BABY FRIENDLY HOSPITAL INITIATIVE: 25 YEARS OF EXPERIENCE IN BRAZIL

ABSTRACT Objective: To describe the experience of the 25-year-old trajectory of the Baby Friendly Hospital Initiative (BFHI) in Brazil. The first unit was implemented in 1992. Methods: Information and data were collected from publications on the World Health Organization (WHO), the United Nations International Children’s Emergency Fund (UNICEF) and the Ministry of Health websites and in national and international journals, about the period 1990-2017. The descriptors used were: “iniciativa hospital amigo da criança”, “hospital amigo da criança”, “baby friendly initiative hospital”, “aleitamento materno” and “breastfeeding”. The number of hospitals in the 25 years, the course of the BFHI and its repercussions on breastfeeding in Brazil were evaluated. Results: The BFHI is an intervention strategy in hospital care at birth focused on the implementation of practices that promote exclusive breastfeeding from the first hours of life and with the support, among other measures of positive impact on breastfeeding, of the International Code of Marketing of Breastmilk Substitutes. Currently, the initiative has been revised, updated and expanded to integrate care for newborns in neonatal units and care for women since prenatal care. It can be concluded that, during these 25 years, the quantity of hospitals varied greatly, with numbers still below the capacity of hospital beds. BFHI shows higher rates of breastfeeding than non-accredited hospitals. However, the number of hospitals are still few when compared to other countries. Conclusions: The BFHI has contributed to breastfeeding in Brazil in recent decades. Greater support for public policies is needed to expand the number of accredited institutions in the country.</div

BABY FRIENDLY HOSPITAL INITIATIVE: 25 YEARS OF EXPERIENCE IN BRAZIL

ABSTRACT Objective: To describe the experience of the 25-year-old trajectory of the Baby Friendly Hospital Initiative (BFHI) in Brazil. The first unit was implemented in 1992. Methods: Information and data were collected from publications on the World Health Organization (WHO), the United Nations International Children’s Emergency Fund (UNICEF) and the Ministry of Health websites and in national and international journals, about the period 1990-2017. The descriptors used were: “iniciativa hospital amigo da criança”, “hospital amigo da criança”, “baby friendly initiative hospital”, “aleitamento materno” and “breastfeeding”. The number of hospitals in the 25 years, the course of the BFHI and its repercussions on breastfeeding in Brazil were evaluated. Results: The BFHI is an intervention strategy in hospital care at birth focused on the implementation of practices that promote exclusive breastfeeding from the first hours of life and with the support, among other measures of positive impact on breastfeeding, of the International Code of Marketing of Breastmilk Substitutes. Currently, the initiative has been revised, updated and expanded to integrate care for newborns in neonatal units and care for women since prenatal care. It can be concluded that, during these 25 years, the quantity of hospitals varied greatly, with numbers still below the capacity of hospital beds. BFHI shows higher rates of breastfeeding than non-accredited hospitals. However, the number of hospitals are still few when compared to other countries. Conclusions: The BFHI has contributed to breastfeeding in Brazil in recent decades. Greater support for public policies is needed to expand the number of accredited institutions in the country.</div

Gestational age estimated using the epidermal skin thickness of the forearm in comparison with GA at birth by early obstetric ultrasonography.

<p>Equation: Gestational age (weeks) = −28.0 + 12.8 <i>Ln</i> (Thickness) − 4.4 Incubator stay + 0.015 standard fetal growth; <i>R</i> = 0.777, <i>R</i>² = 0.604, P < 0.001.</p

Clinical characteristics of the studied gestation and newborns, considering birth weight patterns.

<p>Clinical characteristics of the studied gestation and newborns, considering birth weight patterns.</p

Neonatal skin with dermal layer measurements in stillbirths from biopsies over the plantar surface of the foot.

Scale: 200 μm. Skin at (A) 21 weeks of gestation, 406.5 μm; (B) 34 weeks of gestation, 284.6 μm; and (C) 40 weeks of gestation.</p

Magnitudes of the skin layer thicknesses of 222 newborns on the first day of life.

<p>(A) Distribution corresponds to the epidermal skin over the forearm. Values: n = 217; mean (SD), 172.4 (19.6) μm and 95% CI of the mean, 169.8–175.1. (B) Distribution corresponds to the dermal skin over the forearm. Values: n = 217; mean (SD), 974.0 (290.0) μm; 95% CI of the mean, 994.9–1061.8; and median (IQR), 974.0 (290.0) μm. (C) Distribution corresponds to the epidermal skin over the plantar surface. Values: n = 219; mean (SD), 174.6 (17.5) μm; 95% CI of the mean, 172.2–176.9. (D) Distribution corresponds to the dermal skin over the plantar surface. Values: n = 219; mean (SD), 1244.5 (869.0) μm; 95% CI of the mean, 1125.2–1263.9); and median (IQR), 1244.5 (869.0) μm.</p

Variation of skin thickness at birth according to birthweight patterns and examination site in newborns.

<p>Variation of skin thickness at birth according to birthweight patterns and examination site in newborns.</p

Excel spreadsheet presenting unidentified clinical data and skin thickness measurement from the acquisitions.

(PDF)</p

High-frequency ultrasonography image of the skin over the forearm with automated epidermal thickness estimation.

<p>(A) Skin ultrasonography image. (B) The red lines and the grid in between indicate the area over which dermal thickness is calculated using the DermaLab^® software. (C) The red color corresponds to the automated epidermal boundary detection by our dedicated software. (D) The white and black limits of the epidermis correspond to the automated mean thickness estimation by our dedicated software.</p

Environmental conditions and neonatal oximetry during the newborn assessment.

<p>Environmental conditions and neonatal oximetry during the newborn assessment.</p