提高管理水平 做好爱婴社区工作

西城区卫生局在巩固爱婴区工作的基础上，以爱婴社区国际合作项目为引导，提高管理水平，探索爱婴社区管理方法，搞好部门协作，街道搭台，卫生部门提供技术服务，做好母乳喂养工作，提高妇幼保健工作水平     

创建爱婴区 推动妇幼卫生社区服务全面发展

浦东新区把创建爱婴区工作做为实施《中华人民共和国母婴保健法》，提高出生人口素质，保障妇女儿童健康的重要工作纳入管委会、社会发展局的工作计划和乡（镇）、街道的目标管理；把这项工作做为浦东新区精神文明建设和物质文明建设的结合点，发动新区各有关委、办、局积极参与和支持爱婴活动；把这项工作作为卫生部门认真贯彻预防为主卫生方针的具体行动，动员妇幼保健工作者和医务人员全力投入，形成保健和临床相结合的服务体系。     

Breastfeeding Rates and Hospital Breastfeeding Practices in Canada: A National Survey of Women

Background: The Baby‐Friendly Hospital Initiative was launched by the World Health Organization and UNICEF in 1989 to promote, protect, and support breastfeeding worldwide. The objective of this study was to report breastfeeding rates and adherence to the Baby Friendly Hospital Initiative of the World Health Organization and UNICEF in Canada, as reported by participants in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Methods: Eligible women (n = 8,244) were identified from a randomly selected sample of infants born 3 months before the May 2006 Canadian Census, and stratified by province or territory. Birth mothers living with their infants at the time of interview were invited to participate in a computer‐assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews took approximately 45 minutes and were completed when infants were between 5 and 10 months old (between 9 and 14 months in the territories). Completed responses were obtained from 6,421 women (78% response rate). Nineteen of 309 questions concerned early mother‐infant contact and breastfeeding practices. Results: Breastfeeding intention (90.0%) and initiation (90.3%) rates were high, although exclusive breastfeeding rates at 6 months after birth (14.4%) were lower than desirable. The findings suggested a low adherence to several best practices advocated by the Baby‐Friendly Hospital Initiative. Conclusion: Although breastfeeding initiation rates were relatively high in Canada, exclusive breastfeeding duration fell short of globally recommended standards.     

Implementing two national responsibilities of the revised UNICEF/WHO Baby‐Friendly Hospital Initiative: A two‐country case study

The 2018 implementation guidance for the Baby‐Friendly Hospital Initiative (BFHI) recommends institutionalising the ten Steps through nine national responsibilities for universal coverage and sustainability. As countries adapt BFHI programmes to this paradigm shift away from traditional designation programmes, documenting and sharing policy and programme experience are critical and currently sparse. This qualitative case study included desk reviews of published and grey literature on BFHI programming, national plans and policy documents specific to the selected national responsibilities for universal coverage and key informant (KI) interviews across a range of actors. In the Kyrgyz Republic, the case study explored responsibility 5, development and implementation of incentives and/or sanctions, and responsibility 6 in Malawi, providing technical assistance (TA). In both countries, the three sustainability responsibilities (national monitoring [7] communication and advocacy [8] and financing [9]) as they relate to the universal coverage of the targeted responsibilities were also explored. Thirty‐eight respondents in the Kyrgyz Republic described approaches that were used in the health system, including BFHI designation plaques, performance‐based financing and financial sanctions. However, currently, there are no formal incentives and sanctions. In Malawi, TA was utilised for national planning and to introduce quality improvement processes. Forty‐seven respondents mostly described provisions of TA in building and strengthening the capacity of providers. More programmatic evidence to demonstrate which types of incentives or sanctions can be effective and sustained and more documentation of how TA is provided across multiple aspects of implementation are needed as countries institutionalise BFHI.     

Impact of the Baby‐friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review

The Baby‐friendly Hospital Initiative (BFHI) is a key component of the World Health Organization/United Nations Children's Fund Global Strategy for Infant and Young Child Feeding. The primary aim of this narrative systematic review was to examine the impact of BFHI implementation on breastfeeding and child health outcomes worldwide and in the United States. Experimental, quasi‐experimental and observational studies were considered eligible for this review if they assessed breastfeeding outcomes and/or infant health outcomes for healthy, term infants born in a hospital or birthing center with full or partial implementation of BFHI steps. Of the 58 reports included in the systematic review, nine of them were published based on three randomized controlled trials, 19 followed quasi‐experimental designs, 11 were prospective and 19 were cross‐sectional or retrospective. Studies were conducted in 19 different countries located in South America, North America, Western Europe, Eastern Europe, South Asia, Eurasia and Sub‐Saharan Africa. Adherence to the BFHI Ten Steps has a positive impact on short‐term, medium‐term and long‐term breastfeeding (BF) outcomes. There is a dose–response relationship between the number of BFHI steps women are exposed to and the likelihood of improved BF outcomes (early BF initiation, exclusive breastfeeding (EBF) at hospital discharge, any BF and EBF duration). Community support (step 10) appears to be essential for sustaining breastfeeding impacts of BFHI in the longer term.     

