title: Expansion of the baby-friendly hospital initiative ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations.
abstract: In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother's own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding. Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up.
authors.affiliation: Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden. kerstin.hedberg_nyqvist@kbh.uu.se
authors.forename: Kerstin H
authors.initials: KH
authors.lastname: Nyqvist
authors.forename: Anna-Pia
authors.initials: AP
authors.lastname: Häggkvist
authors.forename: Mette N
authors.initials: MN
authors.lastname: Hansen
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kylberg
authors.forename: Annemi L
authors.initials: AL
authors.lastname: Frandsen
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Maastrup
authors.forename: Aino
authors.initials: A
authors.lastname: Ezeonodo
authors.forename: Leena
authors.initials: L
authors.lastname: Hannula
authors.forename: Laura N
authors.initials: LN
authors.lastname: Haiek
mesh_terms: D001942:Breast Feeding; D002983:Clinical Competence; D004496:Education, Continuing; D005260:Female; D006293:Health Promotion / Q000379:methods / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D015931:Intensive Care, Neonatal / Q000379:methods / Q000592:standards*; D060127:Kangaroo-Mother Care Method / Q000592:standards; D007774:Lactation; D012386:Rooming-in Care / Q000592:standards
keywords: Baby-Friendly Hospital Initiative; breastfeeding; breastfeeding promotion; neonatal intensive care unit; preterm infants