Pediatrics, Neonatology, Thomas Jefferson University/Nemours, Philadelphia, Pennsylvania, USA.
J Matern Fetal Neonatal Med. 2022 Feb;35(4):657-662. doi: 10.1080/14767058.2020.1730796. Epub 2020 Feb 23.
The Baby Friendly Hospital initiative (BFHI) is a global initiative of the World Health Organization developed in 1991 to promote and support successful breastfeeding. It has led to increased rates of exclusive breastfeeding. Exclusive breastfeeding may increase risk for hypoglycemia, hyperbilirubinemia, and dehydration requiring higher level of neonatal care.
To determine if there was a change in admissions to the Neonatal Intensive Care Unit (NICU) from the newborn nursery after the adoption of BFHI in a large urban hospital.
This is a retrospective analysis of all neonates admitted to the NICU from the newborn nursery between January 2007 and December 2016 at Thomas Jefferson University Hospital, in Philadelphia, PA, USA. Demographics, clinical characteristics and primary diagnosis for admission were compared between those admitted before (January 2007 to December 2011) and after (January 2012 to December 2016) the initiation of BFHI.
A total of 20,124 infants were born and 3,684 infants (18.3%) were admitted to NICU. 570 infants (2.8% of live birth) were admitted to the NICU from the newborn nursery, 282 (49.5%) were born before and 288 (50.5%) born after BFHI. There was no significant difference in the number of infants admitted from the newborn nursery either as a percentage of total deliveries (2.8 versus 2.9%, = .6) or percentage of total NICU admissions (15.5 versus 15.5%, = 1.0) before and after the BFHI. Additionally, there was no difference in number of infants admitted with a diagnosis of possible sepsis, hypoglycemia, neonatal abstinence syndrome (NAS) and hyperbilirubinemia between the two groups. However, significantly more infants admitted with hypoglycemia required IV fluids for hypoglycemia after the initiation of BFHI (8 out of 27 versus 21 out of 28, .001). The age of admission was higher and the duration of NICU stay was shorter in infants admitted after the initiation of the BFHI.
The BFHI has not led to a significant change in the number of infants admitted to NICU from the newborn nursery or reasons for their admissions. However, since its adoption, there has been an increase in the use of IV fluids for treatment of hypoglycemia. These findings suggest a role for additional treatments other than formula to prevent IV fluid use, such as glucose gel. Change in NICU guidelines for the management of possible sepsis and NAS may have impacted the duration of hospitalization in infants born after BFHI.
婴儿友好医院倡议（BFHI）是世界卫生组织于 1991 年发起的一项全球性倡议，旨在促进和支持成功母乳喂养。它已导致纯母乳喂养率的增加。纯母乳喂养可能会增加低血糖、高胆红素血症和脱水的风险，需要更高水平的新生儿护理。
确定在一家大型城市医院采用 BFHI 后，从新生儿病房到新生儿重症监护病房（NICU）的入院人数是否发生变化。
这是对美国宾夕法尼亚州费城托马斯杰斐逊大学医院新生儿病房至 2016 年 12 月期间所有入住 NICU 的新生儿进行的回顾性分析。比较了在 BFHI 启动之前（2007 年 1 月至 2011 年 12 月）和之后（2012 年 1 月至 2016 年 12 月）入院的患者的人口统计学、临床特征和主要诊断。
共有 20124 名婴儿出生，3684 名（18.3%）婴儿入住 NICU。570 名婴儿（活产婴儿的 2.8%）从新生儿病房转入 NICU，其中 282 名（49.5%）出生于 BFHI 之前，288 名（50.5%）出生于 BFHI 之后。从新生儿病房转入 NICU 的婴儿数量无论是在总分娩量中的比例（2.8%对 2.9%， = .6）还是在总 NICU 入院量中的比例（15.5%对 15.5%， = 1.0），BFHI 前后均无显著差异。此外，两组之间可能因败血症、低血糖、新生儿戒断综合征（NAS）和高胆红素血症而入院的婴儿数量没有差异。然而，在 BFHI 启动后，因低血糖而需要静脉输液治疗低血糖的入院婴儿数量显著增加（8 例中有 27 例，21 例中有 28 例， = .001）。BFHI 启动后入院的婴儿年龄更高，NICU 住院时间更短。
BFHI 并未导致从新生儿病房转入 NICU 的婴儿数量或其入院原因发生重大变化。然而，自采用 BFHI 以来，用于治疗低血糖的静脉输液量有所增加。这些发现表明，除了配方奶之外，还需要使用其他治疗方法来预防静脉输液的使用，例如葡萄糖凝胶。BFHI 后，可能因败血症和 NAS 而住院的婴儿住院时间缩短，可能与 NICU 管理指南的改变有关。
