Effect of early skin-to-skin contact after delivery on duration of breastfeeding: a prospective cohort study.

AIM: To study the influence on breastfeeding of skin-to-skin contact after birth. METHODS: Using a prospective cohort study design, a group of 1250 Polish children was investigated with 3 y follow-up. RESULTS: The implementation of the practice significantly increased mean duration of exclusive breastfeeding by 0.39 mo and overall breastfeeding duration by 1.43 mo. The infants kept with the mothers for at least 20 min were exclusively breastfed for 1.35 mo longer and weaned 2.10 mo later than those who had no skin-to-skin contact after delivery. The skin-to-skin contact after birth significantly coexisted with the other hospital practices supportive to breastfeeding, especially rooming-in without separation longer than 1 h per 24 h [relative risk (RR) = 3.18, 95% confidence interval (95% CI): 2.34-4.31] and first breastfeeding within 2 h after birth (RR = 2.94, 95% CI: 2.36-3.67. Multivariate analysis performed by a general linear model with duration of exclusive breastfeeding as the dependent variable indicated skin-to-skin contact and mother education as two independent variables influencing the duration of exclusive breastfeeding. CONCLUSION: The results indicate that extensive mother-infant skin-to-skin contact lasting for longer than 20 min after birth increases the duration of exclusive breastfeeding.

[Skin-to-skin contact after birth as a factor determining breastfeeding duration]. / Kontakt skóra-do-skóry po porodzie jako czynnik warunkujacy czas trwania karmienia piersia.

Using prospective cohort study design the influence of skin-to-skin contact after birth on breastfeeding was analyzed in a group of 1250 three years old Polish children. The implementation of this practice significantly increased the mean exclusive breastfeeding duration by 0.4 month and overall breastfeeding by 1.4 months. The effect of skin-to-skin contact duration after birth was also observed. The infants kept with the mothers at least 30 minutes were 1.2 month longer exclusively breastfed and 1.7 month later weaned than those who had the shorter contact. The skin-to-skin contact after birth significantly coexisted with the other hospital practices supportive for breastfeeding: early first feeding [(OR=9,73), 95%CI:6.87-13.80] exclusive breastfeeding in the maternity ward [(OR=4,30), 95%CI:3.15- 5.89], rooming-in [(OR=2,78), 95%CI:2.05-3.78] and elimination of bottle [(OR=3,70), 95%CI:2.69-5.09]. Multivariate linear regression analysis showed that mother-infant contact afterbirth was a significant and independent factor for exclusive breastfeeding continuation.

[Birth weight as a factor influencing infant feeding in Polish maternity wards]. / Masa Ciala jako czynnik warunkujacy sposób zywienia noworodków w oddzialach polozniczo-noworodkowych w polsce.

Data on 11784 newborns collected by staff in 427 maternity hospitals in 1995 were analysed. In all 97.2% of newborns were breastfed, but only 72.5% with birth weight less than 2500 g. Univariate logistic regression model with birth weight as a continuous variable was applied to calculate the probability of breastfeeding initiation. Using bivariate logistic regression models, different groups of newborns were compared to explain the additional influence of 4 dichotomous variable: type of delivery (normal birth and caesarean section), neonatal problems (jaundice, birth asphyxia, disorders of adaptation after birth, infections, congenital malformations) and two hospital practices: rooming-in and skin-to-skin contact. Multivariate conditional logistic regression model showed that the independent prognostic factors for breastfeeding initiation were: birth weight (continuous), rooming-in (OR=5.5; CI(OR)=3.9-7.9) skin-to-skin contact after birth (OR=3.4; CI(OR)=2.6-4.5) and lack of neonatal problems (OR=2.1; CI(OR)=1.6-2.7). Logistic regression curves showed that influence of skin-to-skin contact and rooming-in after birth on breastfeeding initiation was more evident for newborn with lower birth weight.

[Determinants of newborn feeding in maternity hospital care. Part II: factors associated with exclusive breast feeding]. / Uwarunkowania zywienia noworodków w szpitalnej opiece poporodowej Czesc II: czynniki warunkujace wylaczne karmienie piersia.

