority of newborns with gestational age 37 weeks or more have a birth weight 3000 grams or more. Birth weight 3000 grams or more is a proxy to capture term newborns without gestational age recorded in EHR system. Only one birth weight value should be recorded. In cases where there is conflicting data, use the document recording the birth weight closest to the time of delivery. 

If dextrose or glucose 40% gel is given, it is considered a medication not a feeding. This should be reflected as such in the newborn's EHR documentation.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Inpatient hospitalizations for single newborns who were born in the hospital that ends during the measurement period, and with either of the following conditions:
 - An estimated gestational age at birth of >= 37 weeks
 - Birth weight >= 3000 grams without an estimated gestational age at birth

Initial Population

Inpatient hospitalizations for newborns who were with any of the following conditions:
•	admitted to the Neonatal Intensive Care Unit (NICU)
•	transferred to an acute care facility, or other health care facility
•	expired during the hospitalization
•	a length of stay greater than 120 days that ends during the measurement period
•	a diagnosis of galactosemia
•	subject to parenteral nutrition

Inpatient hospitalizations for newborns who were fed breast milk only since birth

Not Applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex

eMeasure Perinatal Care (ePC)