Breastfeeding sick children in hospital: Exploring the experiences of mothers in UK paediatric wards

There is a paucity of literature exploring the challenges of breastfeeding sick children in hospital. Previous research has focused on single conditions and hospitals which limits understanding of the challenges in this population. Although evidence suggests that current lactation training in paediatrics is often inadequate, it is unclear where the specific training gaps are. This qualitative interview study of UK mothers aimed to explore the challenges of breastfeeding sick infants and children on a paediatric ward or paediatric intensive care unit. From 504 eligible respondents, a sample of 30 mothers of children aged 2–36 months with various conditions and demographic backgrounds was purposively chosen, and a reflexive thematic analysis undertaken. The study identified previously unreported impacts such as complex fluid needs, iatrogenic withdrawal, neurological irritability and changes to breastfeeding behaviour. Mothers described breastfeeding as emotionally and immunologically meaningful. There were many complex psychological challenges such as guilt, disempowerment, and trauma. Wider struggles such as staff resistance to bedsharing, inaccurate breastfeeding information, lack of food and inadequate breast pump provision made breastfeeding more challenging. There are numerous challenges related to breastfeeding and responsively parenting sick children in paediatrics, and these also impacted maternal mental health. Staff skill and knowledge gaps were widespread, and the clinical environment was not always conducive to supporting breastfeeding. This study highlights strengths in clinical care and provides insight into what measures are perceived as supportive by mothers. It also highlights areas for improvement, which may inform more nuanced paediatric breastfeeding standards and training.     

创建爱婴医院对提高母乳喂养率的作用

目的 观察创建爱婴医院对提高母乳喂养率的作用。方法 通过家访和电话追踪方式收集爱婴医院创建前后各110例产妇的母乳喂养情况,观察创建爱婴医院对出院前、产后一个月、产后四个月的纯母乳喂养、母乳喂养率的影响。结果 创建爱婴医院前110例产妇(对照组)的出院前、产后一个月、产后四个月的纯母乳喂养率分别为76．4％、58．2％、36．4％,母乳喂养率分别为90％、71．8％、62．7％,创建爱婴医院后110例产妇(试验组)的出院前、产后一个月、产后四个月的纯母乳喂养率分别为98．2％、88．2％、76．4％,母乳喂养率分别为99．1％、90．9％、82．7％,两组比较均有统计学差异。结论 创建爱婴医院,采取多种促进、保护和支持母乳喂养的政策,可有助于母乳喂养的成功,提高母乳喂养率。     

Breastfeeding initiation and birth setting practices: a review of the literature

A number of practices during the intrapartum and very early postnatal period may affect breastfeeding initiation. All women should be encouraged to breastfeed soon after birth, with extra attention paid to the identification and offer of extra support for those women at higher risk of not successfully initiating and continuing breastfeeding. Factors that affect breastfeeding initiation include: implementation of the Baby-Friendly Hospital Initiative Ten Steps to Successful Breastfeeding at a service level; avoidance of the use of intramuscular narcotic analgesia, particularly near the end of the first stage of labour; not separating mothers and babies after birth for routine procedures; and placing healthy newborns on their mothers' chest/abdomen (skin-to-skin) routinely. Single strategies are unlikely to increase breastfeeding initiation as stand-alone measures.     

Humane Neonatal Care Initiative

The author has worked for many years in experimental departments in the former Soviet health system. Now, with integration into the western health system, many questions are being asked about high-technology neonatal medicine and whether it is sufficiently humane. The Baby Friendly Hospital Initiative (BFHI) movement is well known all over the world, but unfortunately it is only used for healthy children in maternity hospitals. A paradoxical situation has been created: the routines of maternity wards comply with the BFHI, whereas a neonatal intensive care unit in the same hospital may not meet the requirements of the BFHI. BFHI mainly cover breastfeeding in maternity hospitals. Humane Neonatal Care Initiatives include minimum aggressive therapy, minimum contact between sick newborns and medical staff, and maximum contact with mothers; the number of tests and examinations should be reduced to a minimum. Eleven steps towards the improvement of psychosocial and medical care in units for sick newborns are presented. This article is intended to provoke serious discussion.