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

Abstract

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.

Exploring the Gap Between Needs and Practice in Facilitating Breastfeeding Within the Neonatal Intensive Care Setting: An Italian Survey on Organizational Factors

“…The importance of family-centered care, including the non-separation of infant and parents, is widely acknowledged (17, 20, 21). These findings could be partially explained by a lack of space and beds and are in line with the findings of previous studies (13, 22) that have reported limited parental access as relatively common in Southern European countries. In contrast, in Northern Europe and the UK, the majority of NICUs allow unrestricted parental access and provide facilities such as reclining chairs near the babies' cots, beds and dedicated rooms to ensure parents' presence also during night time (7, 22).…”

“…Consistently with data in literature, all of the investigated NICUs had developed breastfeeding policies, and the large majority exhibited the greatest adherence to the Neo-BFHI human milk expression recommendations (7, 11, 13, 16). Furthermore, the great part of the enrolled NICUs provided parents with written breastfeeding information related to human milk expression and skin-to-skin contact.…”

“…Within this context, the importance of promoting family-centered care during hospital stay has been further underlined (12). A recent survey, including a high number of participating wards, has brought to light the international readiness to expand Neo-BFHI designation (13).…”

Incidence and risk of necrotizing enterocolitis in Denmark from 1994-2014

“…The Swedish definition of NEC was from the ICD-9 system which should not be different from the ICD-10 system. Denmark and Sweden both had high rates of breastfeeding and routine use of human donor milk as well as skin-to-skin care during the periods investigated [17,18]. It may, nevertheless, be speculated that differences in nurse-to-patient ratios, education or feeding regimens may differ systematically between the countries to cause these differences, however it is beyond the scope of this article to go further into this speculation.…”

The association between breastfeeding supportive services during childbirth hospitalization and exclusive breastfeeding at discharge

“…In 2018, WHO and UNICEF updated the guidelines based on the latest evidence on the BFHI and re-emphasized the importance of applying the Ten Steps to Successful Breastfeeding in all delivery facilities [11] . Global evidence has demonstrated that adherence to the BFHI can improve breastfeeding outcomes, including BF initiation and duration up to one year postpartum [12,13] . BF has many bene ts to both mother's and child's health outcomes, such as decreased risk of breast and ovarian carcinoma for mothers [14,15] , and reduced risk of common infections among infants [16] .…”