Effective initiation – NICU lactation QI Phase 1

Though breastfeeding is natural, the technique is a learned skill and it may take time and patience for new mums and their babies to master it. As they become more practised, breastfeeding will become easier and more pleasurable.

Effective initiation – NICU lactation QI Phase 1

Initiating breastfeeding and breast milk supply

When parents are given scientific and factual information about the value of own mother’s milk (OMM), mothers are able to make informed and knowledgeable lactation decisions.1-3

Early, frequent and effective expression is key. Maternal milk volumes need to be monitored to track the performance of clinical practice interventions.3,4

Research has shown that mothers achieving daily volumes of at least 500 ml before day 14 have significantly higher breastfeeding rates at discharge.3

There is emerging evidence that a dose-response relationship exists between the amount of OMM received by prematurely born infants and the risk of clinical morbidities.5 Therefore, the greatest protection is achieved when vulnerable infants receive high dose, long exposure to own mother’s milk.

Healthcare professional informs mother about the importance of own mothers milk

Informed decision – Effective initiation interventions

It all starts with informed decision, which means all families should be provided informative, effective and consistent information about the benefits of breastfeeding and providing own mother’s milk to their infants.

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Woman who uses double breast pump looking at healthcare

Time to first expression – Effective initiation interventions

When the infant cannot breastfeed effectively, pumping within 3 hours after birth has been shown to have a significant impact on future milk supply, infant feeding and subsequent health outcomes.

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Woman using breast pump and looking at her newborn child

Frequent expression – Effective initiation interventions

Breast stimulation by frequent milk expression is an evidence based NICU lactation intervention that helps mothers initiate and build sufficient milk volumes for the long term.

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Critical time period of time to milk coming 72 hours after birth.

Time to milk ‘coming in’ – Effective initiation results

Time to milk ‘coming in’ is an indicator for efficacy of interventions to support effective initiation. When it occurs within 72 h post-birth, it is an important predictor of milk volume adequacy at four weeks. There is a correlation between delayed milk ‘coming in’ and clinically significant negative lactation outcomes.

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Graph showing critical window to build milk supply

Coming to volume – Effective initiation results

Coming to volume is an indicator of the efficacy of the interventions to support effective initiation. Mothers who produce less than 500 ml/day by day 14 are likely to have a less than adequate long-term milk production.

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A newborn baby is fed own mothers milk with the help of a feeding tool.

Dose of own mother's milk (OMM) – Effective initiation results

Dose of own mother’s milk is the ultimate indicator of the efficacy of the interventions to support effective initiation. High dose, long exposure to OMM during critical periods are low cost preventive actions that achieve better health outcomes for all NICU infants.

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1. Meier PP et al. Evidence-based methods that promote human milk feeding of preterm infants: An expert review. Clin Perinatol. 2017; 44(1):1–22.

2. Miracle DJ et al. Mothers' decisions to change from formula to mothers' milk for very-low-birth-weight infants. J Obstet Gynecol Neonatal Nurs. 2004; 33(6):692–703.

3. Hoban R et al. Milk volume at 2 weeks predicts mother's own milk feeding at Neonatal Intensive Care Unit discharge for Very Low Birthweight infants. Breastfeed Med. 2018; 13(2):135–141.

4. Hoban R et al. Proactive Lactation Care is Associated With Improved Outcomes in a Referral NICU. J Hum Lact. 2021:890334421993467.

5. Meier PP et al. Human milk in the neonatal intensive care unit. In: Family Larsson-Rosenquist Foundation, editor. Breastfeeding and breast milk - From biochemistry to impact: A multidisciplinary introduction. 1st ed. Stuttgart: Thieme; 2018.