Do neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding?
OBJECTIVE
to establish how well postnatal ward neonatal hypoglycaemia guidelines facilitate breast feeding and adhere to UNICEF UK Baby Friendly Initiative (BFI) recommendations, and to compare compliance with different recommendations.


METHODS
an appraisal of guidelines obtained via email survey using a UNICEF UK BFI checklist tool. Information about Baby Friendly Health/Hospital Initiative (BFHI) accreditation status was obtained by email questionnaire.


METHODS
tertiary neonatal centres in Australia and New Zealand.


METHODS
22 guidelines were returned from 23 centres eligible to participate.


RESULTS
guidelines generally scored poorly. On a scale ranging from 31 to 124 of overall guideline quality, the median score was 71. On a scale of 9 to 36 for adherence to recommendations to facilitate breast feeding, the median guideline score was 20. Compliance with the recommendation to promote skin-to-skin contact and early breast feeding was poor across all centres, achieving a score of 59 out of 88. Nine of 22 guidelines mentioned skin-to-skin contact after birth and 14 advised feeding within one hour of birth. The recommendation about discussing artificial milk supplementation with parents received a score of 44 out of 88. Fourteen guidelines listed Large for Gestational Age (LGA) infants to be at risk of hypoglycaemia. Few guidelines included up-to-date references or flowcharts.


CONCLUSIONS
guidelines need to recommend early skin-to-skin contact and discussion with parents before artificial milk supplementation. Guidelines suggest LGA neonates are being screened unnecessarily.


CONCLUSIONS
guidelines need constant revision as evidence for best practice expands. The UNICEF UK BFI checklist provides a readily available quality improvement tool.
Sydney Medical School, University of Sydney, Sydney, Australia.
Samantha L
SL
Sundercombe
Sydney School of Public Health, University of Sydney, Sydney, Australia.
Camille H
CH
Raynes-Greenow
Sydney School of Public Health, University of Sydney, Sydney, Australia.
Robin M
RM
Turner
Sydney School of Public Health, University of Sydney, Sydney, Australia. Electronic address: heather.jeffery@sydney.edu.au.
Heather E
HE
Jeffery
D001315:Australia / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D007224:Infant Care / Q000379:methods / Q000592:standards; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000628:therapy; D009520:New Zealand / Q000453:epidemiology; D011181:Postnatal Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011314:Preventive Health Services / Q000379:methods / Q000592:standards
Breast feeding; Guideline; Hypoglycaemia; Protocol