# 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

## TL;DR

A collaboration between Norway and India improved neonatal care in a low-income hospital by sharing knowledge and promoting breastfeeding, leading to lower mortality and better health outcomes.

## Contribution

A locally customized quality improvement program reduced neonatal mortality and morbidity through international collaboration and improved basic care practices.

## Key findings

- Neonatal mortality decreased from 11% in 2016 to 5.5% in 2019.
- Human milk consumption in NICU increased from one third to more than three fourths of total intake.
- Skin-to-skin contact hours and weight gain in neonates significantly improved.

## 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.