title: UNICEF/WHO baby-friendly hospital initiative: does the use of bottles and pacifiers in the neonatal nursery prevent successful breastfeeding? Neonatal Study Group.
abstract: To promote breastfeeding, UNICEF/WHO have launched the "baby-friendly hospital initiative" focusing on hospital care routines during delivery and the first days of life. In industrialised countries, two aspects of the initiative have raised controversy: how do restriction of supplemental feedings and ban of bottles and pacifiers affect long-term breastfeeding performance? From ten centres 602 healthy newborns were randomly assigned either to a UNICEF group with restrictive fluid supplements and avoidance of bottles and pacifiers during the first 5 days of life, or to a standard group with conventional feeding practice. Breastfeeding was encouraged in both groups. The main study endpoints were the prevalences of breast-feeding on day 5, and after 2, 4 and 6 months. Of the newborns 46% violated the UNICEF protocol, mostly because of maternal requests to give a pacifier or supplements by bottle. In the standard group, the drop-out rate was 9.7%. No significant differences in breastfeeding frequency and duration could be found: (UNICEF vs standard) day 5: 100% vs 99%; 2 months: 88% vs 88%; 4 months: 75% vs 71%; 6 months: 57% vs 55%. Inclusion of drop-outs due to pacifier use did not alter the results.
  
  
  CONCLUSIONS
  In our study population fluid supplements offered by bottle with or without the use of pacifiers during the first 5 days of life were not associated with a lower frequency or shorter duration of breastfeeding during the first 6 months of life.
authors.affiliation: Kinderspital, Luzern, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Schubiger
authors.forename: U
authors.initials: U
authors.lastname: Schwarz
authors.forename: O
authors.initials: O
authors.lastname: Tönz
mesh_terms: D001942:Breast Feeding; D019049:Developed Countries; D017408:Guidelines as Topic; D006801:Humans; D007224:Infant Care / Q000592:standards; D007225:Infant Food; D007231:Infant, Newborn; D017283:Neonatal Nursing / Q000592:standards; D014480:United Nations; D014944:World Health Organization