Exclusive Breastfeeding in the Hospital

Abstract

Background: Accurate hospital exclusive breastfeeding (EBF) rates, a core indicator of hospital performance, are important. Objective: The aim of this study was to assess the accuracy of hospital infant feeding data by comparing EBF rates obtained from standard charts in which once-daily observations are recorded with new infant feeding charts in which every feed was documented. Methods: In this cross-sectional study, 157 healthy mother-infant pairs were enrolled at the University Hospital of Split, Croatia, between February and May 2008. Infant feeding data were gathered from 4 sources: (1) standard once-daily observations recorded by pediatricians; (2) new, every-feed observations recorded by nursing staff; (3) interview with the mother before discharge; and (4) Newborn Examination Form, completed on discharge by the pediatrician. WHO definitions were used to determine EBF during the first 48 hours and from birth until discharge. Results: Only 3% of infants were EBF throughout the hospital stay when calculated with the every-feed method, as opposed to 56% and 82%, with the once-daily and newborn examination methods, respectively ( P < .001). Maternal report confirmed the finding that 97% of infants were supplemented with formula, indicating that most formula supplements are not recorded in the standard once-daily charts. Conclusions: Accurate documentation of infant feeding practices is essential for obtaining reliable EBF rates. This study shows that once-daily recordings of infant feeding practices grossly underestimate the prevalence of formula supplementation in breastfed infants, resulting in significantly higher, erroneous EBF rates.