Full implementation of the Ten Steps to Successful Breastfeeding leading to Baby-Friendly designation is an effective strategy to increase breastfeeding initiation rates in the US hospital setting.

This study evaluated the impact of a Baby-Friendly designation on breastfeeding rates in a US neonatal intensive care unit (NICU). The medical records of all surviving infants directly admitted to the Boston Medical Center's level III, 15-bed NICU in 1995 (before Baby-Friendly policies were implemented) and 1999 (when Baby-Friendly status was granted) were reviewed. Infants receiving any breast milk by any means during the first week of enteral feeds were considered to have initiated breastfeeding. Maternal and infant demographics for 1995 and 1999 were comparable. The NICU breastfeeding initiation rate increased from 34.6% (1995) to 74.4% (1999) (P < .001). Among 2-week-old infants, the proportion receiving any breast milk rose from 27.9% (1995) to 65.9% (1999) (P < .001), and the proportion receiving breast milk exclusively rose from 9.3% (1995) to 39% (1999) (P = .002). The implementation of Baby-Friendly policies leading to a Baby-Friendly designation was associated with increased breastfeeding initiation and duration rates.

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