Costs analysis of hospital care for vaginal delivery and elective caesarean section for usual risk pregnant women in the Brazilian Unified National Health System. / Análise de custos da atenção hospitalar ao parto vaginal e à cesariana eletiva para gestantes de risco habitual no Sistema Único de Saúde.

This study estimated the costs of vaginal delivery and elective cesarean section without clinical indication, for usual risk pregnant women from the perspective of the Brazilian Unified Health System. Data was collected from three public maternity hospitals located in the southeast region of Brazil through visits and interviews with professionals. The cost components were human resources, hospital supplies, capital cost and overhead, which were identified, quantified and valued through the micro-costing method. The costs with vaginal delivery, elective cesarean section and daily hospital charge in rooming for the three maternity hospitals were identified. The mean cost of a vaginal delivery procedure was R$ 808.16 and ranged from R$ 585.74 to R$ 916.14 between hospitals. The mean cost of elective cesarean section was R$ 1,113.70, ranging from R$ 652.69 to R$ 1,516.02. The main cost component was human resources for both procedures. When stay in rooming was included, the mean costs of vaginal delivery and cesarean were R$ 1,397.91 (R$ 1,287.50 - R$ 1,437.87) and R$ 1,843.87 (R$ 1,521.54 - R$ 2,161.98), respectively. Cost analyses of perinatal care contribute to the management of health services and are essential for cost-effectiveness analysis.

Esse estudo estimou os custos do parto vaginal e da cesariana eletiva, sem indicação clínica, para gestantes de risco habitual na perspectiva do Sistema Único de Saúde provedor. A coleta de dados incluiu três maternidades públicas situadas na região Sudeste, nas quais foram realizadas visitas e entrevistas com os profissionais. Os itens de custos incluídos foram recursos humanos, insumos hospitalares, custo de capital e administrativos, que foram identificados, quantificados e valorados pelo método de microcusteio. Foram identificados custos com o parto vaginal, cesariana eletiva e diária em alojamento conjunto para as três maternidades. A média do custo do procedimento parto vaginal foi de R$ 808,16 e variou de R$ 585,74 a R$ 916,14 entre as maternidades. O custo médio da cesariana eletiva foi de R$ 1.113,70 com variação de R$ 652,69 a R$ 1.516,02. O principal item de custo foi os recursos humanos em ambos os procedimentos. Com a inclusão do período de permanência em alojamento conjunto, o custo médio do parto vaginal foi de R$ 1.397,91 (R$ 1.287,50 - R$ 1.437,87) e da cesariana R$ 1.843,8791 (R$ 1.521,54 - R$ 2.161,98), este 32% superior ao primeiro. As análises de custo na atenção perinatal contribuem para a gestão dos serviços de saúde, além de serem essenciais para análises de custo-efetividade.

Análise de custos da atenção hospitalar ao parto vaginal e à cesariana eletiva para gestantes de risco habitual no Sistema Único de Saúde / Costs analysis of hospital care for vaginal delivery and elective caesarean section for usual risk pregnant women in the Brazilian Unified National Health System

Resumo Esse estudo estimou os custos do parto vaginal e da cesariana eletiva, sem indicação clínica, para gestantes de risco habitual na perspectiva do Sistema Único de Saúde provedor. A coleta de dados incluiu três maternidades públicas situadas na região Sudeste, nas quais foram realizadas visitas e entrevistas com os profissionais. Os itens de custos incluídos foram recursos humanos, insumos hospitalares, custo de capital e administrativos, que foram identificados, quantificados e valorados pelo método de microcusteio. Foram identificados custos com o parto vaginal, cesariana eletiva e diária em alojamento conjunto para as três maternidades. A média do custo do procedimento parto vaginal foi de R$ 808,16 e variou de R$ 585,74 a R$ 916,14 entre as maternidades. O custo médio da cesariana eletiva foi de R$ 1.113,70 com variação de R$ 652,69 a R$ 1.516,02. O principal item de custo foi os recursos humanos em ambos os procedimentos. Com a inclusão do período de permanência em alojamento conjunto, o custo médio do parto vaginal foi de R$ 1.397,91 (R$ 1.287,50 - R$ 1.437,87) e da cesariana R$ 1.843,8791 (R$ 1.521,54 - R$ 2.161,98), este 32% superior ao primeiro. As análises de custo na atenção perinatal contribuem para a gestão dos serviços de saúde, além de serem essenciais para análises de custo-efetividade.

