Operationalising a Comprehensive Lactation Management Centre in a Tertiary NICU in North India: A Retrospective Implementation Study With Before-After Comparison of Breastfeeding and Counselling Coverage

Background: Feeding practices in neonatal intensive care units (NICUs) are often compromised by limited lactation support and mother-infant separation.A Comprehensive Lactation Management Centre (CLMC) integrates counselling, bedside lactation assistance and donor human milk banking within the NICU.Evidence on the real-world operationalisation of such centres in tertiary care institutions in India remains limited.This study describes the operationalisation of a CLMC in a tertiary NICU and evaluates its effect on exclusive breastfeeding and structured counselling coverage through a before-after comparison.Methodology: This retrospective implementation study was conducted in the NICU and CLMC of a publicsector tertiary centre with 4,200-4,500 deliveries annually.Baseline feeding and counselling practices (April-June 2024) were compared with those in the post-implementation period (July 2024-July 2025).Core components included structured lactation counselling, bedside milk expression support, a functional donor human milk pathway, daily multidisciplinary rounds and WhatsApp-based coordination.Feeding and counselling indicators during the baseline and post-implementation periods, monthly operational trends and donor profiles were analysed.Results: The proportion of mothers receiving structured breastfeeding counselling rose from 87/353 (25%) to 1,613/1,841 (88%).Exclusive breastfeeding at discharge increased from 25/56 (45%) to 436/534 (82%).Over the implementation period, 541 neonates received pasteurised donor human milk (PDHM), and the peak monthly donation volume reached 30,009 ml.Early initiation of milk expression, together with hands-on demonstration and lactation counselling, appeared to drive the change.Mother-infant separation and perceived low milk supply remained persistent barriers.Conclusions: CLMC establishment was associated with improved exclusive breastfeeding and structured breastfeeding counselling coverage.As a retrospective analysis, these findings reflect associations rather than causal effects.Sustaining these gains requires ongoing lactation support and system-level coordination.