Breastfeeding promotion in neonatal intensive care unit: impact of a new program toward a BFHI for high-risk infants

Aim: The study evaluates a breastfeeding promotion program in an Italian neonatal intensive care unit (NICU) over a period of time. Methods: Clinical data of the newborns admitted in the NICU of the Bambino Gesu' Children's Hospital in Rome in 2002 were gathered (78; program implemented) and were compared to similar data collected in 1998 (76; prior to the program) and in 2000 (50; program activated). Breastfeeding management during hospitalization and infant feeding after discharge were examined through maternal interviews. Results: The general features of the newborns and their parents were comparable. In 2002, the rate of exclusively breastfeeding (at breast and/or expressed mother's milk) the first day at home was 51.2% and 64% in 2000 versus 21.2% in 1998 (p < 0.001). In the subset of newborns < 1500 g (VLBWI), the exclusively breastfeeding rate improvement was even more striking after program activation: 55.5% (2002) and 64.3% (2000) versus 4.5% (1998; p < 0.001). The impact of several recognized risk factors (medical condition of the infants, length of hospitalization, distance from maternal residence, type of delivery) on exclusively breastfeeding rate was significantly reduced after the program was implemented, except for higher maternal age. Conclusions: The implementation of a breastfeeding promotion program in NICU has a markedly positive effect on exclusive breastfeeding rate early after discharge. Further studies are necessary in order to adapt the Baby-Friendly Hospital Initiative (BFHI) approach to the NICU setting, taking into account the characteristics of such high-risk infants.