Abstract This study estimated the costs of vaginal delivery and elective cesarean section without clinical indication, for usual risk pregnant women from the perspective of the Brazilian Unified Health System. Data was collected from three public maternity hospitals located in the southeast region of Brazil through visits and interviews with professionals. The cost components were human resources, hospital supplies, capital cost and overhead, which were identified, quantified and valued through the micro-costing method. The costs with vaginal delivery, elective cesarean section and daily hospital charge in rooming for the three maternity hospitals were identified. The mean cost of a vaginal delivery procedure was R$ 808.16 and ranged from R$ 585.74 to R$ 916.14 between hospitals. The mean cost of elective cesarean section was R$ 1,113.70, ranging from R$ 652.69 to R$ 1,516.02. The main cost component was human resources for both procedures. When stay in rooming was included, the mean costs of vaginal delivery and cesarean were R$ 1,397.91 (R$ 1,287.50 - R$ 1,437.87) and R$ 1,843.87 (R$ 1,521.54 - R$ 2,161.98), respectively. Cost analyses of perinatal care contribute to the management of health services and are essential for cost-effectiveness analysis.

The Joys and Frustrations of Breastfeeding and Rooming-In Among Mothers With Opioid Use Disorder: A Qualitative Study.

OBJECTIVES: To investigate perspectives of mothers with opioid use disorder regarding breastfeeding and rooming-in during the birth hospitalization and identify facilitators and barriers. METHODS: We conducted in-depth qualitative interviews with 25 mothers with opioid use disorder 1-12 weeks after delivery. Grounded theory analysis was used until thematic saturation was reached. Findings were triangulated, with experts in the field and a subset of informants themselves, to ensure data reliability. RESULTS: Among 25 infant-mother dyads, 36% of infants required pharmacologic treatment, 72% of mothers initiated breastfeeding, and 40% continued until discharge. We identified the following themes: (1) information drives maternal feeding choice; (2) the hospital environment is both a source of support and tension for mothers exerting autonomy in the care of their infants; (3) opioid withdrawal symptoms negatively impact breastfeeding; (4) internal and external stigma negatively impact mothers' self-efficacy; (5) mothers' histories of abuse and trauma affect their feeding choice and bonding; (6) mothers' recovery makes caring for their infants emotionally and logistically challenging; and (7) having an infant is a source of resilience and provides a sense of purpose for mothers on their path of recovery. CONCLUSIONS: Future interventions aimed at increasing breastfeeding and rooming-in during the birth hospitalization should focus on education regarding the benefits of breastfeeding and rooming-in, supporting mothers' autonomy in caring for their infants, minimizing stigma, and maximizing resilience.

Evaluation of factors contributing to the decline in exclusive breastfeeding at 6 months postpartum: The 2011-2016 National Surveys in Taiwan.

BACKGROUND: Since 1992, breastfeeding promotion in Taiwan considerably raised the breastfeeding rates; however, more recent surveillance showed that breastfeeding indicators stagnated or even decreased. METHODS: We analyzed 6 cross-sectional national surveys of 69 159 postpartum women to examine the breastfeeding trends at 6 months postpartum during 2011-2016 in Taiwan and the contributing role of maternal and environmental factors. Data were collected through telephone interviews, using structured questionnaires with randomly selected mothers, who gave birth in those years. A multinomial logistic regression was used to analyze the data. RESULTS: Partial breastfeeding rates at 6 months postpartum increased from 2011 to 2016 (25.4%-45.1%, crude odds ratio [OR] = 1.14 per year of study); however, the rates of exclusive breastfeeding at 6 months postpartum declined (24.5%-14.8%, crude OR = 0.91 per year of study). During this period, increases in maternal age and educational level, employment outside the house, and prepregnancy obesity were observed. Despite a growing number of births at certified baby-friendly hospitals, fewer mothers experienced early skin-to-skin contact and rooming-in in 2016 than in 2011. Adjustment for breastfeeding-related factors did not appreciably change the odds ratio for year of birth. Prenatal intention to breastfeed was most strongly associated with breastfeeding at 6 months postpartum (OR > 5). CONCLUSIONS: Maternal and environmental factors in the study could not explain the decline in exclusive breastfeeding. The decline in exclusive breastfeeding, accompanying the increase in partial breastfeeding, suggests that more support is needed for mothers who intend to breastfeed exclusively.

[Women and post-natal care: analysis of a rooming-in facility.] / La donna nel post-parto: uno studio sulla pratica del rooming-in.

