title: Breastfeeding Support in Spanish Neonatal Intensive Care Units and the Baby-Friendly Hospital Initiative.
abstract: BACKGROUND
  The Baby-Friendly Hospital Initiative (BFHI) has a positive effect on breastfeeding in maternity wards; however, few studies have examined to what degree it affects care in neonatal intensive care units (NICUs). Recently, the BFHI has been adapted to the NICUs (Neo-BFHI).
  
  
  OBJECTIVE
  This study aimed to compare breastfeeding support in Spanish NICUs in hospitals with BFHI accreditation or in the process of being accredited (group 1) with NICUs in hospitals that have not yet begun this initiative (group 2).
  
  
  METHODS
  A validated questionnaire on breastfeeding support was distributed to level II and III NICUs in Spanish public hospitals. A univariate analysis and an analysis adjusted for the number of beds in NICUs were conducted. The results of the analysis of 36 breastfeeding support measures are presented in accordance with the Ten Steps to Successful Breastfeeding adapted to NICUs.
  
  
  RESULTS
  Of the 141 participating NICUs, 129 (91%) responded to the questionnaire: 38 NICUs from group 1 and 91 NICUs from group 2. Group 1 had implemented a higher number of breastfeeding support measures than group 2. There were significant differences in 18 measures related to steps 2, 4, 5, 7, and 8 of the Neo-BFHI. In addition, a comparison of NICUs in hospitals with full accreditation (7 of 129) with those in group 2 revealed significant differences in 7 measures pertaining to steps 2, 5, 8, and 9.
  
  
  CONCLUSIONS
  The Spanish NICUs in hospitals with BFHI accreditation or in the process of being accredited have better implementation of practices to promote and support breastfeeding.
authors: 1 Department of Neonatology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors: Clara
authors: C
authors: Alonso-Díaz
authors: 1 Department of Neonatology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors: Isabel
authors: I
authors: Utrera-Torres
authors: 1 Department of Neonatology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors: Concepción
authors: C
authors: de Alba-Romero
authors: 1 Department of Neonatology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors: Beatriz
authors: B
authors: Flores-Antón
authors: 2 Clinic Research Unit, IMAS12-CIBERESP, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors: David
authors: D
authors: Lora-Pablos
authors: 1 Department of Neonatology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors: Carmen Rosa
authors: CR
authors: Pallás-Alonso
mesh_terms: D000068:Accreditation / Q000706:statistics & numerical data; D001942:Breast Feeding / Q000379:methods* / Q000706:statistics & numerical data; D006293:Health Promotion / Q000379:methods* / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data*; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration / Q000706:statistics & numerical data; D011181:Postnatal Care / Q000379:methods / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: Baby-Friendly Hospital Initiative; Spain; Ten Steps to Successful Breastfeeding; breastfeeding; breastfeeding support; premature infants