The PQCNC Core Team is always willing (and delighted!) to visit your facility and meet with your team, your administration, or any other group and present on a wide variety of topics including, but not limitied to, those in the list below.  Please feel free to download , print, and share with others in your facility as needed.  if you'd like us to come please us the 'Contact' link at the top of the page.

PQCNC Site Visit Topics

Does your facility require a Data Use Agreement? - click here to view/download...

Bibliographies, references, resources, and tools to help you in your work...

Use these links to skip to the relevant section of the extranet -


Human Milk Bibliographies:

Click here to view NCCC track citations in PubMed (33)

Click here to view Well Baby track citations in PubMed (41)

PQCNC Human Milk VLBW References - references and literature supporting the action plan provided by the clinical leads

Breastfeeding Resources - references and literature supporting the action plan provided by the clinical leads


Human Milk Webinar Presentations:

Fenruary 2013 HM NCCC Webinar:  "Breastfeeding Support & Insurance Coverage for Electric Pumps"

February HM Well Webinar: “Skin to Skin and the Warm Chain” by Emily Taylor, MPH

March HM Well Webinar: "Breastfeeding frequency and latch" by Miriam Labbok, MD

March HM NCCC Webinar: “Creating Feeding Guidelines Part 1” by Laurie Dunn, MD

April HM NCCC Webinar: "Creating Feeding Guidelines Part 2" by Laurie Dunn, MD


Human Milk Feeding Guidelines:

  1. Guidelines for Enteral Nutrition provided by Forsyth NCCC
  2. Feeding Guidelines for less than 750 gms. provided by WakeMed NCCC
  3. Feeding Guidelines for 751-1000 gms. provided by WakeMed NCCC
  4. Feeding Guidelines for 1001-1250 gms. provided by WakeMed NCCC
  5. Trophic Feeding guidelines provided by Mission NCCC
  6. Feeding guidelines provided by Mission NCCC
  7. Feeding Guidelines provided by Presbyterian NCCC
  8. Feeding Orders provided by Presbyterian NCCC
  9. Feeding Guidelines for Infants < 1000 grams provided by Duke NCCC
  10. Feeding Guidelines for Infants 1001-1250 grams provided by Duke NCCC
  11. Feeding Guidelines for Infants 1251-1500 provided by Duke NCCC
  12. Feeding Order Set provided by Levine NCCC
  13. Feeding Guidelines provided by Levine NCCC
  14. Feeding Protocols for Catawba Valley Medical Center


Human Milk Other Resources:

Presbyterian Letter to Physicians on the Importance of Skin to Skin

Presbyterian Script on Pacifier Use

US Institute of Kangaroo Care - Skin to Skin Competency Checklist

Making Enough Milk, The Key to Successful Breastfeeding..Planning for Day One
By Dr. Jane Morton - This newly released video is a must for every expectant and new mother, for those who plan to use a breast pump, for mothers who struggle with low milk supply, and for professionals who tech or heal breastfeeding mothers. English only, 29 Minutes $65.00

Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study

Understanding Your Baby's Cues - draft document available for adaptation

Children's Hospital of Philadelphia - Skin to Skin Contact (Kangaroo Care) Guidelines - Kangaroo Care tips and info on a free DVD on Kangaroo Care available from Children's Hospital of Philadelphia

Forsyth Kangaroo Care Policy - policy on how to assist parents in providing Kangaroo Care to their infants

Forsyth Kangaroo Care Log - stays at the bedside

Lactation Counseling Script - in talking to mothers who plan to formula feed “…several studies (Jaeger 1997, Miracle 2004, and Sisk 2006) indicate that mothers want evidence-based information about their feeding choices, these discussions do not increase anxiety (Sisk 2006), and these discussions are associated with high rates of pumping initiation and mother's milk feeding in VLBW infants.” This script provides guidance to providers who are searching for a way to have this conversation with mothers.

Critical First Two Weeks - this one pager highlights why we need to know how much milk a mother is producing between days 8-13, expected milk volumes, and What we ccan do to help mothers establish an abundant milk supply...

Hand Expression of Breastmilk - Until recently hand expression of milk has been an under-utilized skill in our institution. But there are many benefits of knowing how to express milk from the breast without the use of expensive or cumbersome pumps. In this video, Dr. Jane Morton demonstrates how easily hand expression can be taught to mothers.

Maximizing Milk Production with Hands On Pumping -  When an infant is unable to breastfeed effectively, and his mother needs to stimulate the breasts and express milk with a breast pump, building and maintaining an adequate supply can be a challenge. This video demonstrates some ways that pumping mothers can increase production without medication.

Oral Care with Colustrum / Breastmilk in the NICU - Mission Children's Hospital Parent Handout on why mouth care with colostrum and breastmilk is important to babies.

Partnering with Patients and Families to Enhance Safety and Quality: A Mini Toolkit (a publication of the Institute for Patient- and Family- Centered Care) - Today, health care leaders, clinicians, and staff are seeking to partner with patients and families to enhance quality and safety. The purpose of this resource is to provide tools and resources that will support these efforts.

