Trends in rooming-in practices among hospitals in the United States, 2007-2015.

BACKGROUND: Rooming-in, or keeping mothers and infants together throughout the birth hospitalization, increases breastfeeding initiation and duration, and is one of the Ten Steps to Successful Breastfeeding. METHODS: The Centers for Disease Control and Prevention's (CDC) Maternity Practices in Infant Nutrition and Care (mPINC) survey is a biennial census of all birth facilities in the United States and its territories. Data from the 2007-2015 mPINC surveys were used to assess trends in the prevalence of hospitals with most (≥90%) infants rooming-in more than 23 hours per day (ideal practice). Hospital practices among breastfed infants not rooming-in at night and reasons why hospitals without ideal rooming-in practices removed healthy, full-term, breastfed infants from their mothers' rooms were also analyzed. RESULTS: The percentage of hospitals with ideal practice increased from 27.8% in 2007 to 51.4% in 2015. Most breastfed infants who were not rooming-in were brought to their mothers at night for feedings (91.8% in 2015). Among hospitals without ideal rooming-in practices, the percentage removing 50% or more of infants from their mothers' rooms at any point during the hospitalization decreased for all reasons surveyed during 2007-2015; however, in 2015, hospitals still reported regularly removing infants for hearing tests (73.2%), heel sticks (65.5%), infant baths (40.2%), pediatric rounds (35.5%), and infant photos (25.4%). CONCLUSIONS: Hospital implementation of rooming-in increased 23.6 percentage points during 2007-2015. Continued efforts are needed to ensure that all mothers who choose to breastfeed receive optimal lactation support during the first days after giving birth.

Evaluation of factors contributing to the decline in exclusive breastfeeding at 6 months postpartum: The 2011-2016 National Surveys in Taiwan.

BACKGROUND: Since 1992, breastfeeding promotion in Taiwan considerably raised the breastfeeding rates; however, more recent surveillance showed that breastfeeding indicators stagnated or even decreased. METHODS: We analyzed 6 cross-sectional national surveys of 69 159 postpartum women to examine the breastfeeding trends at 6 months postpartum during 2011-2016 in Taiwan and the contributing role of maternal and environmental factors. Data were collected through telephone interviews, using structured questionnaires with randomly selected mothers, who gave birth in those years. A multinomial logistic regression was used to analyze the data. RESULTS: Partial breastfeeding rates at 6 months postpartum increased from 2011 to 2016 (25.4%-45.1%, crude odds ratio [OR] = 1.14 per year of study); however, the rates of exclusive breastfeeding at 6 months postpartum declined (24.5%-14.8%, crude OR = 0.91 per year of study). During this period, increases in maternal age and educational level, employment outside the house, and prepregnancy obesity were observed. Despite a growing number of births at certified baby-friendly hospitals, fewer mothers experienced early skin-to-skin contact and rooming-in in 2016 than in 2011. Adjustment for breastfeeding-related factors did not appreciably change the odds ratio for year of birth. Prenatal intention to breastfeed was most strongly associated with breastfeeding at 6 months postpartum (OR > 5). CONCLUSIONS: Maternal and environmental factors in the study could not explain the decline in exclusive breastfeeding. The decline in exclusive breastfeeding, accompanying the increase in partial breastfeeding, suggests that more support is needed for mothers who intend to breastfeed exclusively.

Mounting evidence favoring single-family room neonatal intensive care.

Controversy regarding the optimal design for neonatal intensive care has existed for more than 20 years. Recent evidence confirms that in comparison with the traditional open-bay design, the single-room facility provides for improved control of excessive noise and light, improved staff and parental satisfaction with care and equal, or possibly reduced, cost of care. Single-room care was not associated with any increase in adverse outcomes. To optimize long term developmental outcomes, single-room care must be augmented with appropriate developmental therapy and programs to actively support parental involvement.

Banho de ofurô em recém-nascidos no alojamento conjunto: um relato de experiência / Baño de ofuro en recién nacidos en el alojamiento conjunto: un relato de experiencia / O furo bath in newborns in the rooming-in center: an experience report

Objective: To report the experience of the nursing staff of the rooming-in center of a maternity in Rio de Janeiro with regard to the use of the technique of ofuro bath, by associating the benefits of relaxation and humanized care already described in the literature. Method: This is an experience report of the introduction of a new relaxation technique for newborns. The team was sensitized and trained to use the technique and, subsequently, its members started to perform the care shares in the previously selected neonates. Results: The achieved results showed that, after a few minutes of immersion in the ofuro bucket, the newborns were quieter, thereby ceasing the weeping and falling into asleep during the bath. It was observed an improvement of suction and maintenance of the latch during the breastfeeding, since they become more relaxed after the use of the technique. Conclusion: This experience should be considered as enriching, because it allows the transformation of the care model, thereby favoring the comprehensive care of newborns.

