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 2004-2021 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2021 International Health Terminology Standards Development Organisation. ICD-10 copyright 2021 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, 2018). A Cochrane review substantiates the benefits (Kramer & Kakuma, 2012). Much evidence has now focused on the prenatal and intrapartum period as critical for the success of exclusive (or any) breast feeding (Centers for Disease Control and Prevention [CDC], 2020; CDC, 2013; Petrova, Hegyi, & Mehta, 2007; 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 2020 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. Section on breastfeeding. Policy statement: Breastfeeding and the use of human milk. Pediatrics 2012 Mar; 129 (3): e827-841.'

Reference Type: CITATION

Reference Text: 'ACOG Committee Opinion No. 756 Summary: Optimizing support for breastfeeding as part of obstetric practice. (2018). Obstet Gynecol, 132(4), 1086-1088. https://doi.org/10.1097/AOG.0000000000002891'

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. Division of Nutrition, Physical Activity, and Obesity. (2020). Breastfeeding report card. Retrieved from https://www.cdc.gov/breastfeeding/data/reportcard.htm'

Reference Type: CITATION

Reference Text: 'Feltner, C., Weber, R. P., Stuebe, A., Grodensky, C. A., Orr, C., & Viswanathan, M. (2018). Breastfeeding programs and policies, breastfeeding uptake, and maternal health outcomes in developed countries. In. https://doi.org/10.23970/AHRQEPCCER210'

Reference Type: CITATION

Reference Text: 'Kramer, M. S., & Kakuma, R. (2012). Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews, 2012(8). https://doi.org/10.1002/14651858.cd003517.pub2'

Reference Type: CITATION

Reference Text: 'McGuire, S. (2014). Centers for Disease Control and Prevention. 2013. Strategies to prevent obesity and other chronic diseases: The CDC guide to strategies to support breastfeeding mothers and babies. Atlanta, GA: U.S. Department of Health and Human Services, 2013. Advances in Nutrition, 5(3), 291–292. https://doi.org/10.3945/an.114.005900'

Reference Type: CITATION

Reference Text: 'National Center for Health Statistics. Healthy people 2020 progress table. Healthy people 2020 final review. 2021'

Reference Type: CITATION

Reference Text: 'Perrine, C. G., Chiang, K. V., Anstey, E. H., Grossniklaus, D. A., Boundy, E. O., Sauber-Schatz, E. K., & Nelson, J. M. (2020). Implementation of hospital practices supportive of breastfeeding in the context of COVID-19 - United States, July 15-August 20, 2020. MMWR Morb Mortal Wkly Rep, 69(47), 1767-1770. https://doi.org/10.15585/mmwr.mm6947a3'

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: '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: '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 show 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 start of encounter.

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 5.6. 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) or transferred to a regular intensive care unit (ICU)
•	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)