INTRODUCTION: The practice of rooming-in (R-in) is widely but heterogeneously applied in Italian hospitals and consists in keeping babies in the same room with their mothers from the moment of birth through to the discharge. AIM: Explore the perception and use of R-in among Italian mothers who gave birth in a context where R-in is offered 24h. We aimed at comparing differences among women who consistently use the R-in practice to those who do not. METHOD: Sixty-five women in good health (average age=33.8 years old; sd=4.2) were assigned to two different groups: mothers who always kept their baby in the room (n=35) and mothers who referred their babies more than once to the nursery care (n=30). Women completed a questionnaire about their pregnancy, delivery, hospitalization, and R-in. Medical records were also collected. The two groups were compared with regard to medical/obstetrician/socio-demographic factors, as well as their perception of R-in. RESULTS: We observed no differences in terms of maternal age, education, and parity among the two groups. Women who had undergone Caesarean section were more likely to make use of the nursery care up to 72 hours after delivery (χ2=11,11, p<,001). A considerable proportion of the study population (42%) considered the level of information received about R-in unsatisfying; this percentage is higher (55%) among women who referred to the nursery. DISCUSSION: Women differ in the degree of R-in application use depending on the type of delivery and the subsequent maternal physical condition. It is important to support women by offering them a flexible service that accounts for their possible physical difficulties. Besides, it is crucial to provide an adequate level of information about R-in, so that mothers can feel in control of the situation, especially if they underwent Caesarean section.

Mother-Infant Room-Sharing and Sleep Outcomes in the INSIGHT Study.

OBJECTIVES: The American Academy of Pediatrics recommends infant-parent room-sharing until age 1. We assessed the association between room-sharing and sleep outcomes. METHODS: The Intervention Nurses Start Infants Growing on Healthy Trajectories study is an obesity prevention trial comparing a responsive parenting intervention with a safety control among primiparous mother-infant dyads. Mothers completed the Brief Infant Sleep Questionnaire at 4, 9, 12, and 30 months. Reported sleep duration and overnight behaviors, adjusted for intervention group, were compared among early independent sleepers (own room <4 months), later independent sleepers (own room between 4 and 9 months), and room-sharers at 9 months. RESULTS: At 4 months, reported overnight sleep duration was similar between groups, but compared with room-sharers, early independent sleepers had better sleep consolidation (longest stretch: 46 more minutes, P = .02). At 9 months, early independent sleepers slept 40 more minutes nightly than room-sharers and 26 more minutes than later independent sleepers (P = .008). The longest stretch for early independent sleepers was 100 and 45 minutes more than room-sharers and later independent sleepers, respectively (P = .01). At 30 months, infants sleeping independently by 9 months slept >45 more minutes nightly than those room-sharing at 9 months (P = .004). Room-sharers had 4 times the odds of transitioning to bed-sharing overnight at both 4 and 9 months (P < .01 for both). CONCLUSIONS: Room-sharing at ages 4 and 9 months is associated with less nighttime sleep in both the short and long-term, reduced sleep consolidation, and unsafe sleep practices previously associated with sleep-related death.

Hospital practices to promote breastfeeding: The effect of maternal age.

BACKGROUND: Breastfeeding rates are disproportionately low among young mothers in the United States. Although the use of hospital practices to promote breastfeeding is widely supported, the extent to which these practices help explain breastfeeding disparities by maternal age is unclear. Accordingly, we aimed to explore how maternal age may affect (1) receipt of hospital practices and (2) associations between these practices and exclusive breastfeeding. METHODS: Data were derived from participants (n = 1598) of Listening to Mothers III, a national survey administered to mothers of singleton births in United States hospitals from July 2011 to June 2012. We used multivariable logistic regression models and interaction terms to examine maternal age as an effect modifier. RESULTS: Compared with mothers aged 30 and older, mothers aged 18-19 had lower odds of reporting that nurses helped them initiate breastfeeding when ready (OR 0.59 [95% CI 0.35-0.99]), they roomed-in with their baby (OR 0.32 [95% CI 0.19-54]) and they did not receive a pacifier (OR 0.53 [95% CI 0.32-0.90]). Many associations with breastfeeding were stronger among mothers aged 18-19 and 20-24 than mothers aged 25-29 and 30 and older. Additionally, compared with receiving a pacifier, not receiving a pacifier was associated with greater odds of exclusive breastfeeding at 1 week among mothers aged 30 and older (OR 1.47 [95% CI 1.02-2.11]) but lower odds among mothers aged 18-19 (OR 0.26 [95% CI 0.10-0.70]). CONCLUSIONS: Hospital practices to promote breastfeeding may be differentially implemented by maternal age. Encouraging teenage mothers to room-in with their babies may be particularly important for reducing breastfeeding disparities. Pacifier use among babies of teenage mothers requires further exploration.

