Table 1

Components of the care bundle

Element	Description	Actions required for delivering this element	Time period	Staff involved
1	Promotion of early expressing of breast milk Promoting the use of maternal breast milk	Antenatal/postnatal: ▸ Discuss the benefits of maternal breast milk ▸ Provision of an information pack and supporting materials (syringes, labels, Small Wonders DVD, Bliss leaflets) to support expressing and breast feeding Postnatal: ▸ Support breast feeding and/or expressing within 4–6 h of delivery ▸ Consistent advice through ‘Top Tips’ ▸ Pump hire information ▸ Staff/maternal review of milk expressing and volumes	Ideally antenatally but if unachievable, within 4–6 h of delivery	Midwives, lactation specialists, maternity support workers, neonatologists, neonatal nurses, neonatal support workers, nursery nurses
2	Ongoing support for expressing and breast feeding up to discharge	Staff/maternal review of milk expressing and volumes Daily promotion of positive touch/supportive holding/kangaroo care Pump hire information Discussing maternal queries, for example, diet, rest/sleep Facilitating transition to breast feeding as appropriate	Day 10 up to discharge	Neonatal nurses, neonatologists, lactation and breastfeeding specialists, dieticians, speech and language therapists
3	Standardised enteral feeding guideline	Categorising infants ≤35 weeks according to risk for NEC ▸ Initiating and advancing enteral feeds by following the algorithm and feeding guideline	From birth to discharge	Neonatologists, neonatal nurses, dieticians
4	Aseptic non-touch technique when preparing milk feeds	Following a double checking prompt which follows best practice for defrosting and storing human milk, reducing the risk of incorrect feed administration and avoiding contamination of feeds during preparation	When milk feeds are being stored and prepared	All staff involved in the storage and preparation of milk feeds

NEC, necrotising enterocolitis.