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Do neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding?
Samantha L Sundercombe1, Camille H Raynes-Greenow2, Robin M Turner2
1Sydney Medical School, University of Sydney, Sydney, Australia.
Insights
Neonatal hypoglycaemia guidelines poorly support breastfeeding and UNICEF UK Baby Friendly Initiative (BFI) recommendations. Improving guidelines requires focusing on early skin-to-skin contact and parental counselling before artificial milk supplementation.
Area of Science:
- Neonatal care
- Public health
- Evidence-based practice
Background:
- Postnatal ward guidelines for neonatal hypoglycaemia aim to support breastfeeding.
- UNICEF UK Baby Friendly Initiative (BFI) sets standards for infant feeding support.
- Adherence to BFI recommendations in neonatal care guidelines is crucial for infant well-being.
Purpose of the Study:
- To evaluate how well neonatal hypoglycaemia guidelines facilitate breastfeeding.
- To assess guideline adherence to UNICEF UK Baby Friendly Initiative (BFI) recommendations.
- To compare compliance across different guideline components.
Main Methods:
- Appraisal of 22 neonatal hypoglycaemia guidelines from Australian and New Zealand tertiary neonatal centres.
- Utilized a UNICEF UK BFI checklist tool for guideline assessment.
- Email surveys were used to gather guideline information and Baby Friendly Health/Hospital Initiative (BFHI) accreditation status.
Main Results:
- Guidelines generally scored poorly in overall quality (median 71/124) and breastfeeding support (median 20/36).
- Compliance with promoting skin-to-skin contact (9/22 guidelines) and early feeding (14/22 guidelines) was low.
- Discussion of artificial milk supplementation with parents was inadequately addressed (44/88 score), and many guidelines unnecessarily screened Large for Gestational Age (LGA) infants.
Conclusions:
- Neonatal hypoglycaemia guidelines require revision to include early skin-to-skin contact and parental counselling before artificial milk supplementation.
- Current guidelines may lead to unnecessary screening of LGA neonates.
- Guidelines necessitate regular updates to align with evolving best practices, with the UNICEF UK BFI checklist serving as a valuable quality improvement tool.
Objective:
to establish how well postnatal ward neonatal hypoglycaemia guidelines facilitate breast feeding and adhere to UNICEF UK Baby Friendly Initiative (BFI) recommendations, and to compare compliance with different recommendations.
Design:
an appraisal of guidelines obtained via email survey using a UNICEF UK BFI checklist tool. Information about Baby Friendly Health/Hospital Initiative (BFHI) accreditation status was obtained by email questionnaire.
Setting:
tertiary neonatal centres in Australia and New Zealand.
Participants:
22 guidelines were returned from 23 centres eligible to participate.
Findings:
guidelines generally scored poorly. On a scale ranging from 31 to 124 of overall guideline quality, the median score was 71. On a scale of 9 to 36 for adherence to recommendations to facilitate breast feeding, the median guideline score was 20. Compliance with the recommendation to promote skin-to-skin contact and early breast feeding was poor across all centres, achieving a score of 59 out of 88. Nine of 22 guidelines mentioned skin-to-skin contact after birth and 14 advised feeding within one hour of birth. The recommendation about discussing artificial milk supplementation with parents received a score of 44 out of 88. Fourteen guidelines listed Large for Gestational Age (LGA) infants to be at risk of hypoglycaemia. Few guidelines included up-to-date references or flowcharts.
Key Conclusions:
guidelines need to recommend early skin-to-skin contact and discussion with parents before artificial milk supplementation. Guidelines suggest LGA neonates are being screened unnecessarily.
Implications For Practice:
guidelines need constant revision as evidence for best practice expands. The UNICEF UK BFI checklist provides a readily available quality improvement tool.
