News Brief: The Baby-Friendly Hospital Initiative Network.
J Hum Lact. 2018 Sep 19;:890334418794657
Authors: MacEnroe T
PMID: 30231214 [PubMed - as supplied by publisher]
News Brief: The Baby-Friendly Hospital Initiative Network.
J Hum Lact. 2018 Sep 19;:890334418794657
Authors: MacEnroe T
PMID: 30231214 [PubMed - as supplied by publisher]
"Then You Raise Them with Shirchoy or Cookies": Understanding Influences on Delayed Dietary Diversity among Children in Tajikistan.
Matern Child Nutr. 2018 Sep 19;:e12694
Authors: Klassen AC, Milliron BJ, Suehiro Y, Abdulloeva S, Leonberg B, Grossman S, Chenault M, Bossert L, Maqsood J, Abduzhalilov R, Iskandari M
Dietary diversity is a key component of IYCF as well as adult health. In Tajikistan, a predominantly rural, former Soviet country in Central Asia, we conducted formative research to identify barriers to dietary diversity, and strategies for nutrition behavior change. In Spring, 2016, mixed methods data collection took place across thirteen villages in all five regions, collecting collaborative mapping, structured assessments of stores and markets, home visits for dietary recalls, food storage, preparation and meal observations, focus groups with pregnant women, mothers of young children, fathers, and mothers-in-law, and in-depth expert interviews with local nutrition and health influentials. Overall, maternal diet was adequate in terms of diversity (only 13% reported <5/10 food groups in the past 24 hours); however, only 42% of index children 6-24 months met WHO guidelines for diversity, and only 34% met minimum acceptable diet (MAD) criteria. In addition to issues of poverty and food scarcity, qualitative data reveal many behavioral barriers to timely introduction of diverse complementary foods. Women's strategies focused on gradual introduction of household diet components, without regard for diversity or nutrition. Foods such as meat were seen as costly and thus inappropriate for IYCF, and food taboos (i.e., fresh vegetables) further reduced diversity. Infant food preparation methods such as grinding were seen as impractical, and many foods were withheld until children develop teeth. Possible nutrition education strategies include point-of-purchase campaigns to improve availability and appeal of IYCF-friendly foods, as well as influencing other key household members through mosques, schools and healthcare providers.
PMID: 30231190 [PubMed - as supplied by publisher]
Postnatal exposure to household disinfectants, infant gut microbiota and subsequent risk of overweight in children.
CMAJ. 2018 Sep 17;190(37):E1097-E1107
Authors: Tun MH, Tun HM, Mahoney JJ, Konya TB, Guttman DS, Becker AB, Mandhane PJ, Turvey SE, Subbarao P, Sears MR, Brook JR, Lou W, Takarao TK, Scott JA, Kozyrskyj AL, CHILD Study Investigators
BACKGROUND: Emerging links between household cleaning products and childhood overweight may involve the gut microbiome. We determined mediating effects of infant gut microbiota on associations between home use of cleaning products and future overweight.
METHODS: From the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort, we tested associations between maternal report of cleaning product use and overweight at age 3, and whether associations were mediated by microbial profiles of fecal samples in 3- to 4-month-old infants.
RESULTS: Among 757 infants, the abundance of specific gut microbiota was associated with household cleaning with disinfectants and eco-friendly products in a dose-dependent manner. With more frequent use of disinfectants, Lachnospiraceae increasingly became more abundant (highest v. lowest quintile of use: adjusted odds ratio [AOR] 1.93, 95% confidence interval [CI] 1.08 to 3.45) while genus Haemophilus declined in abundance (highest v. lowest quintile of use: AOR 0.36, 95% CI 0.20 to 0.65). Enterobacteriaceae were successively depleted with greater use of eco-friendly products (AOR 0.45, 95% CI 0.27 to 0.74). Lachnospiraceae abundance significantly mediated associations of the top 30th centile of household disinfectant use with higher body mass index (BMI) z score (p = 0.02) and with increased odds of overweight or obesity (p = 0.04) at age 3. Use of eco-friendly products was associated with decreased odds of overweight or obesity independently of Enterobacteriaceae abundance (AOR 0.44, 95% CI 0.22 to 0.86), with no significant mediation (p = 0.2).
INTERPRETATION: Exposure to household disinfectants was associated with higher BMI at age 3, mediated by gut microbial composition at age 3-4 months. Although child overweight was less common in households that cleaned with eco-friendly products, the lack of mediation by infant gut microbiota suggests another pathway for this association.
