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

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

Title: Compliance with the “Baby-friendly Hospital Initiative for Neonatal Wards” in 36 countries
Author: The Neo-BFHI Survey Group
Date: 2019-04
Language: English
University/Institute: Landspitali - The National University Hospital of Iceland
Department: Faculty of Nursing and Midwifery
Women's and Childrens's Services
Series: Maternal and Child Nutrition; 15(2)
ISSN: 1740-8695
DOI: https://doi.org/10.1111/mcn.12690
Subject: Baby-friendly Hospital Initiative; breastfeeding; lactation; monitoring; neonatal; preterm; Pediatrics, Perinatology and Child Health; Obstetrics and Gynecology; Nutrition and Dietetics; Public Health, Environmental and Occupational Health
URI: https://hdl.handle.net/20.500.11815/3442

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The Neo-BFHI Survey Group 2019 , ' Compliance with the “Baby-friendly Hospital Initiative for Neonatal Wards” in 36 countries ' , Maternal and Child Nutrition , vol. 15 , no. 2 , e12690 . https://doi.org/10.1111/mcn.12690


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.


Funding Information: The authors are grateful to the Minist?re de la Sant? et des Services sociaux du Qu?bec for partly funding the study, funding the Open Access, and their support throughout the project. We would also like to thank Eric Belzile and Fatima Bouharaoui for their statistical support and Marie-Caroline Bergouignan, Julie Botzas-Coluni, and Cleo Zifkin for research assistance (St. Mary's Research Centre, Montreal, Quebec); Helen Brotherton (United Kingdom) for ensuring participation of The Gambia; and Ada Vahtrik (Estonia), Renata Vettorazzi (Slovenia), and Karen Walker (Australia) for recruitment of participants and collection of data in Estonia, Slovenia, and Australia. Lastly, we would like to thank all the neonatal ward managers and staff who volunteered their precious time to participate in the survey. Publisher Copyright: © 2018 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.

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