In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother's own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding. Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up.

Objective: First, to describe the prevalence of both full and partial breast-feeding during the first 6 months; second, to study the associations between selected health service-related factors and cessation of full breast-feeding at three time intervals. Design: Retrospective questionnaires, 6 months after birth. Setting: The Norwegian Mother and Child Cohort Study (MoBa). Subjects: In total, 29 621 women. Results: While 96?6 %, 94?0 %, 90?8 %, 86?9 %, 83?8 % and 80?0 % of the infants were breast-fed at 1, 2, 3, 4, 5 and 6 months, respectively, the corresponding proportions for full breast-feeding were 84?6 %, 79?1 %, 70?9 %, 44?0 %, 16?7 % and 2?1 %. An increased risk of cessation of full breast-feeding during the first month was associated with supplementation during the first week of life with water (relative risk (RR) 1?77; 95 % CI 1?52, 2?06), sugar water (RR 1?73; 95 % CI 1?49, 2?00) or formula (RR 5?99; 95 % CI 5?58, 6?42). An increased risk was also associated with Caesarean delivery (RR 1?08; 95 % CI 1?00, 1?16) and breast-feeding problems (RR 1?56; 95 % CI 1?45, 1?67). Between months 1 and 3, the risk of cessation of full breast-feeding remained elevated in the case of supplementation during the first week of life with water (RR 1?29; 95 % CI 1?14, 1?45), sugar water (RR 1?48; 95 % CI 1?34, 1?64) or formula (RR 1?18; 95 % CI 1?07, 1?29). The same applied to Caesarean delivery (RR 1?15; 95 % CI 1?06, 1?25). Conclusions: Supplementation during the first week, breast-feeding problems and Caesarean delivery are associated with early cessation of full breast-feeding. The results support a cautious approach to supplementation during the first week of life.

The World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care (2009) identifies the need for expanding the guidelines originally developed for maternity units to include neonatal intensive care. For this purpose, an expert group from the Nordic countries and Quebec, Canada, prepared a draft proposal, which was discussed at an international workshop in Uppsala, Sweden, in September 2011. The expert group suggests the addition of 3 "Guiding Principles" to the Ten Steps to support this vulnerable population of mothers and infants: 1. The staff attitude to the mother must focus on the individual mother and her situation. 2. The facility must provide family-centered care, supported by the environment. 3. The health care system must ensure continuity of care, that is, continuity of pre-, peri-, and postnatal care and postdischarge care. The goal of the expert group is to create a final document, the Baby Friendly Hospital Initiative for Neonatal Units, including standards and criteria for each of the 3 Guiding Principles, Ten Steps, and the Code; to develop tools for self-appraisal and monitoring compliance with the guidelines; and for external assessment to decide whether neonatal intensive/intermediate care units meet the conditions required to be designated as Baby-Friendly. The documents will be finalized after consultation with the World Health Organization/United Nations Children's Fund, and the goal is to offer these documents to international health care, professional, and other nongovernmental organizations involved in lactation and breastfeeding support for mothers of infants who require special neonatal care.

Objective: We investigated the association between full breast-feeding up to 6 months as well as partial breast-feeding after 6 months and maternal weight retention at 6, 18 and 36 months after delivery in the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health. Design: Cohort study. Information on exposure and outcome was collected by questionnaire. Setting: Norway. Subjects: Women at 6 months (n 49 676), 18 months (n 27 187) and 36 months (n 17 343) postpartum. Results: Longer duration of full breast-feeding as well as partial breast-feeding was significantly related to lower weight retention at 6 months. At 18 months full breast-feeding (0-6 months) and partial breast-feeding for 12-18 months were significantly related to lower weight retention. At 36 months only full breastfeeding (0-6 months) was significantly related to lower weight retention. For each additional month of full breast-feeding, maternal weight was lowered by 0?50 kg/month at 6 months, 0?10 kg/month at 18 months and 0?14 kg/month at 36 months (adjusted for pre-pregnant BMI, pregnancy weight gain, age and parity). Partial breast-feeding resulted in 0?25 kg/month lower maternal weight at 6 months. Interactions were found between household income and full breastfeeding in relation to weight retention at 6, 18 and 36 months, indicating most benefit among women with low income. Conclusions: The present study supports the hypothesis that full breast-feeding contributes to lower postpartum weight retention and shows that the effect is maintained for as long as 3 years postpartum.