Can "Lactation Scorecards" drive up low rates of breastmilk feeding in NICUs? Low rates of breastfeeding and breastmilk feeding among sick and vulnerable newborns contribute to low survival rates and poor development outcomes. Medela has developed a new tool that enables NICUs to set new targets and measure their performance - The NICU Lactation Care Scorecard.

1. Paul Bolla
Corporate Social Responsibility
NICU Scorecard:
Lactation care and feeding indicators

2. Content
• Background
• Goals
• Scorecard
• Maternal indicators
• Infant indicators
• Use cases
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3. Background –
Shared Values
Build and deliver education and
training programs in Indian public
hospital NICUs
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Our program has identified a
major roadblock for traction
No global standardized, NICU specific data exists ! no data, no issue, no traction

4. Background –
Global data
• 45% of under 5 deaths occur in 1st
month of life
• Complications due to prematurity is the
leading cause
• Breastmilk can reduce the incidence
and severity of complications 1
• Breastfeeding initiation is sub-optimal
in the maternity ward ~45% 1
• Breastfeeding in the NICU is unknown
as is lactation support 2
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Source: WHO and Maternal and Child Epidemiology Estimation Group (MCEE) provisional estimates
2017
1. Victora, C, et al. 2016, Breastfeeding 1,
Lancet
2. Renfrew, MJ. 2016, Healthy Newborn Network

5. Background –
Global strategies
BFHI latest update (maternity and NICU)
Recommendations:
4. Mothers should be coached on expression in case of
separation
5. Mothers and infants should remain together
9. Non-nutritive sucking and Oral therapy may be
beneficial
Monitoring and evaluation:
• Should be built into the system
• Increase exclusive breastfeeding @6 months to 50%
by 2025
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This data should report separately on the the most vulnerable

6. Scorecard goals
• Encourage a collaborative and supportive
environment to improve NICU care
• Outline evidence based practices that
support lactation and optimal feeding
• Outline metrics and standards for these
practices
• Guide Quality Improvement initiatives
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7. Comprehensive
evidence:
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8. 1. Informed decision
2. Time to first expression
3. Frequent expression
4. Time to milk ‘coming in’
5. Coming to volume
Maternal
scorecard
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9. 1. Oral therapy with Own Mother’s
Milk (OMM)
2. Skin to skin
3. Dose of OMM
4. Transitioning to at-breast
feeding
5. Breastfeeding rates
Infant
scorecard
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10. Use cases:
Scorecard supporting QI

11. How to use:
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• Scorecard issued to clinician prior to education session, education tailored to their perceived gaps
• It is interesting to have a nurse and a clinician evaluate themselves and compare the findings
• Ideal for small group work, each team allocated one indicator to discuss:
• Their perceived performance
• How they could measure
• How they could improve
• Comprehensive guide for Quality Improvement initiatives
• Select indicators of interest ! establish baseline performance ! implement practice changes !
evaluate impact ! publish and share your findings to help others learn

12. Additional
resources:
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https://www.medela.com/breastfeeding-professionals/education/education-materials

13. Paul Bolla, Corporate Social Responsibility
Thank you