Department of Pediatrics, Newton-Wellesley Hospital, Newton, MA, United States.
Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States.
Adv Nutr. 2024 Mar;15(3):100183. doi: 10.1016/j.advnut.2024.100183. Epub 2024 Feb 2.
Supporting optimal newborn nutrition and the positive maternal-infant relationship while encouraging safe sleep practices are essential components of maternal and newborn care in the hospital setting following birth. Breastfeeding is widely recognized as the best practice to support the nutritional needs and well-being of the infant, and recommendations have been developed by the WHO, the American Academy of Pediatrics (AAP), and the United States Centers for Disease Control to encourage and successfully support breastfeeding efforts before hospital discharge. The 10 Steps to Successful Breastfeeding, developed and promoted by the WHO, form the basis of the Baby-Friendly Hospital Initiative (BFHI) and have become the international framework for public health initiatives to promote breastfeeding. An evaluation of hospital performance implementing the 10 steps through the process of "Baby-Friendly Designation" (BFD) has been suggested by many breastfeeding advocates as the optimal pathway to attain the goals of the BFHI. However, the WHO has recognized that BFD may not be an appropriate goal in all settings, and indicated, as part of their updated 2018 guidance, that "facilities may make changes in their policies and procedures to obtain the designation, but these changes are not always sustainable, especially when there are no regular monitoring systems in place." In addition, unintended associated issues regarding newborn safety and maternal dissatisfaction with some of the 10 steps have emerged. This perspective discusses the challenges faced by hospitals attempting to implement the BFHI 10 steps and suggests potential solutions to make progress in those efforts with or without BFD and also the efforts needed to support formula feedings when appropriate.
在医院环境中，支持新生儿最佳营养和积极的母婴关系，同时鼓励安全的睡眠实践，是产妇和新生儿护理的重要组成部分。母乳喂养被广泛认为是满足婴儿营养需求和健康的最佳实践，世界卫生组织（WHO）、美国儿科学会（AAP）和美国疾病控制与预防中心（CDC）制定了相关建议，以鼓励并成功支持婴儿在出院前进行母乳喂养。世界卫生组织制定和推广的 10 步母乳喂养成功法构成了“婴儿友好医院倡议”（BFHI）的基础，并成为促进母乳喂养的公共卫生倡议的国际框架。许多母乳喂养倡导者建议，通过“婴儿友好设计指定”（BFD）的过程评估医院实施这 10 步的表现，是实现 BFHI 目标的最佳途径。然而，世界卫生组织已经认识到，在所有情况下 BFD 可能都不是一个合适的目标，并在其 2018 年更新的指导意见中指出，“医疗机构可能会改变其政策和程序以获得指定，但这些变化并不总是可持续的，尤其是在没有定期监测系统的情况下。”此外，还出现了一些关于新生儿安全和产妇对 10 步中的某些步骤不满的意外相关问题。本文从医院的角度出发，讨论了在实施 BFHI 10 步时所面临的挑战，并提出了一些潜在的解决方案，以在有无 BFD 的情况下推动这些努力取得进展，以及在需要时为配方奶喂养提供支持。
