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

BACKGROUND: The Baby-Friendly Hospital Initiative (BFHI) has a positive effect on breastfeeding in maternity wards; however, few studies have examined to what degree it affects care in neonatal intensive care units (NICUs). Recently, the BFHI has been adapted to the NICUs (Neo-BFHI). OBJECTIVE: This study aimed to compare breastfeeding support in Spanish NICUs in hospitals with BFHI accreditation or in the process of being accredited (group 1) with NICUs in hospitals that have not yet begun this initiative (group 2). METHODS: A validated questionnaire on breastfeeding support was distributed to level II and III NICUs in Spanish public hospitals. A univariate analysis and an analysis adjusted for the number of beds in NICUs were conducted. The results of the analysis of 36 breastfeeding support measures are presented in accordance with the Ten Steps to Successful Breastfeeding adapted to NICUs. RESULTS: Of the 141 participating NICUs, 129 (91%) responded to the questionnaire: 38 NICUs from group 1 and 91 NICUs from group 2. Group 1 had implemented a higher number of breastfeeding support measures than group 2. There were significant differences in 18 measures related to steps 2, 4, 5, 7, and 8 of the Neo-BFHI. In addition, a comparison of NICUs in hospitals with full accreditation (7 of 129) with those in group 2 revealed significant differences in 7 measures pertaining to steps 2, 5, 8, and 9. CONCLUSION: 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.

Prácticas de alimentación con leche materna en recién nacidos menores de 1.500 g o de menos de 32 semanas / Feeding practices with human milk in newborns less than 1.500 g or less than 32 weeks

INTRODUCCIÓN: Actualmente no existe una política unificada de cómo promocionar la lactancia materna en la unidad neonatal ni sobre la práctica de nutrición enteral con leche materna (LM) en los prematuros. Nuestro objetivo fue describir las medidas de apoyo a la lactancia y la utilización de LM en grandes prematuros de los hospitales públicos españoles. MÉTODO: Se distribuyó un cuestionario sobre prácticas de alimentación enteral. Se analizaron los datos de las unidades que atendían a menores de 32 semanas o 1.500g. Se realizó un análisis univariante comparando las unidades de nivel II y III. RESULTADOS: La tasa de respuesta fue del 91%. Un total de 93 unidades atienden a menores de 32 semanas o de 1.500 g (17 de nivel II y 76 de nivel III). El 49% registra la tasa de lactancia al alta. En el 75% (70/93) existe una guía de manejo de LM (nivel III 81 vs. nivel II 47%; p = 0,002). El 25% dispone de leche donada. El 46% inicia alimentación trófica en las primeras 6 h. En el 89% el volumen máximo de LM administrado es ≥180 ml/kg/día (nivel III 93 vs. nivel II70%; p = 0,017). Se fortifica en el 96% de las unidades y el 92% la inicia a partir de un volumen determinado de leche. Para modificar la cantidad de fortificante, el 59% utiliza la curva de peso y el 36% criterios analíticos. El 9% emplea fortificante proteico puro. CONCLUSIONES: Existe una gran variabilidad en las medidas de apoyo a la lactancia y en las prácticas de alimentación enteral de los grandes prematuros en las unidades españolas

INTRODUCTION: There is currently no unified policy on either breastfeeding support or enteral nutrition practices, as regards human milk (HM) in pre-term newborns. The aim of this study was to describe breastfeeding support measures, as well as the use of HM in very preterm infants in Spanish public hospitals. METHOD: A questionnaire on enteral feeding practices was distributed. Data were analysed from units caring for newborns less than 32 weeks or 1,500g. A univariate analysis was performed comparing level II and III care units. RESULTS: There was a 91% response rate. A total of 93 units cared for infants less than 32 weeks or 1,500g (17 level II and 76 level III), and 49% of the units recorded the breastfeeding rate on discharge. Around 75% (70/93) had a guideline on managing HM (level III 81 vs. level II 47%,P=.002), and 25% had access to donor human milk. Just under half (46%) started trophic feeding in the first 6h. Target enteral feeding volume in stable preterm infants was ≥ 180 ml/kg/day in 89% of the units (level III 93% vs. level II 70%, P =.017). HM fortifier was used in 96% of the units. In 92%, it was added when the required enteral volume was tolerated. In 59% of the units, adjustments in the quantity of fortifier were made according to weight, and in 36%, it depended on analytical criteria. Some units (9%) used pure protein fortifier. CONCLUSIONS: There is a marked variability in breastfeeding support measures and in feeding practices of preterm infants in Spanish neonatal units

[Feeding practices with human milk in newborns less than 1.500 g or less than 32 weeks]. / Prácticas de alimentación con leche materna en recién nacidos menores de 1.500 g o de menos de 32 semanas.

INTRODUCTION: There is currently no unified policy on either breastfeeding support or enteral nutrition practices, as regards human milk (HM) in pre-term newborns. The aim of this study was to describe breastfeeding support measures, as well as the use of HM in very preterm infants in Spanish public hospitals. METHOD: A questionnaire on enteral feeding practices was distributed. Data were analysed from units caring for newborns less than 32 weeks or 1,500g. A univariate analysis was performed comparing level ii and iii care units. RESULTS: There was a 91% response rate. A total of 93 units cared for infants less than 32 weeks or 1,500g (17 level ii and 76 level iii), and 49% of the units recorded the breastfeeding rate on discharge. Around 75% (70/93) had a guideline on managing HM (level iii 81 vs. level ii 47%, P=.002), and 25% had access to donor human milk. Just under half (46%) started trophic feeding in the first 6h. Target enteral feeding volume in stable preterm infants was ≥ 180ml/kg/day in 89% of the units (level iii 93% vs. level ii 70%, P =.017). HM fortifier was used in 96% of the units. In 92%, it was added when the required enteral volume was tolerated. In 59% of the units, adjustments in the quantity of fortifier were made according to weight, and in 36%, it depended on analytical criteria. Some units (9%) used pure protein fortifier. CONCLUSIONS: There is a marked variability in breastfeeding support measures and in feeding practices of preterm infants in Spanish neonatal units.