Breastfeeding in a US, inner-city neonatal intensive care unit: 10 years post Baby-Friendly designation

Background: Human milk is particularly beneficial for infants admitted to the Neonatal Intensive Care Unit (NICU). The Baby-Friendly Hospital Initiative (BFHI) was launched in 1991, but its application to the NICU was not clearly defined. The current international effort to develop guidelines and criteria for the “Baby-Friendly NICU” has led to a resurgence of interest in this field. Boston Medical Center (BMC), an inner-city, teaching hospital with a 22 bed, Level 3 NICU, published a study demonstrating an association between BFHI implementation and increased NICU breastfeeding in 1999. To date, no studies have evaluated the long-term association between the BFHI and breastfeeding in NICU infants. Our goal was to determine the association between the BFHI and breastfeeding in the NICU over time. Methods: We analyzed demographic and infant feeding data from medical records of all infants admitted to the BMC NICU in 1999 and 2009 and compared rates of initiation and exclusivity between the two years using Chi-square analyses. Results: We excluded infants who died, who were transferred, and whose mothers were not eligible to breastfeed. Breastfeeding initiation increased from 75% (74/117) in 1999 to 85% (85/142) in 2009 (p=0.04). For Black infants, breastfeeding initiation increased from 58% in 1999 to 86% in 2009 (p<0.001). Exclusivity at 2 weeks among all NICU infants did not change significantly between 1999 and 2009. Conclusion: Breastfeeding rates in a US, inner-city, level 3 NICU continued to improve 10 years after Baby-Friendly designation, and the increase was particularly significant among Black infants.