Prolonged rooming-in in infancy is associated with generalized anxiety disorder in the adolescent period.

OBJECTIVE: This study aims to investigate whether anxiety disorders in adolescents have a link with the separation time of bed/bedroom sharing with parents. It also aims to raise awareness in society about the issue of minimizing anxiety disorders in childhood. METHODS: A case-control study was conducted in Sevket Yilmaz Training and Research Hospital between June 2013 and May 2014. The participants included 51 adolescents who were diagnosed as generalized anxiety disorder (GAD) with no-comorbidity and 71 healthy adolescents as the control group, who were chosen randomly. Diagnosis of GAD was based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed) by child and adolescent psychiatry doctors. The Turkish version of the State-Trait Anxiety Inventory (STAI) was used for the control group. A special survey about demographics and bed-sharing statements was constructed for the purpose of the study. The groups were analyzed in terms of duration of co-sleeping (bed-sharing) and rooming-in (keeping the mother and the baby in same room) with parents during infancy and the development of anxiety disorders in later period. RESULTS: Mean duration of rooming-in was significantly longer in the case group than in the control group (p=0.009). Similarly, mean duration of co-sleeping in the case group was longer than that of the control group. However, this difference was not statistically significant (p=0.529). CONCLUSION: Sleeping in the same room with children for a long time may result in anxiety disorders in later period due to possible difficulties in bonding and/or less self-confidence.

Hospital care and early breastfeeding outcomes among late preterm, early-term, and term infants.

BACKGROUND: Compared with term infants (39-41 weeks), early-term (37-38 weeks) and late preterm (34-36 weeks) infants have increased breastfeeding difficulties. We evaluated how hospital practices affect breastfeeding by gestational age. METHODS: This Listening to Mothers III survey cohort included 1,860 mothers who delivered a 34-41-week singleton from July 2011 to June 2012. High hospital support was defined as at least seven practices consistent with the Baby-Friendly Hospital Initiative's Ten Steps for United States hospitals. Logistic regression tested mediating effects of hospital support on the relationship between gestational age and breastfeeding at 1 week postpartum. RESULTS: High hospital support was associated with increased exclusive breastfeeding (AOR 2.21 [95% CI 1.58-3.09]). Just 16.4 percent of late preterm infants experienced such support, compared with early-term (37.9%) and term (30.7%) infants (p = 0.004). Although overall breastfeeding rates among late preterm, early-term, and term infants were 87, 88, and 92 percent, respectively, (p = 0.21), late preterm versus term infants were less likely to exclusively breastfeed (39.8 vs. 62.3%, p = 0.002). Inclusion of hospital support in multivariable modeling did not attenuate the effect of late preterm gestation. DISCUSSION: Differences in practices do not account for decreased exclusive breastfeeding among late preterm infants. Hospital supportive practices increase the likelihood of any breastfeeding.

Fatores do pré-natal e do puerpério que interferem na autoeficácia em amamentação / Los factores del prenatal y del posparto que interfieren en la autoeficacia de la lactancia materna / Pre-natal and puerperium factors that interfere on self-efficacy in breastfeeding

O objetivo deste estudo foi analisar quais os fatores relacionados ao pré-natal e ao puerpério que interferem na autoeficácia em amamentação para as puérperas internadas em alojamento conjunto. Métodos: Pesquisa quantitativa, transversal, realizada com 322 puérperas, no período de dezembro de 2011 a março de 2012, com um instrumento composto pela Breastfeeding Self-Efficacy Scale-Short Form e um formulário para caracterização das puérperas. A análise bivariada foi efetuada no software Statistical Package for Social Science. Resultados: A maioria das puérperas apresentou alta autoeficácia na amamentação. Ocorreu associação estatisticamente significante da autoeficácia na amamentação com o fato de o bebê ter sido colocado para sugar após a primeira hora. Conclusão: A promoção da autoeficácia materna em amamentar deve ter início no pré-natal, ser estimulada precocemente na maternidade e acompanhada durante o puerpério e puericultura. .