OBJECTIVES: To study the effects of newborn status and hospital practices on exclusive breast-feeding in a maternity ward. DESIGN: National survey conducted in January 1995 in 427 hospitals. MATERIALS AND METHODS: Data on 11,422 newborns obtained from hospital staff. Statistical analysis was performed using odds ratios (OR), population attributable risks (PAR%) and logistic regression method. RESULTS: The most important factors for supplementation were: caesarean section (OR = 5.3; PAR = 19.0%), first breastfeeding later than 2 h after birth (OR = 5.2; PAR = 41.3%), mother and newborn separation longer than 1 h/24 h (OR = 3.4; PAR = 44.9%). Logistic regression analysis showed that first feeding in 2 hours is the main prognostic factor for exclusive breastfeeding in a maternity ward. CONCLUSIONS: Changes in hospital practices increase the proportion of exclusively breastfeeding infants during stay in the maternity ward.

[Breast feeding as a component of reproductive health]. / Karmienie piersia jako element cyklu rozrodczego kobiety.

Extensive research, especially in the recent years documents the divers advantages of breastfeeding not only for infants but also for breastfeeding women and their reproductive health. The paper presents the results of epidemiological studies concerning protective effects of breastfeeding against large number of acute and chronic diseases of childhood and possible health benefits for mothers like fertility regulation, stimulation of parenting abilities and protection against breast and ovarian cancer, bone loss, nutritional depletion. The recommendations of hospital postpartum care supportive to physiological initiation of breastfeeding, based on the experience of Baby Friendly Hospital Initiative implementation in Poland is also presented.

[Breast feeding of twins with regard to pre-term infants]. / Karmienie piersia blizniat z uwzglednieniem urodzonych przedwczesnie.

The benefits of breast-feeding for health and development pre-term and full-term infants changed the attitude towards nutrition of twins and higher-order multiples. Mothers of twins are often at risk of unsuccessful initiation of lactation while in hospital. The possibilities to provide appropriate intervention and support when a mother breastfeeds twins are presented.

[Breastfeeding as a vital factor in child health]. / Karmienie piersia warunkiem zdrowia dziecka.

Mother's milk is the only adequate nutrition for infants. In the recent years the extensive research documents the numerous advantages of breastfeeding. Especially important is exclusive mothers' milk feeding for infants in the first six months of life. The results of biological and epidemiological studies concerning protective effects of breastfeeding against acute and chronic diseases of early and later childhood were presented. Further needs of breastfeeding promotion in Poland based on the research conducted in the last years, were stressed.

[Factors associated with exclusive breastfeeding of infants in Poland]. / Uwarunkowania wylacznego karmienia piersia niemowlat polsce.

Factors associated with cessation of exclusive breastfeeding in Poland were studied in 10156 randomly selected infants aged 1-6 months. They were breastfed at the time of data collection. Among them, 4929 (48.5%) infants were exclusively breastfed. In multiple logistic regression analysis, the factors associated with cessation of exclusive breastfeeding were: use of a pacifier, short duration of total breastfeeding and exclusive breastfeeding accepted by mothers, first child in the family, primary education of parents, mother working in farming and non-employed father, maternal smoking and maternal age over 34 years.

[Evaluation as a component of breastfeeding promotion programme]. / Ewaluacja w programie upowszechniania karmienia persia.

Recent years have seen increased emphasis on appropriate development of public health intervention programmes with attention to evaluation. With reference to the breastfeeding promotion programme in Poland, the conceptual framework of evaluation development and implementation is presented. The use of analysis per formed for programme sustainability and progress and in the decision making process is underlined.

Hospital policies and their influence on newborn body weight.

On the basis of data collected in a survey of the practices in maternity wards in Poland, we analysed newborn body weight differences between two groups of hospitals: one with the highest percentage of exclusive breastfeeding and other supportive practices, the other with the lowest. The aim of the study was to investigate whether hospital procedures can influence the newborn weight profile in the first days after birth. Healthy infants--normal birth, birthweight > or = 2500 g, discharged within 2-7 days, no missing data--were chosen for the analyses. The difference between discharge and birthweight, percentage of birthweight loss or gain on the day of discharge and percentage of the infants who at least regain birthweight on the day of discharge were compared between the two groups of hospitals. All analyses indicated the positive influence of exclusive breastfeeding and practices supporting it on infant body weight profile while in hospital.

