EBPI: Improving Newborn Breastfeeding Success after Circumcision

The aim of this EBP project was to facilitate successful breastfeeding in the tern newborn male infants after circumcision.Levin et al.'s (2010) Evidence-Based Practice Improvement model was used to guide the project team. Nurses on the maternity unit at Northern Westchester Hospital noted that male infants who were circumcised within the first 24 hours of birth were sleepy at the breast, displayed no feeding cues for an extended period of time, and often did not feed the prescribed 8 times in the first 24 hours. The inital Pico question was: Does postponing circumcision in newborn term infants until their third day of life, after breastfeeding is established lead to better clinical outcomes( see above variables) than current practice?The project team undertook a systematic review of evidence to find the answer to this question. Suprisingly, the evidence indentified circumcision as a disruption to establishing breastfeeding regardless of when the procedure was performed. What the team discovered from their evidence review was : 1) that there is an optimal window of opportunity to encourage the infant to nurse post circumcision; 2) that this optimal window of time is 30 minutes; and, 3) that a lower dose of Tylenol is recommended to be given for pain control pre operatively than was routinely given at our facility. Small tests of change to test these new practices were performed with 66 babies who underwent  circumcision during the month of January 2010. Baseline and post intervention data were compared after the intervention was implemented for for 1 month.results  demonstrated that the babies were more successful at breastfeeding after circumcision using the new protocol (90%) compared to baseline or pre- implementation practice (75%)