Assessment Tool by UNICEF and LATCH Scoring System for Identification of Inadequacy of Breastfeeding in Early Neonatal Period: An Observational Cross-sectional Comparative Study

Abstract

Background: Breast milk is the most ideal nourishment for a neonate with a high level of bio-efficacy. Learning the right breastfeeding technique is a challenging job, especially for new and young mothers; hence, there is a need for a valid and reliable measuring tool to determine the adequacy of breastfeeding. Objective: To check the adequacy of breastfeeding in mother–neonate dyads using breastfeeding assessment tools by comparing UNICEF and LATCH scoring systems and to test the reliability of the tools through test–retest reliability. Design: An observational cross-sectional comparative study. Setting: Department of Neonatology, Fortis Escorts Hospital, Jaipur, Rajasthan, India. Methods: All stable neonates of ≥34 weeks gestational age born at the private tertiary care hospital were included in the study. Dyads in which breastfeeding was initiated within 6 hours of life were assessed using both LATCH and UNICEF tools on days 1 and 2 of life in the case of normal vaginal delivery and on days 1, 2 and 3 in caesarean deliveries, and were further followed up on days 5 and 7. Results: The median LATCH score and UNICEF score for breastfeeding showed an increase throughout the assessment period. A moderately positive correlation (Spearman’s rho = 0.732) was noticed between the two scores on day 1 of the assessment. On day 2 (Spearman’s rho = 0.81) and day 3 (Spearman’s rho = 0.735), a high positive correlation between the two tools was observed. However, day 4 revealed a low positive correlation (Spearman’s rho = 0.456). Meanwhile, the follow-up scores of both tools showed a high positive correlation (Spearman’s rho = 0.713). Conclusion: The study evidenced a positive correlation between the LATCH and UNICEF scores; both scoring systems displayed a good percent agreement on all the five assessment days. The test–retest reliability was high between the tools on days 1 and 2.