PMID: 30224442 [PubMed - in process]
Scaling up child development centres in Bangladesh.
Child Care Health Dev. 2018 Jan;44(1):19-30
Authors: Khan NZ, Sultana R, Ahmed F, Shilpi AB, Sultana N, Darmstadt GL
BACKGROUND: Child Development Centres (CDCs) have been established within government medical college tertiary hospitals across Bangladesh. Services entail a parent-professional partnership in a child and family friendly environment with a focus on assessment, diagnosis, and management of a range of neurodevelopmental disorders in children and adolescents 0-16 years of age. Services are provided by a multidisciplinary team of professionals (child health physician, child psychologist, and developmental therapist) who emphasize quality of services over the numbers of children seen.
METHODS: In 2008, Dhaka Shishu (Children's) Hospital was given the mandate by the government to conceptualize, train, and monitor CDCs nationwide. Here, we describe the rationale and processes for the establishment of the national network of CDCs and discuss lessons learned on scaling up early childhood development services in a low resource setting.
RESULTS: Fifteen CDCs were established in major government hospitals across Bangladesh and have recorded 208,866 patient visits. The majority (79%) of children were from the lowest and middle-income families, and about one third (30%) were < 2 years of age at first presentation. Two thirds of children seen in follow-up demonstrated improvements in functional skills since their first visit, 77% in their adaptive behaviour (i.e., activities of daily living) and 70% in cognitive functions.
CONCLUSIONS: CDCs are expanding coverage for child neurodevelopment services across Bangladesh through a tiered system of home-based screening, community- and clinic-based functional assessment, and CDC-based diagnosis, support, and referral. Vulnerable populations-the lowest income groups and younger children-comprised the majority of patients, among whom there is high unmet need for psychological services that is being met for the first time. Innovative human resource development, including a 3-month training for the multidisciplinary teams, enabled wide coverage for assessment and diagnosis of a range of neurodevelopmental problems. Demand for services is growing, especially among non-government and private hospitals.
PMID: 29235172 [PubMed - indexed for MEDLINE]
Satisfaction with childbirth services provided in public health facilities: results from a cross- sectional survey among postnatal women in Chhattisgarh, India.
Glob Health Action. 2017;10(1):1386932
Authors: Jha P, Larsson M, Christensson K, Skoog Svanberg A
BACKGROUND: A woman's satisfaction with childbirth services can have a significant impact on her mental health and ability to bond with her neonate. Knowing postnatal women's opinions and satisfaction with services makes the services more women-friendly. Indian women's satisfaction with childbirth services has been explored qualitatively, or by using non-standard local questionnaires, but scientific data gathered with standardised questionnaires are extremely limited.
OBJECTIVE: To measure postnatal Indian women's satisfaction with childbirth services at selected public health facilities in Chhattisgarh, India.
METHODS: Cross-sectional survey using consecutive sampling (n = 1004) was conducted from March to May 2015. Hindi-translated and validated versions of the Scale for Measuring Maternal Satisfaction for Vaginal Births (VB) and Caesarean Births (CB) were used for data collection.
RESULTS: Although most of the women (VB 68.7%; CB 79.2%) were satisfied with the overall childbirth services received, those who had VB were least satisfied with the processes around meeting their neonates (mean subscale score 1.8, SD 1.3), while women having CB were least satisfied with postpartum care received (mean subscale score 2.7, SD 1.2). Regression analyses revealed that among women having VB, interacting with care providers, being able to maintain privacy, and being free from fear of childbirth had a positive influence on overall satisfaction with the childbirth. Among women having CB, earning their own salary and having a positive perception of self-health had associations with overall birth satisfaction.
CONCLUSIONS: Improving interpersonal interaction with nurse-midwives, and ensuring privacy during childbirth and hospital stay, are recommended first steps to improve women's childbirth satisfaction, until the supply gap is eliminated.
PMID: 29087240 [PubMed - indexed for MEDLINE]
Using the COMMVAC taxonomy to map vaccination communication interventions in Mozambique.
Glob Health Action. 2017;10(1):1321313
Authors: Muloliwa AM, Cliff J, Oku A, Oyo-Ita A, Glenton C, Ames H, Kaufman J, Hill S, Cartier Y, Bosch-Capblanch X, Rada G, Lewin S
BACKGROUND: Improved communication about childhood vaccination is fundamental to increasing vaccine uptake in low-income countries. Mozambique, with 64% of children fully vaccinated, uses a range of communication interventions to promote uptake of childhood immunisation.
