UNICEF WHO BABY-FRIENDLY HOSPITAL INITIATIVE - DOES THE USE OF BOTTLES AND PACIFIERS IN THE NEONATAL NURSERY PREVENT SUCCESSFUL BREAST-FEEDING/

To promote breastfeeding, UNICEF/WHO have launched the ''baby-friendly hospital initiative'' focusing on hospital care routines during deliv ery and the first days of life. In industrialised countries, two aspec ts of the initiative have raised controversy: how do restriction of su pplemental feedings and ban of battles and pacifiers affect long-term breastfeeding performance? From ten centres 602 healthy newborns were randomly assigned either to a UNICEF group with restrictive fluid supp lements and avoidance of bottles and pacifiers during the first 5 days of life, or to a standard group with conventional feeding practice. B reastfeeding was encouraged in both groups. The main study end-points were the prevalences of breast-feeding on day 5, and after 2, 4 and 6 months. Of the newborns 46% violated the UNICEF protocol, mostly becau se of maternal requests to give a pacifier or supplements by bottle. I n the standard group, the drop-out rate was 9.7%. No significant diffe rences in breastfeeding frequency and duration could be found: (UNICEF vs standard) day 5: 100% vs 99%; 2 months: 88% vs 88%; 3 months: 75% vs 71%; 6 months: 57% vs 55%. Inclusion of drop-outs due to pacifier u se did not alter the results. Conclusion in our study population fluid supplement offered by bottle with or without the use of pacifiers dur ing the first 5 days of life were not associated with a lower frequenc y or shorter duration of breastfeeding during the first 6 months of li fe.