• Compliance with the "Baby-friendly Hospital Initiative for Neonatal Wards" in 36 countries.

      Maastrup, Ragnhild; Haiek, Laura N; 1 Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. 2 Ministère de la Santé et des Services sociaux, Direction générale de la santé publique, Quebec, Quebec, Canada. 3 McGill University, Department of Family Medicine, Montreal, Quebec, Canada. 4 St. Mary's Hospital, St. Mary's Research Centre, Montreal, Quebec, Canada. (Wiley, 2019-04)
      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.
    • Skin-to-skin care in neonatal intensive care units in the Nordic countries: a survey of attitudes and practices.

      Olsson, Emma; Andersen, Randi D; Axelin, Anna; Jonsdottir, Rakel B; Maastrup, Ragnhild; Eriksson, Mats; Department of Paediatrics, Örebro University Hospital, Sweden. (Wiley-Blackwell, 2012-11)
      To investigate the application of skin-to-skin care (SSC) in the Nordic countries, the existence of guidelines for SSC and the attitudes of neonatal staff towards SSC. One questionnaire was distributed at unit level and one at staff level in all Nordic neonatal intensive care units (n = 109). The unit questionnaire was answered by 95 (87%) units and the staff questionnaire by 1446 staff members (72%). All units offered SSC to various degrees, but guidelines only existed at 47% of them. Units in Denmark, Norway and Sweden seemed to use SSC earlier, longer and in more medically complicated situations than units in Finland and Iceland. Seventy-seven per cent of the units had private rooms where parents and infants could stay together, still the physical environment of the units limited the use of SSC. Medical risks were considered the main barrier for further implementation of SSC, while general development and early interaction were the most frequently mentioned benefits. Skin-to-skin care is implemented in all Nordic neonatal units, but offered to various degrees, to various populations and to varying extents. Danish, Norwegian and Swedish units are offering SSC more extensively than units in Finland and Iceland.