[Influence of immediate newborn care on infant adaptation to the environment]. / Wplyw postepowania z noworodkiem bezposrednio po porodzie na cechy jego adaptacji do srodowiska.

The indicators of newborns' adaptation during 75 min after birth were compared in three randomised groups of full-term newborns: skin-to-skin contact (group I), swaddled newborns beside the mother (group II), swaddled and separated from the mother (group III). The changes in skin temperature, blood glucose, pH, heart rate, respiration rate and crying time were studied. All the above characteristics but pH were significantly the most favourable for infants in the skin-to-skin group. The analysis of individual trends of changes in skin temperature indicated that for all but two newborns not separated from the mother (skin-to-skin or lying besides) the temperature was growing during the observation period, whereas in the separated group, six newborns (27%) had unstable not growing temperature. The mean level of blood glucose was the highest in skin-to-skin group (60.1 mg/dl), lower in group of swaddled and lying beside mother (52.5 mg/dl) and the lowest (49.6 mg/dl) in the separated group. The mean duration of crying time in the skin-to-skin contact was a little shorter than in the group of newborns lying besides the mother and more than three times shorter than in the separated group. The observed number of episodes of crying were 7, 17 and 38 in the three groups respectively. All results indicated that skin-to-skin contact is optimal for newborns', adaptation after birth especially as a protection against hypothermia and hypoglycaemia.

[Determination of newborn feeding in maternity hospital care. Part I: Factors associated with breast feeding initiation]. / Uwarunkowania zywienia noworodków w szpitalnej opiece poporodowej. Czesc I: Czynniki wplywajace na rozpoczecie karmienia piersia.

The data on 11,750 newborns collected in 427 hospitals during the survey of maternity words practices in 1995 were used to analyse the factors related to breastfeeding initiation while in hospital. The statistical analyses were done using percentage of newborn breastfed as well as odds ratio (OR) and population attributable risk in percent (PAR%) of artificial feeding. The identified factors of artificial feeding were: newborn birth weight < 2500 g (OR = 28.2; PAR = 52%), complications in neonatal period (OR = 10.3; PAR = 64%), caesarean section (OR = 4.3; PAR = 32.2%), mother and newborn separation longer than 1h/24h (OR = 13%; PAR = 87.2%), lack of skin-to-skin contact after birth (OR = 8.5; PAR = 60.9%).

[Barriers in breast feeding: contraindications]. / Bariery w karmieniu piersia: przeciwwskazania.

Breast-feeding is the important factor for mother and child health. Many reasons for stopping breast-feeding are not the real contraindications. The most frequent maternal and child contraindications are discussed.

[Barriers in breast feeding: marketing of breast feeding substitutes]. / Bariery w karmieniu piersia: marketing produktów zastepujacych karmienie.

The most important techniques and strategies of marketing breast-feeding substitutes with special consideration of Polish market are discussed. WHO/UNICEF Code recommendations are presented.

[Barriers in breast feeding: cesarean section]. / V. Bariery w karmieniu piersia: cesarskie ciecie.

The rate of cesarean sections in Poland is about 15%. The post partum practice conductive to breast-feeding are less frequently introduced in after caesarean delivery even after adjustment for newborn birth weight. Measures to foster and facilitate successful breast-feeding after caesarean delivery are recommended.

[III. Barriers in breastfeeding: hyperbilirubinemia]. / III. Bariery w karmieniu piersia: hiperbilirubinemia.

Hyperbilirubinemia is a very frequent reason for interrupting breastfeeding in Poland. The pathogenesis of the early and late jaundice related to breastfeeding is discussed. The lack of contraindication to breastfeeding is stressed.

[Barriers in breast feeding: artificial nipples and nipple shields]. / Bariery w karmieniu piersia: smoczki i kapturki.

Early use of artificial nipples and nipple shields results in nipple confusion. This was identified as one of the most important barriers in successful breast-feeding. Alternative method of feeding can prevent breastfeeding problems.