Objective: To determine if systematic implementation of the Spatz Ten Steps for Promoting and Protecting Breastfeedingfor Vulnerable Infants (Ten Steps) would result in an improvement in the percentage of infants receiving mothers ownmilk (MOM) at initiation of feedings and at hospital discharge.Design: Continuous quality improvement (QI) process.Setting: Urban,82-bed,Level-Ⅲ NICU.Patients: Very-low birth-weight (VLBW) infants weighing fewer than 1500 grams.Intervention: The Ten Step method was implemented during a 3-year period.Measurements: Process measurements included percentage of VLBW infants receiving MOM at initiation of feeds,number of mothers of VLBW infants with hospital-grade electric breast pump at hospital discharge,and number ofmothers of VLB3W infants initiating pumping within 6 hours of delivery.Outcome measurements included percentageof VLBW infants with any human milk at discharge to home and parent satisfaction with nurses support of mothersefforts to breastfeed.Balancing measurements included percentage of VLBW infants at less than the third percentilefor growth on the Fenton growth chart at discharge and receiving pasteurized donor milk (PDM).Results: Significant improvements were achieved in the percentages of mothers expressing their milk within 6 hoursof delivery,infants receiving MOM at initiation of feeds,and mothers with a hospital-grade pump at discharge.Improve-ments in these processes resulted in increased parent satisfaction with nurses support of breastfeeding and a 3.1-foldgreater odds of the VLBW infant receiving MOM at discharge in 2013 compared to 2010 (odds ratio[OR]=3.01,95%confidence interval[CI][1.75,5.17],p <.001).Despite an increase in the use of MOM,there was not a significantincrease in VLBW infants discharged at less than the third percentile for growth,and initiation of PDM did not negativelyaffect the percentage of VLBW infants with any human milk at discharge.