Transition to at-breast feeding

Breastfeeding rates – Transition to at-breast feeding results

Time to read: 4 min.

NICU breastfeeding rates are measures of the amount of breastfeeding/breast milk feeding for NICU infants at specific time points. Since many NICU infants are discharged before achieving full feeds at-breast, it is important to capture both breastfeeding as well as the amount and proportion of feeds that are own mother’s milk.

What are NICU breastfeeding rates?

NICU breastfeeding rates are measures of the amount of breastfeeding/breast milk feeding (exclusive, partial or none) for NICU infants at specific time points:

  • Discharge home
  • 2 and 4 weeks post-discharge
  • 3 and 6 months corrected gestational age (CGA)

Capturing breastfeeding rates (amount and proportion) provides qualitative data before achieving full feeds at-breast, it is important to capture both breastfeeding rates as well as the amount and proportion of feeds that are own mother's milk (OMM). This provides qualitative data on timing of OMM feeds and breastfeeding durations throughout the infant’s NICU stay and following discharge home to measure impact of high dose, long exposure of OMM on the reduction of the odds of neonatal comorbidities.1

Why are NICU breastfeeding rates important?

Global breastfeeding rates for healthy term infants are collected at birth and at 6 months of age.2

  • To assess national and subnational comparison and describe trends over time
  • To target at-risk populations and implement interventions to change practice
  • To evaluate and monitor progress and impact of interventions

Standardised breastfeeding rates are not routinely collected for NICU infant-mother dyads at discharge home. The Vermont Oxford Network database (VON) collects measures on any human milk feeding in the 24 hours prior to discharge, but this data is not collected globally and does not differentiate OMM and DHM use.

NICU breastfeeding rates are important to create a clearer picture of how many NICU infants are receiving OMM in the volumes they need.

Quality improvement interventions in lactation best practices that measure breastfeeding rates provide a framework for NICU and maternity services to optimise NICU infant long-term health outcomes and to support mothers with opportunities to continue breastfeeding beyond the NICU period.3,4

How to optimise NICU breastfeeding rates

Continued NICU-specific breastfeeding quantitative data collection after discharge allows healthcare professionals to focus on OMM:

Low exclusive breastfeeding / OMM rates at discharge and subsequent time points may indicate sub-optimal lactation care during the hospital stay,2 and support the working group to discuss areas for improvement and implement practice changes.5

  • provide ongoing proactive lactation support5
  • audit the hospital interventions to support NICU mothers to:
    • effectively initiate, build and maintain milk supply
    • enable NICU infants to transition to at-breast feeding.

Low exclusive breastfeeding / OMM rates at discharge and subsequent time points may indicate sub-optimal lactation care during the hospital stay,2 and support the working group to discuss areas for improvement and implement practice changes.5

How to monitor NICU breastfeeding rates

Collect and review data (from NICU infant medical records and with follow-up calls to parents / outpatient reviews) to measure

  • Percentage of infants exclusively breastfeeding and/or OMM-feeding at
    • infant discharge from the NICU
    • 2 & 4 weeks  after discharge
    • 3 & 6 months corrected gestational age
  • Percentage of infants partially or not breastfeeding and/or OMM-feeding at
    • infant discharge from the NICU
    • 2 & 4 weeks after discharge
    • 3 & 6 months corrected gestational age
References

1. Bigger HR et al. Quality indicators for human milk use in very low-birthweight infants: are we measuring what we should be measuring? J Perinatol. 2014; 34(4):287–291.

2. WHO. Indicators for assessing breastfeeding practices; 2021.

3. Takako H et al. Improving Human Milk and Breastfeeding Rates in a Perinatal Hospital in Japan: A Quality Improvement Project. Breastfeed Med. 2020; 15(8):538–545.

4. Spatz DL et al. Pump early, pump often: A continuous quality improvement project. J Perinat Educ. 2015; 24(3):160–170.

5. Parker MG, Patel AL. Using quality improvement to increase human milk use for preterm infants. Semin Perinatol. 2017; 41(3):175–186.

Related Articles

Articles that may be of interest

Benefits of breast milk

At-risk conditions for initiation

Read more
Transition to at-breast feeding

Skin-to-skin care – Transition to at-breast feeding interventions

Read more
Benefits of breast milk

At-risk conditions for initiation

Read more
Transition to at-breast feeding

Skin-to-skin care – Transition to at-breast feeding interventions

Read more

Get the app!

The Medela Family app helps you to keep track of your baby’s needs from pregnancy to nursery.


  • Pregnancy
  • Breastfeeding
  • Pumping