Objetivo:Analizar los factores relacionados al prenatal y al posparto que interfieren en la autoeficacia de la lactancia materna para las puérperas internadas en un alojamiento conjunto.Métodos:Investigación cuantitativa, transversal, realizada con 322 puérperas, en el período de diciembre de 2011 a marzo de 2012, con un instrumento compuesto por Breastfeeding Self-Efficacy Scale-Short Form y un formulario para la caracterización de las puérperas. El análisis bivariado fue realizado en el software Statistical Package for Social Science.Resultados:La mayoría de las puérperas presentó alta autoeficacia en la lactancia. Ocurrió asociación estadísticamente significante de la autoeficacia en la lactancia después de poner el bebé para mamar pasado la primera hora.Conclusión:La promoción de la autoeficacia de la lactancia materna debe comenzar durante la atención prenatal, también hay que ser estimulada temprano en la maternidad y acompañada durante el puerperio y puericultura.

[Influence of hospital location on short-term fate of premature infants born at 34 weeks of gestation]. / Influence du lieu d'hospitalisation sur le devenir à court terme des prématurés nés à 34 semaines d'aménorrhée.

In France, new care units have emerged in maternity wards for the treatment of moderate prematurity, called mother-child units (MCU). We compared the length of hospitalization between the MCUs and the neonatal units (NNUs) for premature infants born at 34 weeks of amenorrhea at Grenoble university hospital. This was a retrospective, single-center study, including 99 premature infants born from 34 of amenorrhea to 34 weeks+6 days between 2004 and 2009. Were included all premature 34-week infants hospitalized in the NNU or the MCU excluding those with respiratory distress, birth defects, and including infants whose birth weight was less than 1500g admitted to the neonatal intensive care unit or transferred secondarily to the MCU. The characteristics of both groups were similar apart from a lower birth weight in the NNU group (1892 vs. 2182g) and gestational age less than in the NNU group (34.1 vs. 34.3 SA). Our primary outcome, length of hospital stay, was significantly shorter in the MCU (15.4 vs. 20.7 days in the NNU, P<0.01) as well as the duration of nasogastric tube feeding (2.8 vs. 9.1 days, P<0.01). This difference remained after adjustment for birth weight and gestational age. Our retrospective study shows that the length of hospitalization of premature infants born at 34 weeks gestation and hospitalized in our center is significantly shorter when they are admitted to the MCU rather than neonatology. For this reason, this mode of hospitalization in maternity MCUs can be recommended.

[Maternal and hospital factors impacting the utilization of rooming-in care in South Korea: secondary analysis of national health data].

PURPOSE: In this study analysis was done of utilization of rooming-in care in South Korean hospitals in order to examine the factors related to mothers and hospitals that affect rooming-in care. METHODS: With the involvement of 254,414 mothers who gave birth across 953 hospitals, the analysis used the health insurance qualification data of the National Health Insurance Corporations and Health Insurance Review and Assessment Service (2006). Factors associated with rooming-in care were analyzed using a GEE logistic regression analysis to consider factors related to both mothers and hospitals. RESULTS: Only 45.1% of the mothers used rooming-in care. The results of the regression analysis revealed that individual factors of the mothers were not associated with rooming-in care, whereas group factors of the hospitals were. Rooming-in care use was primarily related to small hospital, location of hospital, and higher nurse staffing level. CONCLUSION: The findings of this study indicate that the utilization of rooming-in care is not associated with factors an individual mother, but rather with the group factors of the hospitals. Thus, a policy-based approach considering both of these types of factors is required to enhance the utilization of rooming-in care.

An evaluation of hospital breastfeeding policies in the Philadelphia metropolitan area 1994-2009: a comparison with the baby-friendly hospital initiative ten steps.

