Exclusive Versus Predominant Breastfeeding in Italian Maternity Wards and Feeding Practices Through the First Year of Life

Giovannini, Marcello MD
Riva, Enrica MD
Banderali, Giuseppe MD
Salvioni, Michela MD
Radaelli, Giovanni PhD
Agostoni, Carlo MD

Marcello Giovannini is the chairman and head physician of the Department of Pediatrics, San Paolo Hospital, and chair of pediatrics at the University of Milan. Enrica Riva is the head physician of the Department of Neonatal Medicine, San Paolo Hospital, and full professor of neonatology at the University of Milan. Giuseppe Banderali is an assistant at the Department of Pediatrics and head of the Pediatric Day-Hospital, San Paolo Hospital, Milan. Michela Salvioni is a graduate at the Department of Pediatrics, San Paolo Hospital, Milan. Giovanni Radaelli is a physicist and statistician at the University of Milan. Carlo Agostoni is an associate professor of pediatrics at the University of Milan.

Address correspondence to Giovanni Radaelli, PhD, Units of Medical Statistics, San Paolo Hospital, University of Milan, Via A di Rudinì 8, I-20142 Milan, Italy.

Competing interests declared: This study was supported by the Danone Institute of Italy.

Received for review, March 29, 2004; revised manuscript accepted for publication, November 24, 2004.

Journal of Human Lactation 21(3):p 259-265, August 2005.

Abstract Resumen

Determinants of exclusive versus predominant breastfeeding in the maternity ward and the relationship with later feeding practices were investigated in 1656 mothers who breastfed exclusively or predominantly in the maternity ward. Mothers were interviewed through 12 months postdelivery about feeding practices. Information about the World Heath Organization's (WHO's) 10 steps was collected. At hospital stay, breastfeeding was predominant in 43% of infants. Cesarean section (odds ratio [OR] = 1.75), mother's overweight (OR = 1.74), and non-compliance with the WHO's steps 6 (OR = 1.58), 7 (OR = 1.43), and 8 (OR = 1.76) were determinants of predominant, as opposed to exclusive, breastfeeding. Mothers exclusively, rather than predominantly, breastfeeding in the hospital showed a longer duration of full breastfeeding (mean = 3.6 vs 3.1 months), later introduction of formula (3.8 vs 3.3 months), and lower rate of introduction of formula within 1 month (23% vs 30%). Hospitals need to be compliant with the WHO's steps, and Baby-Friendly Hospital Initiatives should be promoted.

Se investigaron determinantes de lactancia materna exclusiva vs predominante en una unidad de materni-dad, y la relación con las prácticas de alimentación posteriores en 1656 madres que practicaban lactancia materna exclusiva y predominante. Se entrevistaron a las madres durante 12 meses después del parto sobre las prácticas alimenticias. Se tomó información sobre los 10 pasos de la OMS. Durante la hospitalización la lactancia materna predominante fue de 43%. Parto por cesárea (odds ratio [OR] = 1.58), sobrepeso de la madre (OR = 1.74), y no cumplimiento de los siguientes pasos de la OMS 6 (OR = 1.58), 7 (OR =1.43), o 8 (OR =1.76) fueron determinantes de lactancia predominante, al opuesto que exclusiva. Las madres que practican la lactancia materna exclusiva durante la hospitalización, en comparación con predominante, mostraron una duración mas prolongada de lactancia materna com-pleta (promedio, 3.6 vs 3.1 meses), introducción de formula (3.8 vs 3.3 meses), y mas bajas tasas de introducción de formula en el primer mes (23% vs 30%). Los hospitales necesitan cumplir con los pasos de la OMS y deben promover la Iniciativa de Hospital Amigo del Niño.