Sick and vulnerable newborns often need special support to access breastmilk. Laerdal Global Health is responding to this need with a portfolio of new initiatives.

1. Helping Babies Grow
Breastfeeding Innovations Webinar
15 June 2016
Presenters
Tore Laerdal & Cansu Akarsu
Laerdal Global Health

2. 1. Helping Babies Breathe to Helping Babies Grow
2. Small Baby’s Breastfeeding Journey
3. Nifty Feeding Cup Collaboration
4. Making Innovation happen
2

3. Laerdal Global Health
Established 2010 as a not-for-profit company
with the goal of
Helping save 400.000 more lives per year
by
Helping train and equip over 1 million
birth attendants to become efficient lifesavers
Introducing disruptive innovations
Implementing through effective alliances
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4. Helping Babies Breathe
Over 350,000 trained
in 77 countries
30 countries have
national scale up plans
Studies in Tanzania, Uganda and
Nepal show the program can
reduce early mortality by 50%, when
well implemented
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5. Why successful?
Essentials steps only
Hands-on, simulation based
Peer training model
Highly affordable tools
Locally owned implementation
Broadly endorsed
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6. Helping Babies Survive
Helping Babies Breathe Essential Care for Small BabiesEssential Care for Every Baby
28 days
23%
20% 36%
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7. Breastfeeding
and Skin-to-skin Care
are key parts of both training programs
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8. Helping Babies Grow Bundle
MamaBreast CarePlusPreemieNatalie
Nifty
Feeding Cup
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9. https://vimeo.com/170525082/1102982361
How Helping Babies Grow Bundle Works
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10. 1. Helping Babies Breathe to Helping Babies Grow
2. Small Baby’s Breastfeeding Journey
3. Nifty Feeding Cup Collaboration
4. Making Innovation happen
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12. 12

13. What was Kangaroo Mother Care again?
• Skin-to-Skin
• Breastfeeding
• Infection Protection
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14. Exploration Phase
How might we help
provide breast milk for babies who have
not developed suckling reflex?
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15. Literature
Research
15

16. Co-creation
Workshops
16

17. Immersion
Trips
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18. Crowdsourcing
information
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19. Storyboards
19

20. Not
enough
milk
Lack of
patience and
calm time
Wrong
belief on
colostrum
Breast pain
(sore/engorged)
Lack of skills for
breast milk
expression
Lack of clean
containers
Lack of
time and
staff
Lack of clean
equipment
No
suitable
space
Need for
home visits
Challenging to
train and put
mother in
control
Illeteracy Lack of clean
equipment
to measure
Pencil
Paper
Clock
Not knowing
how much &
when to feed
Takes too
much time
Lack of
sleep
Cooling/
storing
Time
management
Lack of
documentation
Lack of
clean and
appropriate
equipment
Hard to know
and teach
Lack of skills
(Afraid of tube,
hard to use cup)
Not knowing
if baby had
enough
Breast and
post partum
problems
Baby sleepy
and not
interested
Family
distraction
Hard to hold
fragile baby,
tiring
Lack of tools for
counselling
Lack of
knowledge and
skills
Not enough
clean tubes
Multiple
births
Relatives
Tube feeding
takes time
Not knowing
how much
baby ate
Not knowing
how to counsel
Needs time
and patience
Mother wants
formula
Assessing baby’s
neuro-muscular
readiness
Baby sleepy
and not
interested
Baby used to
cup, refusing
breast
Not
enough
milk
Poor
attachment
and position
Will the
baby eat
enough?
Not
knowing
baby’s
readiness
Mother is
home with
chores, no
time
Mapping
Painpoints
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21. Growth
Monitoring
http://mrl.li/mok2GjOa
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22. Need Identification
Small Baby’s Breastfeeding Journey
22

23. Obtaining
breast milk
Feeding
method
Transition
to breast
Growth
monitoring
Exclusive
breastfeeding
Feeding amount
and frequency
23

24. Obtaining
breast milk
Feeding
method
Transition
to breast
Feeding amount
and frequency
Growth
monitoring
Exclusive
breastfeeding
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26. Obtaining Breast Milk
FIRST DAYS
- Initiating breastfeeding within first hour
- Baby’s need for rich colostrum
- Establishing breast milk production
without the normal stimuli of the baby
FIRST WEEKS
- Baby’s breastfeeding: compress and vacuum
- Any expression (hand expression vs breast
pumps) should start with stimulation
- When available, pumps are introduced too
early. Hand expression supplements pumping.
Early stimulation
of the breast
Improve effectiveness
of hand expression
26