OBJECTIVES: Using a taxonomy developed by the 'Communicate to Vaccinate' (COMMVAC) project, the study aims to identify and classify the existing communication interventions for vaccination in Mozambique and to find the gaps.
METHODS: We used a qualitative research approach to identify the range of communication interventions used in Mozambique. In-depth semi-structured interviews were carried out with key purposively selected personnel at national level and relevant documents were collected and analysed. These data were complemented with observations of communication during routine vaccination and campaigns in Nampula province. We used the COMMVAC taxonomy, which organises vaccination communication intervention according to its intended purpose and the population targeted, to map both routine and campaign interventions.
RESULTS: We identified interventions used in campaign and routine vaccination, or in both, fitting five of the seven taxonomy purposes, with informing or educating community members predominating. We did not identify any interventions that aimed to provide support or facilitate decision-making. There were interventions for all main target groups, although fewer for health providers. Overlap occurred: for example, interventions often targeted both parents and community members.
CONCLUSIONS: We consider that the predominant focus on informing and educating community members is appropriate in the Mozambican context, where there is a high level of illiteracy and poor knowledge of the reasons for vaccination. We recommend increasing interventions for health providers, in particular training them in better communication for vaccination. The taxonomy was useful for identifying gaps, but needs to be more user-friendly if it is to be employed as a tool by health service managers.
PMID: 28573937 [PubMed - indexed for MEDLINE]
Breastfeeding Programs and Policies, Breastfeeding Uptake, and Maternal Health Outcomes in Developed Countries
Book. 2018 07
Authors: Feltner C, Weber RP, Stuebe A, Grodensky CA, Orr C, Viswanathan M
OBJECTIVES: To summarize the effectiveness of community, workplace, and health care system–based programs and policies aimed at supporting and promoting breastfeeding and determine the association between breastfeeding and maternal health.
DATA SOURCES: We searched PubMed®/MEDLINE®, the Cochrane Library, and CINAHL® from January 1, 1980, to October 12, 2017, for studies relevant to the effectiveness of health care system–based, workplace, and community breastfeeding programs and policies. For evidence on breastfeeding and maternal health, we updated the 2007 Agency for Healthcare Research and Quality report on this topic and searched the same databases from November 1, 2005, to October 12, 2017. For studies of breastfeeding programs and policies, trials, systematic reviews, and observational studies with a control group were eligible; we excluded primary care–based programs delivered as part of routine care. For studies related to breastfeeding and maternal health, we included systematic reviews, case-control studies, and cohort studies.
REVIEW METHODS: Pairs of reviewers independently selected, extracted data from, and rated the risk of bias of relevant studies; they graded the strength of evidence (SOE) using established criteria. We synthesized all evidence qualitatively.
RESULTS: We included 128 studies (137 publications) and 10 systematic reviews. Of these, 40 individual studies were relevant to the effectiveness of breastfeeding programs or policies, and the remainder were relevant to one or more maternal health outcomes. Based on evidence from one large randomized controlled trial (RCT) (Promotion of Breastfeeding Intervention Trial [PROBIT], N=17,046) enrolling mothers who intended to breastfeed and nine cohort studies (1,227,182 women), we graded the SOE for the Baby-Friendly Hospital Initiative (BFHI) as moderate for improving rates of breastfeeding duration. Evidence from eight cohort studies of BFHI (135,983 women) also demonstrates improved rates of breastfeeding initiation (low SOE). Low SOE (k=4 studies; 1,532 women) supports the conclusion that health care education or training of staff alone (without additional breastfeeding support services) does not improve breastfeeding initiation rates. Women, Infants and Children (WIC, a Federal supplemental nutrition program) interventions that focus on peer support are effective in improving rates of breastfeeding initiation and duration (low SOE). We found limited evidence for other (community-based) interventions and no comparative studies on workplace or school-based interventions or harms associated with interventions. For maternal health outcomes, low SOE supports the conclusion that ever breastfeeding or breastfeeding for longer durations may be associated with lower rates of breast cancer, epithelial ovarian cancer, hypertension, and type 2 diabetes, but not fractures. Because of heterogeneity and inconsistent results, we found insufficient evidence on whether breastfeeding is associated with postpartum depression, cardiovascular disease, or postpartum weight change.
CONCLUSIONS: The body of evidence for breastfeeding programs and policies was diverse in terms of interventions and settings. Current evidence supports the benefit of BFHI for improving rates of breastfeeding initiation and duration; however, evidence from one large RCT (PROBIT) has limited applicability, and observational studies do not clearly establish the magnitude of benefit. For women enrolled in WIC, low SOE supports peer-support interventions for improving breastfeeding outcomes. The identified associations between breastfeeding and improved maternal health outcomes are supported by evidence from observational studies, which cannot determine cause-and-effect relationships.