OBJECTIVE: The purpose of this study was to describe current breastfeeding policies and practices among Philadelphia, PA metropolitan hospitals and changes in their policies and practices over time. METHODS: In-person group interviews were conducted to obtain a composite picture of actual breastfeeding policies and practices. One questionnaire per hospital was completed based on responses from group consensus. Twenty-five hospitals providing maternity care were contacted. Information was obtained from personnel representing different areas of maternity services. Hospitals were classified according to the degree to which they were implementing the Ten Steps to Successful Breastfeeding. RESULTS: Mean breastfeeding rates at suburban hospitals were significantly higher than urban hospitals (72% vs. 49%, p = 0.015). Most hospitals were classified as high or moderately high implementers on six of the Ten Steps, including staff training (67%), printed information distributed to breastfeeding mothers (94%), breastfeeding initiation (61%), oral breastfeeding instruction given to mothers (83%), infant feeding schedules (89%), and hospital postpartum support (83%). Most hospitals reported partial or low implementation on two maternity practices: infant formula supplementation (61%) and rooming-in (72%). CONCLUSIONS: In the past 15 years, hospitals in the Philadelphia area have an increased awareness about breastfeeding and enhanced support of breastfeeding by healthcare professionals. In spite of an increase in overall breastfeeding rates, formula supplementation in hospitals and contact time between mothers and their newborns continue to be areas of concern.

Maternal and Hospital Factors Impacting the Utilization of Rooming-in Care in South Korea: Secondary Analysis of National Health Data

PURPOSE: Purpose: In this study analysis was done of utilization of rooming-in care in South Korean hospitals in order to examine the factors related to mothers and hospitals that affect rooming-in care. METHODS: With the involvement of 254,414 mothers who gave birth across 953 hospitals, the analysis used the health insurance qualification data of the National Health Insurance Corporations and Health Insurance Review and Assessment Service (2006). Factors associated with rooming-in care were analyzed using a GEE logistic regression analysis to consider factors related to both mothers and hospitals. RESULTS: Only 45.1% of the mothers used rooming-in care. The results of the regression analysis revealed that individual factors of the mothers were not associated with rooming-in care, whereas group factors of the hospitals were. Rooming-in care use was primarily related to small hospital, location of hospital, and higher nurse staffing level. CONCLUSION: The findings of this study indicate that the utilization of rooming-in care is not associated with factors an individual mother, but rather with the group factors of the hospitals. Thus, a policy-based approach considering both of these types of factors is required to enhance the utilization of rooming-in care.

Weight loss and jaundice in healthy term newborns in partial and full rooming-in.

BACKGROUND: An inadequate start of breastfeeding has been associated with reduced caloric intake, excessive weight loss and high serum bilirubin levels in the first days of life. The rooming-in has been proposed as an optimal model for the promotion of breastfeeding. AIM: The aim of this study was to compare two different feeding models (partial and full rooming-in) to evaluate differences as regard to weight loss, hyperbilirubinemia and prevalence of exclusive breastfeeding at discharge. METHODS: A total of 903 healthy term newborns have been evaluated; all the newborns were adequate for gestational age, with birth weight > or = 2800 g and gestational age > or = 37 weeks. RESULTS: The maximum weight loss (mean +/- SD), expressed as percent of birth weight, was not different in the two models (partial vs. full rooming-in 5.8% +/- 1.7%vs. 6% +/- 1.7%). A weight loss > or = 10% occurred in less than 1% in both groups. There were no statistical differences neither as mean of total serum bilirubin (partial vs. full rooming-in 10.5 +/- 3.3 vs. 10.1 +/- 2.9 mg/dl), nor as prevalence of hyperbilirubinemia (total serum bilirubin > or = 12 mg/dl). The prevalence of severe hyperbilirubinemia (total serum bilirubin > or = 18 mg/dl) and the use of phototherapy were not statistically different. Maximum weight loss was similar in the two models, even dividing by total serum bilirubin levels. At the discharge, exclusively breastfed newborns were 81% in full rooming-in and 42.9% in partial rooming-in. CONCLUSIONS: In conclusion, our results allow considering our assistance models similar as regards to severe hyperbilirubinemia and pathological weight loss in term healthy newborns even if full rooming-in is associated with higher prevalence of exclusive breastfeeding at the discharge.

[Justifications for formula supplementation in low-risk newborns at a Baby-Friendly Hospital]. / Justificativas para uso de suplemento em recém-nascidos de baixo risco de um Hospital Amigo da Criança.

The Baby-Friendly Hospital Initiative recommends not giving newborn infants any food or drink other than breast milk unless medically indicated. This study investigated the prevalence and alleged reasons for giving formula supplementation to rooming-in newborns at a Baby-Friendly Hospital. Participants were 300 formula-supplemented, exclusively rooming-in newborns at a Baby-Friendly Hospital in Rio de Janeiro, Brazil. Reasons for formula supplementation were classified as acceptable or unacceptable in accordance with the WHO/UNICEF Baby-Friendly Hospital Initiative guidelines. A supplementation prevalence of 33.3% was found. The main allegations were: hypogalactia/ agalactia (36.8%), conditions involving risk of hypoglicemia (21.1%), cesarean section (7.9%), stomatognathic system-related conditions (7.4%), maternal conditions (6.3%), and absence of maternal HIV serology (4.5%). Cesarean section was associated with a higher risk of supplementation (RP = 2.1; 95%CI: 1.77-2.55) as compared to vaginal delivery. Supplementation prevalence was high, and only 9% of the allegations were justified.