27. Obtaining
breast milk
Feeding
method
Transition
to breast
Growth
monitoring
Exclusive
breastfeeding
Feeding amount
and frequency
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29. Feeding Amount and Frequency
- Mother’s perception of baby’s need can be too high
- Leading to overfeeding or feeding of other substances than breast milk
- Understanding baby’s hunger and satiety cues requires skills
- Extra device (syringe) is needed for measuring milk
- Feeding amount need to be adjusted based on growth
- Guidelines are not comprehensive or easy to apply in real-life
More research needed on
feeding amount & frequency
Training on hunger
and satiety cues
29

30. Obtaining
breast milk
Transition
to breast
Growth
monitoring
Exclusive
breastfeeding
Feeding amount
and frequency
Feeding
method
30

31. Feeding Method
Feeding From Breast, Alternative Oral Feeding, NG tube Feeding
Help classifying a baby
for right feeding method
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- First step: Positioning the baby on the breast
- If not latchin: Assessing ability to regulate Breathing - Swallowing - Suckling
- NG Tube Feeding
- Cup/Spoon Feeding
- 83% of preterms are late and moderate preterms
- Who are more likely stable at birth
- May not need NG tube feeding
- Can potentially benefit from cup/spoon feeding until transition to breast

32. Tanzania
Ethiopia
Malawi Rwanda Pune, India
Ethiopia
Nepal Pune, IndiaAhmedabad, India Mumbai, India
Malawi Lucknow, India
Tanzania
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33. Challenges with Cup/Spoon Feeding
Inconsistent tools reused
No standard cup/spoon size
Pouring milk in to inactive baby’s mouth
Feeding baby in horizontal position
Pace of feeding not controlled by baby
Impatience during baby’s feeding breaks
Baby not kept warm while feeding
Improve alternative oral feeding
to fit the needs of small babies
33

34. Obtaining
breast milk
Growth
monitoring
Exclusive
breastfeeding
Feeding amount
and frequency
Feeding
method
Transition
to breast
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36. Transition to Breast
- Challenging period with combined feeding methods (from breast and with cup/spoon)
- Not emphasized enough in guidelines
- Getting discharged before baby latches on breast
- Reduced StS durations after discharge from hospital
- Biggest concern during transition: How much did the baby take from breast?
Develop a step-by-step
approach to ensure transition
Improve guidelines to focus
more on transition to breast
36

37. Obtaining
breast milk
Exclusive
breastfeeding
Feeding amount
and frequency
Feeding
method
Transition
to breast
Growth
monitoring
37

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39. Growth Monitoring
FIRST TWO WEEKS
- Baby loses up to 10% birth weight in the 1st week
- Losing more weight is a danger sign, feeding
should improve, baby may need to be treated
- Growth charts do not zoom in on the first weeks
ONWARDS
- Weekly weight gain is more relevant than
absolute weight
- Scales need to be at around 10-20g accuracy
for measuing weight change in small babies.
Most hand-held scales are at 50g accuracy.
Easy tracking of weight loss
to prevent reaching 10%
Ways to regulate feeding
based on weekly weight gain
39

40. Obtaining
breast milk
Exclusive
breastfeeding
Feeding amount
and frequency
Feeding
method
Transition
to breast
Growth
monitoring
40

41. Hand
expression
Alternative
oral feeding
Growth
Monitoring
Feeding
volumes
http://mrl.li/mok2GjOa
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42. 1. Helping Babies Breathe to Helping Babies Grow
2. Mother and Small Baby’s Breastfeeding Journey
3. Nifty Feeding Cup Collaboration
4. Making Innovation happen
42

43. Design Brief
How might we improve alternative oral feeding
for feeding small infants correctly?
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44. Design Brief
How might we improve alternative oral feeding
for feeding small infants correctly?
WHO recommended
cup/spoon feeding
Tracking
volume of milk
Allowing baby to
actively take milk
(not pouring in mouth)
Holding the baby
semi-upright
(not lying down)
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45. • Facilitate baby’s active participation in feeding by
providing small volumes without pouring
• Soft surface area for interaction of tongue/lips and
milk, stimulating baby to suckle and swallow
• Graduations for measuring volume of milk.
• Easy to clean and reusable
• Improve training for assessing which preterms are
qualified for cup/spoon feeding
Define cup/spoon
As a feeding method for preterm babies
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46. https://vimeo.com/170658029/9a14f86a4f
Collaborative Design Process
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47. Prototyping
47

48. User Testing
48

49. Hand
expression
Iterative Prototyping
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50. Nifty Team
Collaboration
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51. https://vimeo.com/168943955/721d55a449
Launch at Women Deliver Conference 2016
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53. Obtaining
breast milk
Feeding amount
and frequency
Feeding
method
Transition
to breast
Growth
monitoring
Exclusive
breastfeeding
53

54. 1. Helping Babies Breathe to Helping Babies Grow
2. Mother and Small Baby’s Breastfeeding Journey
3. Nifty Feeding Cup Collaboration
4. Making Innovation happen
54

55. Innovation is all about impact.
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57. Efficient implementation requires collaboration
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58. Helping Babies Grow Bundle
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