Compliance with the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI): A cross-sectional study in 36 countries.
Matern Child Nutr. 2018 Sep 10;:e12690
Authors: Maastrup R, Haiek LN, Lubbe W, Meerkin DY, Wolff L, Hatasaki K, Alsumaie MA, De Leon-Mendoza S, Ng YPM, Shorey S, Conti R, Leme T, Rossetto EG, Acosta AA, Nuñez AEO, Toala E, Gonzalez MEO, Berger A, Hennequin Y, Bosnjak AP, Niela-Vilén H, Laurent C, Rousseau S, Jonsdottir R, Chapin EM, Smildzere A, Tamelienė R, Žemaitienė R, Arendt M, Hansen MN, Huitfeldt AS, Bernatowicz-Łojko U, do Céu Barbieri-Figueiredo M, França AP, Abolyan L, Pastbina I, Pallás-Alonso C, Pumarega MTM, Eriksson M, Flacking R, Johnson E, Anderson S, Berkman J, Boswall D, Brown D, Emberley J, LeDrew M, Scringer-Wilkes M, Semenic S, Perriman N, O'Donoghue D
In 2012, the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI) began providing recommendations to improve breastfeeding support for preterm and ill infants. This cross-sectional survey aimed to measure compliance on a global level with the Neo-BFHI's expanded Ten steps to Successful Breastfeeding and three Guiding Principles in neonatal wards. In 2017 the Neo-BFHI Self-Assessment questionnaire was used in 15 languages to collect data from neonatal wards of all levels of care. Answers were summarized into compliance scores ranging from 0 to 100 at the ward, country and international levels. A total of 917 neonatal wards from 36 low, middle and high-income countries from all continents participated. The median international overall score was 77, and median country overall scores ranged from 52 to 91. Guiding Principle 1 (respect for mothers), Step 5 (breastfeeding initiation and support), and Step 6 (human milk use) had the highest scores, 100, 88, and 88, respectively. Steps 3 (antenatal information) and 7 (rooming-in) had the lowest scores, 63 and 67, respectively. High-income countries had significantly higher scores for Guiding principle 2 (family-centered care), Step 4 (skin-to-skin contact) and Step 5. Neonatal wards in hospitals ever-designated Baby-friendly had significantly higher scores than those never designated. Sixty percent of managers stated they would like to obtain Neo-BFHI designation. Currently, Neo-BFHI recommendations are partly implemented in many countries. The high number of participating wards indicates international readiness to expand Baby-friendly standards to neonatal settings. Hospitals and governments should increase their efforts to better support breastfeeding in neonatal wards.
PMID: 30198645 [PubMed - as supplied by publisher]
Exclusive breast feeding and dehydration fever in newborns during the first days of life.
J Matern Fetal Neonatal Med. 2018 Sep 10;:1-5
Authors: Kenaley KM, Greenspan J, Aghai ZH
OBJECTIVES: To determine the prevalence of dehydration fever in infants admitted to the Neonatal Intensive Care Unit (NICU) from the well newborn nursery with fever in the first days of life.
STUDY DESIGN: Retrospective data analysis of term infants admitted to the NICU from the well newborn nursery with fever (n = 75). Infants were divided into two groups based on hydration status using clinical and laboratory signs of dehydration. Clinical and laboratory variables were compared between the two groups.
RESULTS: Fifty-three of the 75 infants admitted to the NICU with fever had clinical and laboratory signs of dehydration (71%). Infants with dehydration were more likely to be exclusively breast fed and present with fever at >24 h of age. There were no positive blood or cerebrospinal fluid cultures in infants with dehydration. The incidence of dehydration fever increased after implementation of an "Exclusive Breast Feeding" policy from 1.4/1000 to 3.5/1000 live births (p ≤ .01).
CONCLUSIONS: Dehydration is associated with fever in exclusively breast fed infants during the first several days of life. There were no cases of serious bacterial or viral infections in the cohort of febrile infants with clinical and laboratory signs of dehydration.
PMID: 30196730 [PubMed - as supplied by publisher]
The World Health Organization Code and Exclusive Breastfeeding in China, India, and Vietnam.