Objetivo: Relatar a experiência da equipe de enfermagem do alojamento conjunto de uma maternidade do Rio de Janeiro quanto ao uso da técnica de banho de ofurô, associando aos benefícios do relaxamento e assistência humanizada já descritos na literatura. Método: Relato de experiência da introdução de uma nova técnica de relaxamento para recém-nascidos. A equipe foi sensibilizada e capacitada para utilização da técnica e, após isso, iniciaram a realização nos cuidados aos neonatos previamente selecionados. Resultados: Os resultados alcançados demonstraram que, após poucos minutos de imersão no balde de ofurô, os recém-nascidos apresentaram-se mais tranquilos, cessando o choro e adormecendo no decorrer do banho. Também observou-se melhoria de sucção e manutenção da pega no aleitamento materno, pois estes encontravam-se mais relaxados após a utilização da técnica. Conclusão: Considera-se esta experiência enriquecedora, pois possibilita a transformação do modelo assistencial, favorecendo o cuidado integral aos recém-nascidos.

Objetivo: Relatar la experiencia del equipo de enfermería del alojamiento conjunto de una maternidad de Rio de Janeiro para el uso de la técnica del baño de ofuro, asociando a los beneficios de la relajación y asistencia humanizada ya descritos en la literatura. Método: Relato de experiencia de la introducción de una nueva técnica de relajación para los recién nacidos. La equipo fue sensibilizada y capacitada para la utilización de la técnica, y después de eso, empezaron a actuar en el cuidado de los recién nacidos previamente seleccionados. Resultados: Los resultados alcanzados mostraron que después de algunos minutos de inmersión en el cubo de ofuro los recién nacidos se quedaban más tranquilos, dejando el lloro y adormeciendo durante el baño. También se observó mejoría de succión y manutención de agarrar el pecho durante la lactancia materna, pues ellos se encontraban más relajados después de la utilización de la técnica. Conclusión: Se considera esta experiencia enriquecedora, pues permite la transformación del modelo asistencial, favoreciendo la atención integral a los recién nacidos.

Early skin-to-skin contact, rooming-in, and breastfeeding: a comparison of the 2004 and 2011 National Surveys in Taiwan.

OBJECTIVES: We examined progress in the practice of early skin-to-skin contact and rooming-in, and their association with breastfeeding, using national samples of postpartum women in the years 2004 and 2011 in Taiwan. METHODS: This study was a secondary data analysis using 2004 and 2011 national surveys of 12,201 and 12,405 postpartum women, respectively. RESULTS: More women had early skin-to-skin contact in 2011 than in 2004 (54.9% vs 20.6%, p < 0.001). Although fewer women practiced rooming-in in 2011 than in 2004 (33.8% vs 45.8%, p < 0.001), the percentage of women rooming-in for 24 hours improved from 6.1 percent to 22.7 percent from 2004 to 2011, and for rooming-in from 12 to less than 24 hours, the percentage improved from 4.3 percent to 10.9 percent (p < 0.001). The rate of breastfeeding increased by 50 percent during hospitalization (from 57.4% to 85.6%) and by 150 percent at 6 months postpartum (from 20.1% to 50.2%). After adjustment for background characteristics, women who had early skin-to-skin contact were more than twice as likely to breastfeed their infants during hospitalization, and about 1.2 times as likely to breastfeed at 6 months postpartum. The odds ratio for breastfeeding at 6 months generally increased as the duration of rooming-in increased in 2004 (OR ranged from 1.37 to 2.47). In 2011, only rooming-in for 12 to less than 24 hours (OR = 1.31) and 24 hours (OR = 1.98) daily significantly increased the odds ratio for breastfeeding at 6 months postpartum. CONCLUSIONS: Significant improvements in early skin-to-skin contact, the duration of rooming-in, and breastfeeding were observed in Taiwan. Early skin-to-skin contact and rooming-in for more than 12 hours were associated with increased chances for exclusive breastfeeding and breastfeeding at 6 months postpartum.

A comparison of parent satisfaction in an open-bay and single-family room neonatal intensive care unit.