Justificativas para uso de suplemento em recém-nascidos de baixo risco de um Hospital Amigo da Criança / Justifications for formula supplementation in low-risk newborns at a Baby-Friendly Hospital

A Iniciativa Hospital Amigo da Criança preconiza que não se dê a recém-natos nenhum outro alimento ou líquido além do leite materno, a não ser que haja indicação clínica (passo 6). Este estudo teve como objetivo verificar a prevalência e identificar justificativas alegadas para suplementação ao aleitamento materno em recém-nascidos de alojamento conjunto. A amostra foi composta por 300 recém-nascidos de um Hospital Amigo da Criança do Rio de Janeiro, Brasil, que usaram suplemento dentre os que permaneceram exclusivamente em alojamento conjunto. As justificativas alegadas para uso de suplemento foram classificadas como aceitáveis ou não segundo critérios da Iniciativa Hospital Amigo da Criança. A prevalência de uso de suplemento foi de 33,3 por cento. As principais justificativas foram: hipogalactia/agalactia (36,8 por cento), condições de risco para hipoglicemia (21,1 por cento), parto cesáreo (7,9 por cento), condições relativas ao sistema estomatognático (7,4 por cento), condições maternas (6,3 por cento) e ausência de resultado de teste rápido anti-HIV (4,5 por cento). O parto cesáreo esteve associado à maior risco de uso de suplemento (RP = 2,1; IC95 por cento: 1,77-2,55) em relação ao parto vaginal. A prevalência do uso de suplemento foi elevada, sendo 9 por cento das justificativas alegadas aceitáveis.

The Baby-Friendly Hospital Initiative recommends not giving newborn infants any food or drink other than breast milk unless medically indicated. This study investigated the prevalence and alleged reasons for giving formula supplementation to rooming-in newborns at a Baby-Friendly Hospital. Participants were 300 formula-supplemented, exclusively rooming-in newborns at a Baby-Friendly Hospital in Rio de Janeiro, Brazil. Reasons for formula supplementation were classified as acceptable or unacceptable in accordance with the WHO/UNICEF Baby-Friendly Hospital Initiative guidelines. A supplementation prevalence of 33.3 percent was found. The main allegations were: hypogalactia/ agalactia (36.8 percent), conditions involving risk of hypoglicemia (21.1 percent), cesarean section (7.9 percent), stomatognathic system-related conditions (7.4 percent), maternal conditions (6.3 percent), and absence of maternal HIV serology (4.5 percent). Cesarean section was associated with a higher risk of supplementation (RP = 2.1; 95 percentCI: 1.77-2.55) as compared to vaginal delivery. Supplementation prevalence was high, and only 9 percent of the allegations were justified.

Epidemiology of co-sleeping and nighttime waking at 12 months in a birth cohort.

OBJECTIVE: To investigate the prevalence and factors associated with co-sleeping and nighttime waking among the children of the Pelotas 2004 cohort at 12 months of age. METHODS: All children born in the city of Pelotas, RS, Brazil during 2004 were enrolled on a longitudinal study. Mothers were interviewed at delivery and once more at 12 months of age to obtain information on their sociodemographic and reproductive characteristics and on their children's sleep and the environment in which their children sleep. Co-sleeping was defined as habitually sharing the bed with another person. Multivariate analysis was performed using Poisson regression. RESULTS: The prevalence of co-sleeping at 12 months was 45.8% (95%CI 44.2-47.3). Co-sleeping was more common among mothers with low socioeconomic status, less education, younger mothers, mothers with more previous births and among children who wake at night. The prevalence of nighttime waking was 46.1% (95%CI 44.6-47.7). Nighttime waking was more common among boys and among the offspring of mothers who had had a greater number of previous pregnancies and of mothers who had been employed while pregnant. CONCLUSION: Co-sleeping and nighttime waking are common among this study population, indicating a need to continue follow-up in order to observe how long these habits persist through childhood and to investigate their consequences for child development and behavior.

