Little is known about rates of breastfeeding and breastmilk feeding in NICUs in low and middle income settings. Access Health International has joined forces with three tertiary referral hospitals in the states of Maharashtra, Andhra Pradesh and Karnataka in India to document newborn nutrition in their NICUs. The results are important and make a strong case for more investment in this neglected area of child nutrition.

1. Assessment of
challenges in feeding
“mothers own milk”
to babies admitted in
three NICUs in India
Dr. Ajitkumar Sudke
Director, Quality and Process Improvement
ACCESS Health International

2. Flow of the presentation
2
1
Research objectives2
Mobile Application3
Preliminary Research analysis4
Background

3. Preterm babies need mother’s own
milk (MOM) the most!
Are small and sick babies receiving
MOM in public and private sector in
India ?

4. 1992
CSSM
Progra
m
Essentia
l
newborn
care -
Exclusiv
e
Breastfe
eding
1997
RCH I
Essentia
l
newborn
care -
Exclusiv
e
Breastfe
eding
2005
RCH II
NRHM
IMNCI
Program
Focus on
correct
position
for
Breastfee
ding
2011
FBNC
Setting
up
SNCUs
,
NBSUs
and
NBCCs
2013
RMNC
H+A
Early
initiatio
n and
exclusiv
e
breastfe
eding
included
in the
5 X 5
Matrix
2016
MAA
Progra
m
Bring
focus on
promotio
n of
breastfe
eding at
commun
ity and
facility
level
2017
Lactati
on
Manage
ment
Centers
– Focus on
feeding
mothers
milk to
sick and
small
newborns
in SNCUs.
CLMCs,
LMCs and
LSUs to be
set up
across the
country
The Newborn care
journey in India with
focus on Breastfeeding

5. Research objectives
• Identify culturally acceptable and easily adoptable
quality indicators that can be measured to ensure
adequate early initiation and continued supply of
MOM in babies admitted to neonatal intensive care
units
• Develop and use digital data collection tool (mobile
application) to help collection of data related to
current feeding practices.

6. Methodology
• Indian consortium comprising of representatives
of 3 tertiary referral neonatal ICUs was formed
• Brain storming meeting with the lactation experts
• Available published evidence was reviewed

7. Mobile Application Development

9. Mobile Application in Play store
9

10. NICU Quality Indicators
Identified
Mother Milk
Expression Related
Baby feeding Related Supportive Activities
Timing of first
expression
Daily dose of MOM Daily duration of KMC
Frequency of expression Percent composition
of MOM, donor
human milk and
formula feeds
Frequency of oral
care with MOM
Frequency of night time
expression
Breastfeeding Non-nutritive sucking
Use of breast pump
Volume of milk
expressed per day

11. Status of data collection
Hospital Place
Babies
enrolled
KEM Hospital, Pune Maharashtra 150
SVRR Medical College,
Tirupati
Andhra Pradesh 120
Rainbow Hospitals,
Bangalore
Karnataka 30
Total 300

12. Early findings from the assessment
• Data of 25/150 is analyzed from KEM Hospital, Pune
• 21/25 babies were delivered through C-Section
• Average Length of Stay in NICU by babies - 7.6 days
Maternal indicator Baseline Comments
Informed decision 19/ 19 On track
Time to first expression 4/ 17 < 3 hours
2/ 17 3-6 hours
11/ 17 > 6 hours
Engage labor room staff
in QI to improve
Frequency of expression Av. 7 times per day Very committed
mothers
Time to milk ‘coming in’ 23/ 25 delayed Assess efficiency and
effectiveness of
expression methods
Coming to volume NA Only 1 mother stayed
for 14 days
Av. vol. day 6 – 131ml

13. Early findings from the assessment
Infant indicator Baseline Comments
Oral therapy None documented Low cost intervention
Skin to skin 2 mothers, 95 minutes total Strengthen use of KMC
facilities
Dose of OMM 14343 ml OMM
8567 ml Formula
Improved lactation
support required
Transition to at-breast No NNS documented
3 mothers with some
breastfeeding documented
Increase exposure period
of baby to breast before
discharge
Breastfeeding post
discharge
5 mothers exclusive at last
survey point
Indicates improved
support required during
hospitalization

14. 14
Hypoglycemia < 45mg% Prematurity < 34 weeks Prematurity < 34 weeks,Low birth weight < 1800gm,Oligura
48%
4%4%4%
24%
4%4%4%4%
Reasons for Admission into NICU

15. 15
VLBW
20%
LBW
68%
ELBW
8%
>3000 Gms
4%
>3000 Gms ELBW LBW VLBW
32%
60%
8%
Level 1 NICU
Level 2 SNCU/Low Dependency
Level 3 NICU/High Dependency
Categorization of babies
based on Birth Weight
Categorization of babies based
Admissions into NICU

16. Next Steps
• Complete the research analysis
• Explore opportunities to increase the scope of the
research agenda beyond these three hospitals in India
• Explore partnerships to strengthen the lactation
management and feeding babies
● Confirm provisional gap analysis
● Identify feasible practice changes and develop Quality Improvement
Interventions
● Implement and monitor impact
● Share findings
16

17. THANK YOU!
For more information, please contact
ajitkumar.sudke@accessh.org