1 Departments of Family Medicine and Clinical Skills, University of Split School of Medicine, Split, Croatia.
2 Health Centre of Split and Dalmatia County, Split, Croatia.
J Hum Lact. 2018 Feb;34(1):106-115. doi: 10.1177/0890334417703367. Epub 2017 Jun 11.
The primary goal of the Baby-Friendly Hospital Initiative (BFHI) is to create conditions in maternity facilities that enable women to initiate and sustain the practice of breastfeeding exclusively. Research aim: This study aimed to determine hospital practices and breastfeeding rates before and after BFHI implementation and assess compliance with UNICEF/World Health Organization (WHO) standards for seven of the BFHI's Ten Steps to Successful Breastfeeding ( Ten Steps).
Mothers of healthy, term infants ( N = 1,115) were recruited from the postnatal ward of the University Hospital of Split, Croatia, between February 2008 and July 2011 and followed for 12 months in a repeated-measures, prospective, longitudinal, three-group, nonequivalent, cohort study. Breastfeeding rates, hospital practices-including seven of the Ten Steps-and maternal sociodemographic data were collected.
Parts of all seven Ten Steps that were assessed improved significantly post-BFHI. Step 3 ("antenatal education") showed the least improvement, whereas Step 7 ("rooming-in"; 2.6% pre-BFHI vs. 98.5% post-BFHI) and Step 9 ("no pacifiers/teats"; 21.8% pre-BFHI vs. 99.4% post-BFHI) showed the greatest improvement. Six months after Baby-Friendly designation, only Steps 7 and 9 were in full compliance with UNICEF/WHO standards. In-hospital, exclusive-breastfeeding rates rose markedly ( p < .001), but no change occurred in breastfeeding rates at 3, 6, or 12 months.
Full implementation of the BFHI was associated with significant improvement in hospital practices and in-hospital, exclusive-breastfeeding rates, but it did not affect breastfeeding rates postdischarge, emphasizing the vital role of community support. Baby-Friendly Hospital Initiative standards declined rapidly post-hospital designation, indicating the need for regular monitoring and reassessment as well as ongoing, effective training for hospital staff.
婴儿友好医院倡议（BFHI）的主要目标是在产科设施中创造条件，使妇女能够开始并持续进行纯母乳喂养。研究目的：本研究旨在确定 BFHI 实施前后的医院实践和母乳喂养率，并评估其对联合国儿童基金会/世界卫生组织（WHO）成功母乳喂养的十项措施（Ten Steps）中七个标准的遵守情况。
2008 年 2 月至 2011 年 7 月，从克罗地亚斯普利特大学医院的产后病房招募了 1115 名健康足月婴儿的母亲，并在重复测量、前瞻性、纵向、三组、非等效、队列研究中对其进行了 12 个月的随访。收集了母乳喂养率、医院实践（包括十个步骤中的七个）和产妇社会人口统计学数据。
评估的七个十项措施中的所有部分在 BFHI 后都有显著改善。第 3 步（“产前教育”）的改善最小，而第 7 步（“母婴同室”；BFHI 前为 2.6%，BFHI 后为 98.5%）和第 9 步（“不使用奶嘴/橡皮奶头”；BFHI 前为 21.8%，BFHI 后为 99.4%）的改善最大。在被指定为婴儿友好型医院后 6 个月，只有第 7 步和第 9 步完全符合联合国儿童基金会/世界卫生组织的标准。住院期间，纯母乳喂养率显著上升（p<0.001），但在 3、6 和 12 个月时，母乳喂养率没有变化。
BFHI 的全面实施与医院实践和住院期间纯母乳喂养率的显著改善相关，但对出院后的母乳喂养率没有影响，这强调了社区支持的重要作用。在医院指定为婴儿友好型后，婴儿友好型医院倡议标准迅速下降，表明需要定期监测和重新评估，以及对医院工作人员进行持续有效的培训。