Epidemiologia do co-leito e do despertar noturno aos 12 meses de idade em uma coorte de nascimentos / Epidemiology of co-sleeping and nighttime waking at 12 months in a birth cohort

OBJETIVO: Investigar a prevalência e os fatores associados ao co-leito e ao despertar noturno entre as crianças da coorte de Pelotas de 2004, aos 12 meses de idade. MÉTODOS: Todas as crianças nascidas em 2004 em Pelotas (RS) foram incluídas em um estudo longitudinal. Ao nascer e aos 12 meses de idade, as mães foram entrevistadas sobre características sociodemográficas e reprodutivas e sobre o sono e o ambiente em que a criança dorme. Co-leito foi definido como o compartilhamento habitual da cama com outra pessoa. As análises multivariáveis foram realizadas por regressão de Poisson. RESULTADOS: A prevalência de co-leito aos 12 meses foi de 45,8 por cento (IC95 por cento 44,2-47,3). O co-leito foi maior entre as mães de baixo nível socioeconômico, menos escolarizadas, mais jovens, com maior paridade e entre crianças que acordam à noite. A prevalência de despertar noturno foi de 46,1 por cento (IC95 por cento 44,6-47,7). O despertar noturno foi mais freqüente entre os meninos e entre filhos de mães com maior paridade, e menos freqüente entre mães que trabalharam fora durante a gravidez. CONCLUSÃO: O co-leito e o despertar noturno são freqüentes na população estudada, indicando a necessidade de acompanhamento para observar a persistência destes hábitos ao longo da infância e investigar suas conseqüências sobre o comportamento e o desenvolvimento infantis.

OBJECTIVE: To investigate the prevalence and factors associated with co-sleeping and nighttime waking among the children of the Pelotas 2004 cohort at 12 months of age. METHODS: All children born in the city of Pelotas, RS, Brazil during 2004 were enrolled on a longitudinal study. Mothers were interviewed at delivery and once more at 12 months of age to obtain information on their sociodemographic and reproductive characteristics and on their children's sleep and the environment in which their children sleep. Co-sleeping was defined as habitually sharing the bed with another person. Multivariate analysis was performed using Poisson regression. RESULTS: The prevalence of co-sleeping at 12 months was 45.8 percent (95 percentCI 44.2-47.3). Co-sleeping was more common among mothers with low socioeconomic status, less education, younger mothers, mothers with more previous births and among children who wake at night. The prevalence of nighttime waking was 46.1 percent (95 percentCI 44.6-47.7). Nighttime waking was more common among boys and among the offspring of mothers who had had a greater number of previous pregnancies and of mothers who had been employed while pregnant. CONCLUSION: Co-sleeping and nighttime waking are common among this study population, indicating a need to continue follow-up in order to observe how long these habits persist through childhood and to investigate their consequences for child development and behavior.

Rooming-in compared with standard care for newborns of mothers using methadone or heroin.

OBJECTIVE: To evaluate the effect of rooming-in (rather than standard nursery care) on the incidence and severity of neonatal abstinence syndrome among opioid-exposed newborns and on the proportion of mothers who retain custody of their babies at hospital discharge. DESIGN: Retrospective cohort study. SETTING: Lower mainland in southwestern British Columbia. PARTICIPANTS: We selected 32 women in the city of Vancouver known to have used heroin or methadone during pregnancy between October 2001 and December 2002. Comparison groups were a historical cohort of 38 women in Vancouver and a concurrent cohort of 36 women cared for in a neighbouring community hospital. MAIN OUTCOME MEASURES: Need for treatment with morphine, number of days of treatment with morphine, and whether babies were discharged in the custody of their mothers. RESULTS: Rooming-in was associated with a significant decrease in need for treatment of neonatal abstinence syndrome compared with the historical cohort (adjusted relative risk [RR] 0.40, 95% confidence interval [CI] 0.20 to 0.78) and the concurrent cohort (adjusted RR 0.39, 95% CI 0.20 to 0.75). Rooming-in was also associated with shorter newborn length of stay in hospital compared with both comparison groups. Newborns who roomed in at BC Women's Hospital were significantly more likely to be discharged in the custody of their mothers than babies in the historical cohort (RR 2.23, 95% CI 1.43 to 3.98) or the concurrent cohort (RR 1.52, 95% CI 1.15 to 2.53) were. CONCLUSION: Rooming-in might ease opioid-exposed newborns' transition to extrauterine life and promote more effective mothering.