OBJECTIVE: The purpose of this research was to test the hypothesis that parental satisfaction with neonatal intensive care is greater in a single-family room facility as compared with a conventional open-bay neonatal intensive care unit (NICU). METHODS: This investigation was a prospective cohort study comparing satisfaction survey results for parents who responded to a commercially available parent NICU satisfaction survey following the provision of NICU care in open-bay and single-family room facilities. A subset of 16 items indicative of family-centered care was also computed and compared for these two NICU facilities. RESULTS: Parents whose babies received care in the single-family room facility expressed significantly improved survey responses in regard to the NICU environment, overall assessment of care, and total survey score than did parents of neonates in the open-bay facility. With the exception of the section on nursing in which scores in both facilities were high, nonsignificant improvement in median scores for the sections on delivery, physicians, discharge planning, and personal issues were noted. The total median item score for family-centered care was significantly greater in the single-family room than the open-bay facility. CONCLUSIONS: Parental satisfaction with care in the single-family room NICU was improved in comparison with the traditional open-bay NICU. The single-family room environment appears more conducive to the provision of family-centered care. Improved parental satisfaction with care and the potential for enhanced family-centered care need to be considered in decisions made regarding the configuration of NICU facilities in the future.

Evoluçäo da assistência materno-infantil na cidade de Säo Paulo (1984-1996) / Secular trends in maternal and child health care in S. Paulo city, Brazil (1984-1996)

Objetivo: Descrever a evoluçäo da assistência materno-infantil, com base nas informaçöes extraídas em dois inquéritos domiciliares realizados nos anos de 1984/85 e 1995/96, na cidade de Säo Paulo, SP. Métodos: Foram estudadas amostras probabilísticas da populaçäo entre zero e 59 meses de idade: 1.016 crianças em 1984/85 e 1.280 crianças em 1995/96. Três componentes da assistência materno-infantil foram investigados: assistência pré-natal, assistência ao parto e ao recém-nascido e assistência de puericultura. Resultados: Aspectos favoráveis da evoluçäo da assistência materno-infantil na cidade de Säo Paulo foram a manutençäo da cobertura universal da assistência hospitalar ao parto, a expansäo substancial do alojamento conjunto mäe-filho na maternidade, o aumento no número de consultas de puericultura no primeiro ano de vida e, sobretudo, a universalizaçäo da cobertura das vacinas BCG, tríplice e anti-sarampo. Aspectos desfavoráveis foram o progresso muito modesto e claramente insuficiente da assistência pré-natal, a manutençäo de quase 50 por cento de cesarianas e a näo expansäo da puericultura após o primeiro ano de vida. Conclusöes: Estimativas sobre a evoluçäo da assistência materno infantil no conjunto das áreas urbanas do país em período semelhante confirma e acentua o desempenho insatisfatório da assistência pré-natal em Säo Paulo. Comparaçöes favoráveis a Säo Paulo säo registradas apenas quanto a cobertura vacinal. A influência que mudanças na assistência materno-infantil podem ter exercido sobre a evoluçäo de diferentes indicadores do estado de saúde das crianças da cidade é examinada em artigos subseqüentes

Influencias dos diferentes tipos de alojamento sobre recem-nascidos na pratica do aleitamento materno / Influence of the different types of room on newborns during breastfeeding

O presente estudo foi realizado no Centro Medico Socialde Vila Lobato, que e um servico ambulatorial primario para criancas e gestantesda Faculdade de Medicina de Ribeirao Preto - FMRPUSP, no periodo de 1 de janeirode 1980 a 31 de dezembro de 1984, abrangendo 132 criancas. O estudo foi longitudinal e retrospectivo, tendo sido possivel constituir dois grupos distintos de criancas, diferindo de acordo com sua permanencia hospitalar no periodo pos-parto,em Alojamento Conjunto e bercario tradicional. Apos a analise estatistica de todas as variaveis envolvidas no estudo, o unico dado que diferencia os dois gruposera o local de internacao no periodo pos-parto. Embora exista uma tendencia a maior amamentacao no grupo que utilizou o Alojamento Conjunto, a analise estatistica mostrou que essa diferenca nao e significativa, devendo-se, porem, consideraro papel importante desempenhado pelo CMSCVL no estimulo a pratica do aleitamentomaterno, o que pode ter homogenizado os dois grupos. O tempo mediano de desmame,encontrado para a populacao estudada de 132 criancas foi de dez meses e para as que ficaram no bercario tradicional, oito meses. Foram identificadas tambem as causas de desmame para a populacao estudada, que se mostraram semelhantes as referidas em outros trabalhos publicados