Matern Child Nutr. 2018 Sep 08;:e12685
Authors: Robinson H, Buccini G, Curry L, Perez-Escamilla R
Promoting exclusive breastfeeding (EBF) is a highly feasible and cost-effective means of improving child health. Regulating the marketing of breastmilk substitutes is critical to protecting EBF. In 1981, the World Health Assembly adopted the WHO International Code of Marketing of Breastmilk Substitutes (the Code), prohibiting the unethical advertising and promotion of breastmilk substitutes. This comparative study aimed to (i) explore the relationships among Code enforcement and legislation, infant formula sales, and EBF in India, Vietnam, and China; (ii) identify best practices for Code operationalization; and (iii) identify pathways by which Code implementation may influence EBF. We conducted secondary descriptive analysis of available national-level data and seven high level key informant interviews. Findings indicate that the implementation of the Code is a necessary but insufficient step alone to improve breastfeeding outcomes. Other enabling factors, such as adequate maternity leave, training on breastfeeding for health professionals, health systems strengthening through the Baby Friendly Hospital Initiative (BFHI), and breastfeeding counseling for mothers, are needed. Several infant formula industry strategies with strong conflict of interest were identified as harmful to EBF. Transitioning breastfeeding programs from donor-led to government-owned is essential for long-term sustainability of Code implementation and enforcement. We conclude that the relationships among the Code, infant formula sales, and EBF in India, Vietnam, and China are dependent on countries' engagement with implementation strategies and the presence of other enabling factors.
PMID: 30194804 [PubMed - as supplied by publisher]
Evaluation of Ready, Set, BABY: A prenatal breastfeeding education and counseling approach.
Birth. 2018 Sep 06;:
Authors: Parry KC, Tully KP, Hopper LN, Schildkamp PE, Labbok MH
BACKGROUND: Comprehensive prenatal education on infant feeding is recommended by many United States health organizations because of the need to maximize maternal preparedness for managing lactation physiology. Ready, Set, BABY (RSB) is a curriculum developed for counseling women about breastfeeding benefits and management including education on optimal maternity care practices. We hypothesized that RSB would be acceptable to mothers and that mothers' strength of breastfeeding intentions would increase, and their comfort with the idea of formula feeding would decrease after educational counseling using the materials. We also hypothesized that mothers' knowledge of optimal maternity care practices would increase after participation.
METHODS: Materials were sent to a total of seven sites in the United States and Puerto Rico. Local health care practitioners completed training before counseling mothers with the curriculum. A pre- and postintervention questionnaire was administered to participants. Statistical analysis of results included paired t tests, Wilcoxon signed-rank tests, and McNemar's tests.
RESULTS: Four hundred and sixteen expectant women participated. In the pre- and postintervention comparison, maternal participation in RSB significantly improved Infant Feeding Intentions Scale scores (P < 0.001) and knowledge of Baby-Friendly recommended maternity care practices (P < 0.001), while significantly decreasing comfort with the idea of formula feeding (P < 0.001). The education materials were positively rated by participants.
CONCLUSIONS: The findings indicate that the approach of using RSB in prenatal counseling group classes or individual sessions improves breastfeeding intentions. Future testing is needed to determine the effectiveness of the materials for impacting breastfeeding outcomes.
PMID: 30191591 [PubMed - as supplied by publisher]
The effect of maternity practices on exclusive breastfeeding rates in U.S. hospitals.
Matern Child Nutr. 2018 Sep 04;:e12670
Authors: Patterson JA, Keuler NS, Olson BH
The Baby-friendly Hospital Initiative (BFHI) includes a set of 10 evidenced-based maternity practices that when used together have been shown to improve breastfeeding outcomes. In 2007, the Centers for Disease Control and Prevention launched the Maternity Practices in Infant Nutrition and Care (mPINC) survey to assess and monitor these and other evidenced-based maternity practices. The purpose of this study was to explore individual maternity practices measured in the 2013 mPINC survey, along with hospital demographic information, and their relationships with exclusive breastfeeding (EBF) rates, using a sample of United States (U.S.) hospitals. We obtained mPINC survey data from 69 BFHI hospitals and 654 non-BFHI hospitals in the U.S., and EBF rates from The Joint Commission, a leading hospital accreditation agency. On the basis of linear regression analysis, we found that most maternity practices studied were significantly associated with EBF rates (max adjusted R2 = 14.9%). We found a parsimonious model with an adjusted R2 of 47.3%. This study supports the need for a systematic approach in providing breastfeeding support as no one maternity care practice was able to explain the variability in EBF rates as well as a collection of maternity care practices.
PMID: 30182474 [PubMed - as supplied by publisher]
A Youth-Friendly Pharmacy Initiative: Decreasing Unintended Pregnancies Among Disenfranchised Youth.
