Background: The critical time to continue or stop breastfeeding is during the first month after hospital discharge. Mothers receive lactation and physical support by fathers and others bottle-feeding human or formula milk to their infants.

Purpose: To describe the effect of feeders (mothers, fathers, and others) and different milk feeding on infants' weekly exclusive breastfeeding rates, from birth to 1 month after discharge.

Methods: This study was a secondary analysis of a descriptive longitudinal study of mothers' (full-term: n = 77; late preterm: n = 39) breastfeeding experience, frequency of feeding, and infant feeding behaviors. Mothers completed a weekly questionnaire of who (mothers, fathers, and others) fed their infants human or formula milk by direct breastfeeding or bottle-feeding.

Results: More than 60% of mothers reported fathers and others bottle-fed their infants. Exclusive breastfeeding rates were significantly higher when only mothers fed their infants at week 1 (P < .001), week 3 (P < .05), and week 4 (P < .05). Exclusive breastfeeding rates were negatively affected across time by bottle-feeding any human or formula milk for all feeders. When fathers bottle-fed their infants at week 1, the relative rates of exclusive breastfeeding at week 4 decreased to 52% (OR = 0.103; 95% CI, 0.26-0.404; P < .0001).

Implication for Practice: Individuals providing early bottle-feeding adversely affect breastfeeding outcomes. Providers need to address maternal and paternal knowledge gaps about early breastfeeding practice.

Implications for Research: Further research is needed to explore clinical standard of care for management of infant weight loss, early supplementation, and support of exclusive breastfeeding outcomes.

Background: The opportunity to establish a direct breastfeeding (DBF) relationship with a preterm infant, if desired by the mother or lactating parent, is a known driver of positive healthcare experiences. Preterm birth is an independent risk factor for early human milk (HM) cessation, and DBF at the first oral meal promotes continued DBF during hospitalization and HM duration beyond discharge. While the Spatz 10-step model for protecting and promoting HM and breastfeeding in vulnerable infants provides best practices, lack of standardized implementation results in missed opportunities to meet parents' DBF goals.

Purpose: To standardize clinical practices to increase DBF at the first oral meal, total DBF meals during hospitalization, and use of test weighing to measure milk transfer for preterm infants.

Methods: Quality improvement methods were used to develop and implement Encourage, Assess, Transition (EAT): a DBF protocol for infants less than 37 weeks gestation at birth, in a level II neonatal intensive care unit.

Results: Thirty-eight (45%) infants from 27.7 to 36.7 weeks of gestation initiated the protocol. The proportion of infants' DBF at first oral meal increased from 22% to 54%; mean DBF meals during hospitalization increased from 13.3 to 20.3; and use of test weighing increased by 166%.

Implications for Practice and Research: Standardizing DBF practices with the EAT protocol increased DBF during hospitalization-a known driver of patient experience-and HM duration beyond discharge, in hospitalized preterm infants. Researchers should validate the reported benefits of EAT (increased DBF during hospitalization, use of test weighing, and improved patient experience), methods to promote passive dissemination of evidence, and sustain change.

Video abstract available at:
https://journals.lww.com/advancesinneonatalcare/pages/video.aspx?v=61

Developed by world leaders in lactational pharmacology, this essential reference contains the most current, complete, and evidence-based information available on the transmission of maternal drugs into human milk. It thoroughly addresses one of the most commonly asked questions by breastfeeding mothers—which drugs are safe, and which are hazardous for the infant? The new twentieth edition adds 72 new drugs, updates 356 medications with new data, and adds new information to 927 drugs.

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Les politiques et pratiques de soins favorables à l’allaitement sont évaluées sur la base des normes internationales proposées par l’Organisation mondiale de la santé (OMS) et le Fonds des Nations Unies pour l’enfance (UNICEF). Ces normes sont adaptées au système de santé et de services sociaux québécois et s’adressent aux établissements publics de santé et de services sociaux qui veulent mettre en place les meilleures pratiques en allaitement. Les normes actuellement en vigueur sont l’objet d’une circulaire ministérielle sur le processus d’obtention ou de maintien de la certification « Ami des bébés » (2016-012). Les normes présentées dans ce document remplaceront les Outils d’information pour les établissements de novembre 2004 (annexes I, II et III de la circulaire 2016-012).