Breastfeeding Support in Spanish Neonatal Intensive Care Units and the Baby-Friendly Hospital Initiative

Alonso-Díaz, Clara; Utrera-Torres, Isabel; Alba-Romero, Concepción de; Flores-Antón, Beatriz; Lora-Pablos, David; Pallás‐Alonso, Carmen Rosa

doi:10.1177/0890334416658246

Cited by 17 publications

(16 citation statements)

References 20 publications

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“…The groups identified in the correspondence analysis showed a pattern similar to other studies in which friendly paediatric breastfeeding practices may demonstrate a positive effect on breastfeeding at hospital discharge [ 19 , 37 ], an important condition for maintaining this practice [ 38 ].…”

Section: Discussionsupporting

confidence: 76%

Breastfeeding patterns in cohort infants at a high-risk fetal, neonatal and child referral center in Brazil: a correspondence analysis

et al. 2020

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Background To investigate the prevalence and patterns of breastfeeding at discharge and in the first six months of life in a high-risk fetal, neonatal and child referral center. Methods Prospective, longitudinal study that included the following three steps: hospital admission, first visit after hospital discharge and monthly telephone interview until the sixth month of life. The total number of losses was 75 mothers (7.5%). Exposure variables were sorted into four groups: factors related to the newborn, the mother, the health service and breastfeeding. The dependent variable is breastfeeding as per categories established by the WHO. All 1200 children born or transferred to the high-risk fetal, neonatal and child referral center, within a seven-day postpartum period, from March 2017 to April 2018, were considered eligible for the study, and only 1003 were included. The follow-up period ended in October 2018. For this paper, we performed an exploratory analysis at hospital discharge in three stages, as follows: (i) frequencies of baseline characteristics, stratified by risk for newborn; (ii) a multiple correspondence analysis (MCA); and (iii) clusters for variables related to hospital practice and exclusive breastfeeding (EBF). Results The prevalence of EBF at hospital discharge was 65.2% (62.1–68.2) and 20.6% (16.5–25.0) in the six months of life. Out of all at-risk newborns, 45.7% were in EBF at discharge. The total inertia corresponding to the two dimensions in the MCA explained for 75.4% of the total data variability, with the identification of four groups, confirmed by the cluster analysis. Discussion Our results suggest that robust breastfeeding hospital policies and practices influence the establishment and maintenance of breastfeeding in both healthy and at-risk infants. It is advisable to plan and implement additional strategies to ensure that vulnerable and healthy newborns receive optimal feeding. It is necessary to devote extra effort particularly to at-risk infants who are more vulnerable to negative outcomes. Conclusion At-risk newborns did not exclusively breastfeed to the same extent as healthy newborns at hospital discharge. A different approach is required for at-risk neonates, who are more physically challenged and more vulnerable to problems associated with initiation and maintenance of breastfeeding.

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Section: Discussionsupporting

confidence: 76%

Breastfeeding patterns in cohort infants at a high-risk fetal, neonatal and child referral center in Brazil: a correspondence analysis

et al. 2020

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“…It has been shown that compliance with BFHI standards was significantly higher when reported by staff/managers than parents themselves (Haiek, ). Still, health care professional self‐reports remain one of the most accessible sources of information to measure compliance, and comparison of the present results was done with such studies (Alonso‐Diaz et al, ; Grizzard et al, ; Maastrup et al, ).…”

Section: Discussionmentioning

confidence: 88%

“…Higher scores obtained by neonatal wards in hospitals ever‐designated Baby‐friendly may be related to the fact that BFHI certification includes some practices related to neonatal care, but it may also demonstrate that maternity and neonatal wards do not operate in isolation (Taylor, Gribble, Sheehan, Schmied, & Dykes, ) and the certification process in one ward may have a beneficial effect on the revision of policies and practices of the other one (Alonso‐Diaz et al, ). Even though only four countries in the present survey had a Baby‐friendly neonatal certification process separate from the original one, 60% of the respondents expressed intentions to obtain or maintain BFHI certification for their neonatal ward.…”

