title: [Feeding practices with human milk in newborns less than 1.500 g or less than 32 weeks].
abstract: BACKGROUND
  There is currently no unified policy on either breastfeeding support or enteral nutrition practices, as regards human milk (HM) in pre-term newborns. The aim of this study was to describe breastfeeding support measures, as well as the use of HM in very preterm infants in Spanish public hospitals.
  
  
  METHODS
  A questionnaire on enteral feeding practices was distributed. Data were analysed from units caring for newborns less than 32 weeks or 1,500g. A univariate analysis was performed comparing level ii and iii care units.
  
  
  RESULTS
  There was a 91% response rate. A total of 93 units cared for infants less than 32 weeks or 1,500g (17 level ii and 76 level iii), and 49% of the units recorded the breastfeeding rate on discharge. Around 75% (70/93) had a guideline on managing HM (level iii 81 vs. level ii 47%, P=.002), and 25% had access to donor human milk. Just under half (46%) started trophic feeding in the first 6h. Target enteral feeding volume in stable preterm infants was ≥ 180ml/kg/day in 89% of the units (level iii 93% vs. level ii 70%, P =.017). HM fortifier was used in 96% of the units. In 92%, it was added when the required enteral volume was tolerated. In 59% of the units, adjustments in the quantity of fortifier were made according to weight, and in 36%, it depended on analytical criteria. Some units (9%) used pure protein fortifier.
  
  
  CONCLUSIONS
  There is a marked variability in breastfeeding support measures and in feeding practices of preterm infants in Spanish neonatal units.
authors.affiliation: Servicio de Neonatología, Hospital 12 de Octubre, Madrid, España. Electronic address: claraalonsodiaz@gmail.com.
authors.forename: Clara
authors.initials: C
authors.lastname: Alonso-Díaz
authors.affiliation: Servicio de Neonatología, Hospital 12 de Octubre, Madrid, España.
authors.forename: Isabel
authors.initials: I
authors.lastname: Utrera-Torres
authors.affiliation: Servicio de Neonatología, Hospital 12 de Octubre, Madrid, España.
authors.forename: Concepción
authors.initials: C
authors.lastname: de Alba-Romero
authors.affiliation: Servicio de Neonatología, Hospital 12 de Octubre, Madrid, España.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Flores-Antón
authors.affiliation: Servicio de Neonatología, Hospital 12 de Octubre, Madrid, España.
authors.forename: María
authors.initials: M
authors.lastname: López-Maestro
authors.affiliation: Unidad de Epidemiología Clínica, Hospital 12 de Octubre, Instituto de Investigación Biomédica Imas12, Madrid, España.
authors.forename: David
authors.initials: D
authors.lastname: Lora-Pablos
authors.affiliation: Servicio de Neonatología, Hospital 12 de Octubre, Madrid, España.
authors.forename: Carmen R
authors.initials: CR
authors.lastname: Pallás-Alonso
mesh_terms: D001942:Breast Feeding; D004750:Enteral Nutrition; D005247:Feeding Behavior; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008895:Milk, Human; D010818:Practice Patterns, Physicians'; D013030:Spain; D011795:Surveys and Questionnaires
keywords: Alimentación enteral; Apoyo a la lactancia materna; Breastfeeding support; Enteral feeding; Enteral nutrition; Fortificación de leche materna; Human milk; Human milk fortification; Leche materna; Nutrición enteral; Prematuros; Preterm infants; Recién nacidos de muy bajo peso; Very low birth weight