Health Promot Pract. 2018 Sep 03;:1524839918796214
Authors: Roberts CB, Bedell J
Teens from neighborhoods that have experienced historical and contemporary disinvestment have among the highest rates of teen pregnancy, yet they have less access to resources to reduce unintended pregnancies. In recognition of this, the New York City Department of Health and Mental Hygiene (NYCDOHMH) developed the Youth-Friendly Pharmacy Initiative. Over 7 consecutive months in 2015, educational materials and free NYCDOHMH condoms were placed strategically in independent pharmacies in the South Bronx. Refills were made monthly. Pharmacists were directed to order free refills from the NYCDOHMH after the project ended. To evaluate the feasibility of the study, a survey with teens (15-19 years) at the study midpoint and a 3-month post follow-up assessment were conducted. The retention rate over 7 months was 96.4% (27/28 pharmacies). Forty-three percent (2,068/4,830) of the booklets and 87.9% (43,841/49,850) of the condoms were taken by patrons. The posters and pamphlets were recognized by 63.6% and 27.3% of the teens, respectively. Forty-percent of the teens were aware of the free condoms, and one third had taken the free condoms. In the post assessment, 20% of the sampled pharmacies independently sought out resources for free condom refills. Pharmacies are positive sexual and reproductive health resources for underserved teens.
PMID: 30175629 [PubMed - as supplied by publisher]
Fathers' cortisol and testosterone in the days around infants' births predict later paternal involvement.
Horm Behav. 2018 Aug 27;:
Authors: Kuo PX, Braungart-Rieker JM, Burke Lefever JE, Sarma MS, O'Neill M, Gettler LT
Human paternal behavior is multidimensional, and extant research has yet to delineate how hormone patterns may be related to different dimensions of fathering. Further, although studies vary in their measurement of hormones (i.e., basal or reactivity), it remains unclear whether basal and/or reactivity measures are predictive of different aspects of men's parenting. We examined whether men's testosterone and cortisol predicted fathers' involvement in childcare and play with infants and whether fathers' testosterone and cortisol changed during fathers' first interaction with their newborn. Participants were 298 fathers whose partners gave birth in a UNICEF-designated "baby-friendly" hospital, which encourages fathers to hold their newborns 1 h after birth, after mothers engage in skin-to-skin holding. Salivary testosterone and cortisol were measured before and after fathers' first holding of their newborns. Basal and short-term changes in cortisol and testosterone were analyzed. Fathers were contacted 2-4 months following discharge to complete questionnaires about childcare involvement. Fathers' cortisol decreased during the time they held their newborns on the birthing unit. Fathers' basal testosterone in the immediate postnatal period predicted their greater involvement in childcare. Both basal and reactivity cortisol predicted fathers' greater involvement in childcare and play. Results suggest that reduced basal testosterone is linked with enhanced paternal indirect and direct parenting effort months later, and that higher basal cortisol and increases in cortisol in response to newborn interaction are predictive of greater paternal involvement in childcare and play, also months later. Findings are discussed in the context of predominating theoretical models on parental neuroendocrinology.
PMID: 30165061 [PubMed - as supplied by publisher]
The uptake and implementation of the Baby Friendly Health Initiative in Australia.
Women Birth. 2018 Aug 08;:
Authors: Esbati A, Henderson A, Taylor J, Barnes M
PROBLEM: Despite evidence that implementation of the Initiative has been effective in increasing breastfeeding rates and duration of breastfeeding worldwide; the uptake is low with only 70 Baby Friendly accredited maternity facilities across Australia (approximately 23% of facilities).
BACKGROUND: The Ten Steps to Successful Breastfeeding and International Code of Marketing of Breastmilk Substitutes shaped the foundation for the Initiative to implement practices that protect, promote and support breastfeeding. There is evidence that implementation of the Initiative is impacted by individual and organisational culture, organisational support, and education. Organisational change is also identified as playing an important role in the successful implementation of the Initiative. Despite policy and guideline support for the Initiative at national and state levels in Australia the uptake of the Initiative is low.
AIM: The aim of this research was to explore health practitioners' perspectives about the uptake and implementation of the Initiative in Australia.
METHODS: Semi-structured, face-to-face, telephone and Skype interviews were conducted with 12 health practitioners. Thematic analysis was used to analyse data.
RESULTS: Participants identified that the uptake and implementation of the Initiative in Australia is complex. This complexity was related to six themes: (1) policy and guideline support for the Initiative, (2) leadership support to implement the Initiative, (3) improving breastfeeding and Initiative-related knowledge, (4) improving communication between stakeholders regarding the Initiative, (5) accreditation and reaccreditation processes, and (6) implementation complexity.