Section: Discussionmentioning

confidence: 99%

“…Restrictions in parents' presence beside their infant in neonatal wards have decreased in the last decades (Davis et al, ). However, studies continue to document differences between countries, for example, with more restrictions noted in Southern than Northern Europe (Alonso‐Diaz et al, ; Greisen et al, ; Maastrup et al, ; Pallas‐Alonso et al, ), indicating more efforts are required to protect the rights of infants to be cared for by their parents (Office of the United Nations High Commissioner for Human Rights, ). Challenges involved in avoiding mother–infant separations are well recognized (Flacking et al, ); it has previously been found that Step 7 was one of the least implemented steps in maternity wards (Haiek, ).…”

Section: Discussionmentioning

confidence: 99%

“…However, most surveys have relied on health‐care professional self‐reports, being the most accessible source of information (Centers for Disease Control and Prevention; Crivelli‐Kovach & Chung, ; Grizzard, Bartick, Nikolov, Griffin, & Lee, ). To date only Denmark and Spain have published countrywide surveys on breastfeeding‐related policies and practices in neonatal wards, both of which are from the manager's perspective (Alonso‐Diaz et al, ; Maastrup et al, ). Thus, such policies and practices have not been documented in most countries.…”

Section: Introductionmentioning

confidence: 99%

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Compliance with the “Baby‐friendly Hospital Initiative for Neonatal Wards” in 36 countries

Maastrup

Haiek

Lubbe³

et al. 2018

Maternal & Child Nutrition

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In 2012, the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI) began providing recommendations to improve breastfeeding support for preterm and ill infants. This cross-sectional survey aimed to measure compliance on a global level with the Neo-BFHI's expanded Ten Steps to successful breastfeeding and three Guiding Principles in neonatal wards. In 2017, the Neo-BFHI Self-Assessment questionnaire was used in 15 languages to collect data from neonatal wards of all levels of care. Answers were summarized into compliance scores ranging from 0 to 100 at the ward, country, and international levels. A total of 917 neonatal wards from 36 low-, middle-, and high-income countries from all continents participated. The median international overall score was 77, and median country overall scores ranged from 52 to 91. Guiding Principle 1 (respect for mothers), Step 5 (breastfeeding initiation and support), and Step 6 (human milk use) had the highest scores, 100, 88, and 88, respectively. Step 3 (antenatal information) and Step 7 (rooming-in) had the lowest scores, 63 and 67, respectively. High-income countries had significantly higher scores for Guiding Principles 2 (family-centered care), Step 4 (skin-to-skin contact), and Step 5. Neonatal wards in hospitals ever-designated Baby-friendly had significantly higher scores than those never designated. Sixty percent of managers stated they would like to obtain Neo-BFHI designation. Currently, Neo-BFHI recommendations are partly implemented in many countries. The high number of participating wards indicates international readiness to expand Baby-friendly standards to neonatal settings. Hospitals and governments should increase their efforts to better support breastfeeding in neonatal wards.

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Changes in breastfeeding support practices in Spanish neonatal units

Díaz

Betancourt

Bértolo

et al. 2020

Anales de Pediatría (English Edition)

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Breastfeeding Support in Spanish Neonatal Intensive Care Units and the Baby-Friendly Hospital Initiative

Abstract: The Spanish NICUs in hospitals with BFHI accreditation or in the process of being accredited have better implementation of practices to promote and support breastfeeding.

Cited by 17 publications

References 20 publications

Breastfeeding patterns in cohort infants at a high-risk fetal, neonatal and child referral center in Brazil: a correspondence analysis

Breastfeeding patterns in cohort infants at a high-risk fetal, neonatal and child referral center in Brazil: a correspondence analysis

Compliance with the “Baby‐friendly Hospital Initiative for Neonatal Wards” in 36 countries

Changes in breastfeeding support practices in Spanish neonatal units

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