The Run Chart: A simple analytical tool for learning from variation in health care processes - Run charts allow us to understand objectively if the changes we make to a process or system over time lead to improvements and do so with minimal mathematical complexity. This method of analyzing and reporting data is of greater value to improvement projects and teams than traditional aggregate summary statistics that ignore time order. Because of its utility and simplicity, the run chart has wide potential application in healthcare for practitioners and decision-makers.

CDC, Breastfeeding, 10 steps -
Background: Childhood obesity is a national epidemic in the United States. Increasing the proportion of mothers who breastfeed is one important public health strategy for preventing childhood obesity. The World Health Organization and United Nations Children’s Fund (UNICEF) Baby-Friendly Hospital Initiative specifies Ten Steps to Successful Breastfeeding that delineate evidence-based hospital practices to improve
breastfeeding initiation, duration, and exclusivity.
Methods: In 2007 and 2009, CDC conducted a national survey of U.S. obstetric hospitals and birth centers. CDC analyzed these data to describe the prevalence of facilities using maternity care practices consistent with the Ten Steps to Successful Breastfeeding.
Results: In 2009, staff members at most hospitals provide prenatal breastfeeding education (93%) and teach mothers breastfeeding techniques (89%) and feeding cues (82%). However, few hospitals have model breastfeeding policies (14%), limit breastfeeding supplement use (22%), or support mothers postdischarge (27%). From 2007 to 2009, the percentage of hospitals with recommended practices covering at least nine of 10 indicators increased only slightly, from 2.4% to 3.5%. Recommended maternity care practices vary by region and facility size.

Calculating postnatal growth velocity in very low birth weight (VLBW) premature infants - Objective: Currently, there is no standardized approach to the calculation of growth velocity (GV; g kg –1 day–1) in hospitalized very low birth weight (VLBW) infants. Thus, differing methods are used to estimate GV, resulting in different medical centers and studies reporting growth results that are difficult to compare. The objective of this study was to compare actual GV calculated from infant daily weights during hospitalization in a Neonatal Intensive Care Unit (NICU) with estimated GV using two mathematical models that have been shown earlier to provide good estimated GVs in extremely low birth weight (ELBW) infants: an exponential model (EM) and a 2-Point model (2-PM).

Impact of a Feeding Log on Breastfeeding Duration and Exclusivity -
The aim of this study was to test the efficacy of a daily feeding log, guided by Bandura’s social cognitive learning theory, on breastfeeding duration and exclusivity in primiparous mothers.

The impact of feeding interval on feeding outcomes in very low birth-weight infants - Objective: Test the hypothesis that very low birth-weight (VLBW) infants fed every 2 h (q2) are able to reach full enteral feedings more quickly than infants fed every 3 h (q3).

ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting the Rate of Maternal Milk Secretion - (First Revision January 2011)
Galactogogues commonly have been used to increase a faltering rate of milk production, often due to the effects of maternal or infant illness and hospitalization or because of regular separation such as work or school. One very common area of use has been the neonatal intensive care unit, where the aim has been to stimulate initial secretory activation or augment declining milk secretion in these mothers. Mothers who are not breastfeeding but are expressing milk by hand or with a pump often experience a decline in milk production after several weeks. Galactogogues have also been used for adoptive breastfeeding (induction of lactation in a woman who was not pregnant with the current child) and relactation (reestablishing milk secretion after weaning).

Handout: Why should I give breast milk to my baby? -
The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend mother’s milk as the ideal food for babies.

WakeMed Patient Information handout: Breast Milk for Your Baby in the NICU/SCN - English Spanish

Evaluation of human milk fortification from the time of the first feeding: Effects on infants of less than 31 weeks gestational age - article to determine whether human milk fortification from the time of the first feeding significantly improves weight gain and bone mineral status in infants of <31 weeks estimated gestational age as compared with delayed or standard human milk fortification.


Donor Milk

  1. Benefits of donor human milk for preterm infants: Current Evidence
  2. Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis
  3. Donor human milk in preterm infant feeding: evidence and recommendations
  4. Formula milk versus donor breast milk for feeding preterm or low birth weight infants (Review)

Shared Resources from Teams

  1. Levine HM NCCC data collection sheet  
  2. Levine staff notice about Human Milk Folder
  3. Levine parent pumping letter
  4. Poster describing unit initiative for Exclusive Breast Milk for VLBW Infant from Mission Hospital
  5. Mom’s Milk Resource Packet from Betty H. Cameron Women’s and Children’s Hospital
  6. Badge card for staff to prompt pumping support from Jeff Gordon's Children's Hospital
  7. Handout “Progression of feedings at Breast” from Jeff Gordon's Children's Hospital
  8. Handout “Transition Bottle to Breast” from Jeff Gordon's Children's Hospital
  9. Screen savers to promote breast milk from Duke ICN
  10. Parent Handouts “Banked Human Milk” and “Human Milk for Oral Care” from Mission Hospital
  11. Parent Brochure to promote Kangaroo Care from Mission Hospital
  12. Unit Newsletter about the Human Milk Initiative from Mission Hospital