CONCLUSION: Using organisational change theories as a guide to implementation of the Initiative may be useful for facilities intending to become accredited.
PMID: 30098980 [PubMed - as supplied by publisher]
Association between rooming-in policy and neonatal hyperbilirubinemia.
Pediatr Neonatol. 2018 Jun 12;:
Authors: Shan KH, Wang TM, Lin MC
BACKGROUND: The practices promoted by the Baby-friendly Hospital Initiative have become a part of current mainstream postpartum infant care. Rooming-in to facilitate skin-to-skin contact and breastfeeding is a major component of this initiative. However, whether rooming-in is associated with admission for neonatal hyperbilirubinemia has seldom been reported. The aim of this study was to evaluate the association between rooming-in and neonatal hyperbilirubinemia.
METHODS: This was a retrospective cohort study. Term neonates were consecutively enrolled from the nursery of a medical center from January 2011 to December 2013. During the study period, rooming-in care was strongly encouraged according to the World Health Organization guidelines, if the parents agreed. The endpoint was defined as admission for phototherapy. Risk of neonatal hyperbilirubinemia in rooming-in neonates was calculated. Potential confounding factors, including exclusive breastfeeding, potential ABO incompatibility, Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, and body weight loss (BWL), were adjusted by multiple logistic regression models.
RESULTS: Totally, 3341 infants were enrolled in this study after excluding 40 infants admitted for other reasons. The rooming-in rate increased yearly during the study period. However, the rate of neonatal hyperbilirubinemia also increased simultaneously. The odds ratio (OR) of neonatal hyperbilirubinemia in the rooming-in group was 7.04 (95% CI, 4.41∼11.24). The rooming-in group demonstrated a higher percentage of exclusive breastfeeding and BWL >10% at 3 days of age. After adjusting for potential confounding factors, rooming-in was still a significant risk factor for neonatal hyperbilirubinemia (OR: 8.48; 95% CI: 5.04∼14.25).
CONCLUSIONS: The practice of rooming-in is now part of the mainstream postpartum newborn care. However, the increased incidence of neonatal hyperbilirubinemia is a potential side effect of which healthcare providers should be aware. Further research is needed to confirm the role of rooming-in in neonatal hyperbilirubinemia.
PMID: 30089533 [PubMed - as supplied by publisher]
Factors associated with breastfeeding support from health care professionals by implementing a Clinical Practice Guideline.
Birth. 2018 Jul 26;:
Authors: Harillo-Acevedo D, Ramos-Morcillo AJ, Ruzafa-Martinez M
BACKGROUND: The prevalence and duration of breastfeeding are at low levels and may be improved by the support of health care professionals. Our objective was to determine the effect of implementing a breastfeeding clinical practice guideline on factors associated with breastfeeding support by health care professionals, adopting a Theory of Planned Behavior approach.
METHODS: We conducted an observational, cross-sectional study during 2016 in a health area with implemented clinical practice guideline on breastfeeding, comparing the results with data from a previous cross-sectional study (2011) in the same area, in a standard-care area, and in a Baby-Friendly Hospital Initiative (BFHI)-accredited area. A validated questionnaire (four scales: attitudes, beliefs, subjective norms, and behavioral intention) was completed by professionals in each area. Descriptive analysis was followed by comparisons among the different settings using the chi-square test.
RESULTS: In the area with the implemented clinical practice guideline, the professionals scored significantly higher in subjective norms and beliefs than had been recorded in 2011 (preimplementation), and their scores for all four scales were significantly higher than in the standard-care area. Professionals obtained significantly higher scores for subjective norms in the BFHI-accredited area than in the other settings.
CONCLUSIONS: Clinical practice guideline implementation improved the responses of professionals on breastfeeding support in subjective norms and beliefs scales. There is a need for activities to assist breastfeeding in a practical manner and for more effective measures to ensure compliance with the International Code of Marketing of Breast-milk Substitutes.
PMID: 30051575 [PubMed - as supplied by publisher]
Determinants of in-hospital feeding practices in Shiraz, Iran: Results of a prospective cohort study.
Birth. 2018 Jul 27;:
Authors: Zarshenas M, Zhao Y, Binns CW, Scott JA
BACKGROUND: In-hospital feeding practices have been shown negatively to affect breastfeeding exclusivity and duration. The purpose of this study was to report the prevalence and determinants of delayed breastfeeding, provision of traditional prelacteal foods, and use of infant formula in hospital.
