Exclusive Breastfeeding in the Hospital

Abstract

Accurate hospital exclusive breastfeeding (EBF) rates, a core indicator of hospital performance, are important. 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. 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. 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. 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.