Sundercombe Samantha L, Raynes-Greenow Camille H, Turner Robin M, Jeffery Heather E
Sydney Medical School, University of Sydney, Sydney, Australia.
Sydney School of Public Health, University of Sydney, Sydney, Australia.
Midwifery. 2014 Dec;30(12):1179-86. doi: 10.1016/j.midw.2014.04.004. Epub 2014 Apr 28.
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.
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.
tertiary neonatal centres in Australia and New Zealand.
22 guidelines were returned from 23 centres eligible to participate.
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.
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.
guidelines need constant revision as evidence for best practice expands. The UNICEF UK BFI checklist provides a readily available quality improvement tool.
确定产后病房新生儿低血糖指南在促进母乳喂养以及遵循联合国儿童基金会英国爱婴医院倡议（BFI）建议方面的效果，并比较对不同建议的依从性。
使用联合国儿童基金会英国BFI清单工具，通过电子邮件调查对指南进行评估。通过电子邮件问卷获取有关爱婴医院倡议（BFHI）认证状态的信息。
澳大利亚和新西兰的三级新生儿中心。
从23个符合参与条件的中心返回了22份指南。
指南的总体得分普遍较低。在总体指南质量从31分到124分的评分范围内，中位数为71分。在促进母乳喂养建议的依从性评分从9分到36分的范围内，指南的中位数得分为20分。所有中心在促进皮肤接触和早期母乳喂养建议方面的依从性都很差，在88分中得分为59分。22份指南中有9份提到了出生后的皮肤接触，14份建议在出生后一小时内进行喂养。关于与父母讨论人工喂养补充的建议在88分中得分为44分。14份指南将大于胎龄（LGA）婴儿列为低血糖风险人群。很少有指南包含最新参考文献或流程图。
指南需要建议早期皮肤接触，并在人工喂养补充之前与父母进行讨论。指南表明对LGA新生儿进行不必要的筛查。
随着最佳实践证据的扩展，指南需要不断修订。联合国儿童基金会英国BFI清单提供了一个现成的质量改进工具。
