Identification and Field Testing of Quality Indicators for Improving Mothers’ Own Milk Supply for Babies Admitted in Neonatal Intensive Care Units in India

Introduction: This study was undertaken to understand barriers to own mother’s milk (OMM) supply for NICU babies.\r\nMethods: Multi-centric, observational study over 6months. Mother-baby dyad were sampled for pre-defined quality indicators. An app was developed for data collection. \r\nResults: Total 279 babies were enrolled (KEM-148, Rainbow-29, SVRR-102). Mode of delivery was LSCS in 56% babies. Weight distribution was 2.5kg 26%. Only 48% mothers felt that they were adequately informed regarding breastfeeding. Time to first milk expression (n=204) was 12hours in 67.64%. Median frequency of milk expression was 3 (IQR 2-5) on the day of birth, 7.5 on day7 (IQR 1.3-10) and 8 on day14 (IQR 1-10). ‘Time to milk coming in’(TMCI) was 6days in 34% mothers. 38% mothers did not achieve ‘milk coming in’. Use of formula-feeding was in 75.3% babies on day1, reduced to 15.3% by day7 and 5.6% by day14. Use of OMM was 24.3% on day1 which increased to 84.6% by day7 and to 94.1% by day14. Exclusive breastfeeding rate was 93% at the time of NICU discharge, it declined to 60% by 1month post discharge and to 0% by 6 months.\r\n

Conclusions: Poor antenatal knowledge on breastfeeding, Delayed initiation of milk expression, less frequent expressions are important barriers for OMM supply for NICU babies. There is a need to identify barriers to exclusive breastfeeding post discharge.