METHODS: Between June 2014 and March 2015, 700 women were recruited from three public and two private maternity hospitals in Shiraz, Iran. Data were collected at recruitment via face-to-face interviews and extracted from medical records. Multivariable logistic regression was used to explore the association of feeding practices with a variety of maternal characteristics and hospital practices.
RESULTS: Only 32.2% of infants were breastfed within 1 hour of birth, with 40.8% receiving a traditional prelacteal food, and 34.9% given formula during their hospital stay. Compared with infants delivered vaginally, those delivered by cesarean were more likely to have experienced delayed breastfeeding and received formula, but less likely to have received traditional prelacteal foods. Infants who did not experience skin-to-skin contact were more likely to have experienced delayed breastfeeding and received traditional prelacteal foods and formula in hospital.
CONCLUSIONS: Although four out of the five hospitals were designated as Baby-Friendly, several of the 10 Steps to Successful Breastfeeding were not adhered to. The high rate of cesarean delivery was a barrier to the early initiation of breastfeeding and the majority of infants did not experience early skin-to-skin contact. Maternity care practices should be reviewed and include a clear breastfeeding care plan for women who undergo a cesarean delivery.
PMID: 30051498 [PubMed - as supplied by publisher]
Preoperative care of Polypoid exposed mucosal template in bladder exstrophy: the role of high-barrier plastic wraps in reducing inflammation and polyp size.
Int Braz J Urol. 2018 May-Jun;44(3):591-599
Authors: Sabetkish N, Sabetkish S, Kajbafzadeh AM
OBJECTIVE: To assess the role of high-barrier plastic wrap in reducing the number and size of polyps, as well as decreasing the inflammation and allergic reactions in exstrophy cases, and to compare the results with the application of low-barrier wrap.
MATERIALS AND METHODS: Eight patients with bladder exstrophy-epispadias complex (BEEC) that had used a low density polyethylene (LDPE) wrap for coverage of the exposed polypoid bladder in preoperative care management were referred. The main complaint of their parents was increase in size and number of polyps. After a period of 2 months using the same wrap and observing the increasing pattern in size of polyps, these patients were recommended to use a high-barrier wrap which is made of polyvinylidene chloride (PVdC), until closure. Patients were monitored for the number and size of polyps before and after the change of barriers. The incidence of para-exstrophy skin infection/inflammation and skin allergy were assessed. Biopsies were taken from the polyps to identify histopathological characteristics of the exposed polyps.
RESULTS: The high barrier wrap was applied for a mean ± SD duration of 12±2.1 months. Polyps' size and number decreased after 12 months. No allergic reaction was detected in patients after the usage of PVdC; three patients suffered from low-grade skin allergy when LDPE was applied. Also, pre-malignant changes were observed in none of the patients in histopathological examination after the application of PVdC.
CONCLUSION: Polyps' size and number and skin allergy may significantly decrease with the use of a high-barrier wrap. Certain PVdC wraps with more integrity and less evaporative permeability may be more "exstrophy-friendly".
PMID: 29368874 [PubMed - indexed for MEDLINE]
Mapping, Measuring, and Analyzing the Process of Skin-to-Skin Contact and Early Breastfeeding in the First Hour After Birth.
Breastfeed Med. 2018 Jul 23;:
Authors: Cadwell K, Brimdyr K, Phillips R
BACKGROUND: Although the benefits of immediate, continuous, uninterrupted skin-to-skin contact (SSC) and early breastfeeding have been widely researched and confirmed, the challenge remains to improve the consistency of this practice. Fewer than half of newborns worldwide are breastfed in the first hour.
DESIGN: Cross-sectional descriptive study utilizing iterative review and analysis of video ethnography as well as data extracted from patient records.
SAMPLE AND SETTING: Eighty-four medically uncomplicated mothers and full-term newborns were observed during the first hour after birth at a Baby-Friendly designated hospital in the United States.
FINDINGS: Process mapping using an algorithm which included Robson criteria indicated that although included mothers were expected to give birth vaginally and had no medical concerns that would preclude eligibility for SSC in the first hour after birth, 31 of 84 newborns (37%) did not receive immediate SSC after vaginal birth as planned and only 23 (27.4%) self-attached and suckled.
CONCLUSION: Process mapping of optimal skin-to-skin practice in the first hour after birth using the algorithm, HCP-S2S-IA, produced an accurate and useful measurement, illuminating how work is conducted and providing patterns for analysis and opportunities for improvement with targeted interventions.
PMID: 30036081 [PubMed - as supplied by publisher]