Interactive scorecard – NICU QI Tools

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Interactive scorecard – NICU QI Tools

Our interactive NICU scorecard is a simple but effective tool to help you assess human milk feeding in your NICU and capitalise on the value of own mother’s milk (OMM).

Our scorecard is based on ten questions relating to evidence-based best practices shown to improve lactation in the NICU. Answering these questions can help evaluate performance and assess priorities.

Human milk feeding in your NICU

A tool to help ensure more positive outcomes

Your resources
Tailored from your NICU assessment

Every additional drop of own mother’s milk (OMM) positively impacts the health and wellbeing of our most vulnerable infants.

Medela has created a simple but effective tool to help you assess human milk feeding in your NICU and capitalise on the value of OMM.

Evidence-based best practices can help ensure mothers of NICU infants initiate, build and maintain sufficient milk volumes to allow long-term breastfeeding.

These practices should be monitored and assessed especially during the early, critical window (the first hours and days after birth). This tool helps you do this in a measured and methodical way.

Your resources
Tailored from your NICU assessment

There are ten questions relating to the evidence-based lactation best practice pathway shown to improve:

Effective initiation of lactation
Transition to at-breast feeding

While you may already implement all or some of these practices, this tool may help you to evaluate your performance and priorities.

As these practices are not standard, you may not have data to answer all questions. If this is the case, simply answer ‘unsure / no data’ where relevant.

It takes just five minutes to complete the questions. Click and drag along the ruler to answer. Once finished, you can access your report and the resources tailored to your requirements.

References

Spatz DL. J Perinat Neonatal Nurs. 2004; 18(4):385–396.
Miracle DJ et al. J Obstet Gynecol Neonatal Nurs. 2004; 33(6):692–703.
Meier PP et al. In: Family Larsson-Rosenquist Foundation, editor. 1st ed. Stuttgart: Thieme; 2018.
Parker LA et al. FASEB J. 2017; 31(1 Suppl):650.19.
Meier PP et al. Clin Perinatol. 2017; 44(1):1–22.
Meier PP et al. J Perinatol. 2012; 32(2):103–110.
Spatz DL et al. J Perinat Educ. 2015; 24(3):160–170.
UNICEF, WHO. Geneva, New York: WHO; UNICEF; 2020. 42 p.
Hill PD et al. J Hum Lact. 2001; 17(1):9–13.
Meier PP et al. J Perinatol. 2016; 36(7):493–499.
Post EDM et al. J Perinatol. 2016; 36(1):47–51.
Torowicz DL et al. Breastfeed Med. 2015; 10(1):31–37.
Prime DK et al. Breastfeed Med. 2012; 7(6):442–447.
Hill PD et al. J Hum Lact. 1996; 12(3):193–199.
Nommsen-Rivers LA et al. Am J Clin Nutr. 2010; 92(3):574–584.
Hoban R et al. Breastfeed Med. 2018; 13(2):135–141.
Hoban R et al. J Hum Lact. 2021:890334421993467.
Sisk PM et al. J Perinatol. 2007; 27(7):428–433.
Alshaikh B et al. Breastfeed Med. 2015; 10(7):355–361.
Johnson TJ et al. Neonatology. 2015; 107(4):271–276.
Meier P et al. J Pediatr. 2017; 180:15–21.
Patel AL et al. Arch Dis Child Fetal Neonatal Ed. 2017; 102(3):F256-F261.
Patel AL et al. J Perinatol. 2013; 33(7):514–519.
Bigger HR et al. J Perinatol. 2014; 34(4):287–291.
Patra K et al. Neonatology. 2017; 112(4):330–336.
Lee J et al. Pediatrics. 2015; 135(2):e357-66.
Sohn K et al. J Perinatol. 2016; 36(2):106–111.
Snyder R et al. Pediatr Neonatol. 2017; 58(6):534–540.
Acuña-Muga J et al. J Hum Lact. 2014; 30(1):41–46.
Narayanan I et al. Arch Dis Child. 1991; 66(2):241–244.
Lubbe W. J Eval Clin Pract. 2018; 24(1):80–88.
Lubbe W, Ham-Baloyi W ten. BMC. Pregnancy. Childbirth. 2017; 17(1):130.
Wilson E et al. Matern Child Nutr. 2018; 14(1).
World Health Organization. Geneva: WHO; 1991. Report WHO/CDD/SER/91.14, Corr.1.

Your resources
Tailored from your NICU assessment

Your NICU scorecard: 1/10

Q1
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What % of NICU mothers receive standardised, NICU-specific information on the value of their milk, and how to initiate, build and maintain adequate volumes?

Unsure / No data

Why this matters:

Providing consistent information to NICU families enables them to make an informed decision and understand their alternative breastfeeding pathway.^1–3

Your resources
Tailored from your NICU assessment

Your NICU scorecard: 2/10

Q2
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What % of NICU mothers pumped or breastfed within 3 hours of delivery?

Unsure / No data

Why this matters:

Stimulating the breasts with vacuum in the first hours after birth (pump with initiation technology or baby) is important. This supports timely initiation and long-term milk production.^4–8

Your resources
Tailored from your NICU assessment

Your NICU scorecard: 3/10

Q3
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What % of NICU mothers express eight or more times every 24 hours?

