Sharing Milk and Knowledge in the Neonatal Intensive Care Unit Improves Care for Neonates in a Low- and Middle-Income Population-A North-South Collaboration

Kirsti Haaland; Srishti Goel; Gunjana Kumar; Ingvild Andresen Hurv; Isha Thapar; Jitesh Jalthuria; Sushma Nangia

doi:10.3390/children12030326

Sharing Milk and Knowledge in the Neonatal Intensive Care Unit Improves Care for Neonates in a Low- and Middle-Income Population-A North-South Collaboration

Children (Basel). 2025 Mar 4;12(3):326. doi: 10.3390/children12030326.

Authors

Kirsti Haaland^{1

2}, Srishti Goel³, Gunjana Kumar⁴, Ingvild Andresen Hurv⁵, Isha Thapar⁶, Jitesh Jalthuria⁶, Sushma Nangia⁷

Affiliations

¹ Department of Global Health, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, Kirkeveien 166, 0450 Oslo, Norway.
² Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Ullevål, Kirkeveien 166, 0450 Oslo, Norway.
³ Lifeline Advanced Neonatal Centre, 63 & 64, Cool Road, Waryam Nagar, Jalandhar 144001, Punjab, India.
⁴ National Institute of Medical Science & Research, NH-11C, Delhi-Jaipur Expressway, Jaipur 303121, Rajasthan, India.
⁵ Institute for Nursing, Faculty of Health, VID Specialised University, Theodor Dahls vei 10, 0370 Oslo, Norway.
⁶ National Comprehensive Lactation Management Centre, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, Connaught Place, New Delhi 110001, India.
⁷ Department of Neonatology, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, Connaught Place, New Delhi 110001, India.

Abstract

Background: Basic healthcare may significantly decrease neonatal morbidity and mortality. Attention to this, particularly in populations where rates of potentially preventable illness and death within the first weeks of life are extremely high, will have a positive impact on global health. Objective: This manuscript presents the development and impact of a quality improvement programme to reduce the evidence-practice gap in care for neonates admitted to the NICU in a public hospital in India. The programme was locally customised for optimal and sustainable results. Method: The backbone of the project was educational exchange of neonatal nurses and physicians between Norway and India. Areas of potential improvement in the care for the neonates were mainly identified by the clinicians and focus areas were subject to dynamic changes over time. In addition, a service centre for lactation counselling and milk banking was established. Progress over the timeframe 2017-2019 was compared with baseline data. Results: The project has shown that after a collaborative effort, there is a significant reduction in mortality from 11% in the year 2016 to 5.5% in the year 2019. The morbidity was reduced, as illustrated by the decrease in the proportion of neonates with culture-proven sepsis. Nutrition improved with consumption of human milk by the NICU-admitted neonates remarkably increasing from one third to more than three forth of their total intake, and weight gain in a subgroup was shown to increase. With the introduction of family participatory care, hours of skin-to-skin contact for the neonates significantly increased. Additional indicators of improved care were also observed. Conclusions: It is feasible to reduce neonatal mortality and morbidity in a low- and middle-income hospitalised population by improving basic care including nutrition relatively inexpensively when utilising human resources.

Keywords: KMC; QI; breastfeeding; clinical health; collaboration; donor breast milk; educational exchange; global health; human milk; infection control; morbidity; mortality; neonate; nursing; nutrition; preterm infant.

Grants and funding

The project was funded by NOREC (Organisational ID: NO 981965132) and Oslo University Hospital, Norway.