Breastfeeding support in Italian Pediatric Intensive Care Units: a nationwide survey on protocols, practices, and...

Breastfeeding is recognized as the optimal source of nutrition in the first months of life. Pediatric Intensive Care Units (PICUs) play a crucial role in ensuring breastfeeding continuity for hospitalized infants in a critical care setting. However, despite the proven numerous benefits of breast milk in promoting the psychological well-being and short- and long-term health of hospitalized children, data on breastfeeding support in PICUs are sparse. This study aimed to assess the presence of written protocols and related clinical practices supporting breastfeeding in Italian PICUs. A cross-sectional survey with a 44-item questionnaire was conducted among the 26 Italian PICUs, collecting data on structural characteristics, breastfeeding policies, and parental involvement. Given the small sample size, Fisher's exact tests, rather than chi-square tests, were used for comparisons. Logistic regression was performed to explore predictors of policy adoption. All the Italian PICUs participated. Results showed that only 27% of PICUs had written breastfeeding protocols, mainly covering infant feeding guidance, donor human milk use, and milk expression/storage, and 23% provided mandatory training for healthcare staff. While most units (96.1%) allowed at least one parent to remain with the child 24 h a day or to leave only for short periods, only 38.4% enabled maternal hospitalization in the same ward to support breastfeeding. Additionally, 57.6% actively promoted maintenance of maternal breast milk supply by providing breast pumps in the ward, while 61.5% considered offering donor human milk. Logistic regression analysis found no significant predictors of breastfeeding policy adoption, suggesting that institutional commitment and leadership engagement may be more influential than structural factors alone. These findings indicate that breastfeeding support in Italian PICUs is limited and inconsistent, underscoring the need for standardized national policies, written protocols, mandatory staff training, and improved infrastructure.

These findings indicate that breastfeeding support in Italian PICUs is limited and inconsistent, underscoring the need for standardized national policies, written protocols, mandatory staff training, and improved infrastructure.

• Breastfeeding offers important nutritional, immunological, and psychological benefits for critically ill infants, but intensive care hospitalization can compromise its continuity. • Although breastfeeding support has been widely studied in NICUs, evidence on policies and practices in PICUs is still very limited.

• This nationwide Italian survey shows that breastfeeding support in PICUs remains heterogeneous, with limited use of formal protocols, staff training, and dedicated maternal support measures. • The absence of clear structural predictors suggests that local leadership and unit culture may play a central role in shaping breastfeeding practices.