Unsure / No data

Why this matters:

Frequent expression is critical to achieving adequate volumes.^7–9 Pumping with initiation technology before milk ‘comes in’ helps achieve target volumes.^{6, 10–12} Double pumping (simultaneous expression) every 2–3 hours yields more milk in less time and results in higher prolactin concentrations.^13,14

Your resources
Tailored from your NICU assessment

Your NICU scorecard: 4/10

Q4
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What % of NICU mothers have their milk ‘come in’ within 72 hours of delivery?

Unsure / No data

Why this matters:

Three consecutive expression volumes of >20 ml are an indicator of milk ‘coming in’.⁶ Delayed secretory activation (> 72 hours after delivery) has been associated with a shortened lactation and is a sign that increased lactation care is needed.¹⁵

Your resources
Tailored from your NICU assessment

Your NICU scorecard: 5/10

Q5
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What % of NICU mothers ‘come to volume’ (500 ml daily total) by day 14?

Unsure / No data

Why this matters:

Coming to volume by day 14 indicates that milk supply is on track to meet the long-term needs of the infant (750–800 ml daily).^{8, 16} Lactation care should continue even when expression volumes exceed the daily infant feed volumes.¹⁷

Your resources
Tailored from your NICU assessment

Your NICU scorecard: 6/10

Q6
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What % of NICU infants are fed exclusively human milk in the first 14 days of life?

Unsure / No data

Why this matters:

Total avoidance of bovine formula from days 0–14 reduces necrotising enterocolitis.^18-21 High dose OMM (> 50ml/kg/day) from days 0–28 reduces the risk of late onset sepsis and other morbidities.^22-25

Your resources
Tailored from your NICU assessment

Your NICU scorecard: 7/10

Q7
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What % of exclusively tube-fed infants receive oral therapy with OMM at least once/day?

Unsure / No data

Why this matters:

Regularly applying small amounts (0.1-0.2 ml) of OMM inside the infant’s cheeks is safe, has potential health benefits, motivates and sustains mothers to continue expressing milk for their infants, and empowers parents as the infants appear to respond to the taste.^26-28

Your resources
Tailored from your NICU assessment

Your NICU scorecard: 8/10

Q8
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What % of NICU infants receive a minimum of one hour uninterrupted skin-to-skin care per day?

Unsure / No data

Why this matters:

Skin-to-skin care helps transition to direct feeding at breast, helps improve milk volumes and is associated with a longer duration of breastfeeding.^{8, 29}

Your resources
Tailored from your NICU assessment

Your NICU scorecard: 9/10

Q9
{{q9headline}}

What % of exclusively tube-fed infants perform non-nutritive sucking (NNS) at least once/day?

Unsure / No data

Why this matters:

Non-nutritive sucking supports exclusive, at-breast feeding.^30-32 Monitoring at-breast experiences can help healthcare professionals provide specific guidance and care.^{1, 8}

Your resources
Tailored from your NICU assessment

Your NICU scorecard: 10/10

Q10
{{q10headline}}

What % of NICU infants are fed exclusively breast milk at 2–4 weeks post-discharge?

Unsure / No data

Why this matters:

Low rates of exclusive breastfeeding at discharge, 2–4 weeks post-discharge, and 6 months of life can indicate sub-optimal lactation care during the hospital stay.^{24, 33, 34}

Your resources
Tailored from your NICU assessment

Your NICU scorecard:

Unsure / No data

You have answered
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Up to 30%

You have answered
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30% to 60%

You have answered
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Over 60%

You have answered
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Unsure / No data

You have the following indicators in this category:

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How can I optimise this?

Recognise the value of OMM and ensure the mothers and infants in your care benefit from it.

Have you considered commencing quality improvement in lactation practices?

Start collecting specific data and metrics in lactation and feeding practices.

Check out the ‘Your resources’ section to find materials that may help you continue to improve and develop.

Up to 30%

You have the following indicators in this category:

{{headline}}

How can I optimise this?

Recognise the value of OMM and ensure the mothers and infants in your care benefit from it.

Have you considered commencing quality improvement in lactation practices?

Start collecting specific data and metrics in lactation and feeding practices.

Check out the ‘Your resources’ section to find materials that may help you continue to improve and develop.

30% to 60%

You have the following indicators in this category:

{{headline}}

How can I optimise this?

Recognise the value of OMM and ensure the mothers and infants in your care benefit from it.

Have you considered commencing quality improvement in lactation practices?

Start collecting specific data and metrics in lactation and feeding practices.

Check out the ‘Your resources’ section to find materials that may help you continue to improve and develop.

Over 60%

You have the following indicators in this category:

{{headline}}

How can I optimise this?

Recognise the value of OMM and ensure the mothers and infants in your care benefit from it.

Have you considered commencing quality improvement in lactation practices?

Start collecting specific data and metrics in lactation and feeding practices.

Check out the ‘Your resources’ section to find materials that may help you continue to improve and develop.

How do I get support?

We have tailored a set of resources based on your answers to help you start taking full advantage of the value of OMM in your NICU. To view, click on the button, right.

Your resources
Tailored from your
NICU assessment

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30% to 60%: {{ howmanyquestions(30, 60) }} indicator/s

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Over 60%: {{ howmanyquestions(60, 101) }} indicator/s

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NICU toolkit summary:
Assessing human milk feeding
practices in your NICU

Questions

Minutes to complete

Interactive scorecard – NICU QI Tools

There are ten questions relating to the evidence-based lactation best practice pathway shown to improve:

References

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