San Giovanni Valdarno, Italy
San Giovanni Valdarno, Italy

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Bonet M.,French Institute of Health and Medical Research | Bonet M.,University Pierre and Marie Curie | Blondel B.,French Institute of Health and Medical Research | Blondel B.,University Pierre and Marie Curie | And 9 more authors.
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2011

Objectives: To compare breastfeeding rates at discharge for very preterm infants between European regions and neonatal units, and to identify characteristics associated with breast feeding using multilevel models. Methods: Population-based cohort of 3006 very preterm births (22-31 weeks of gestation) discharged home from neonatal units in eight European regions in 2003. Results: Breastfeeding rates varied from 19% in Burgundy to 70% in Lazio, and were correlated with national rates in the entire newborn population. Women were more likely to breast feed if they were older, primiparous and European; more premature, smaller and multiple babies or those with bronchopulmonary dysplasia were breast fed less. Variations across regions and neonatal units remained statistically significant after adjusting for maternal, infant and unit characteristics. Conclusion: It is possible to achieve high breastfeeding rates for very preterm infants, but rates varied widely across regions and neonatal units throughout Europe.

Bonet M.,University of Paris Pantheon Sorbonne | Bonet M.,University of Paris Descartes | Forcella E.,Laziosanita Agenzia di Sanita Pubblica | Blondel B.,University of Paris Pantheon Sorbonne | And 6 more authors.
BMJ Open | Year: 2015

Objectives: To explore differences in approaches to supporting lactation and breastfeeding for very preterm infants in neonatal intensive care units (NICU) in 3 European regions. Design: Qualitative cross-sectional study carried out by means of face-to-face semistructured interviews. Verbatim transcripts were coded using a theoretical framework derived from the literature and supplemented by data-driven concepts and codes. Setting: 4 purposively selected NICUs in each of 3 European regions in 2010 (Ile-de-France in France, Lazio in Italy, and the former Trent region in the UK). Participants: NICU staff members (n=22). Results: Policies and practices for managing mother's own milk for very preterm babies differed between regions, and were much more complex in Ile-de-France than in the Trent or Lazio regions. Staff approaches to mothers to initiate lactation differed by region, with an emphasis on the nutritional and immunological value of human milk in the Trent region and on the 'normalising' effect of breastfeeding on the motherchild relationship in Lazio. French and English staff expressed conflicting opinions about the use of bottles, which was routine in Italy. Italian informants stressed the importance of early maternal milk expression and feeding, but also mentioned discharging infants home before feeding at the breast was established. In Ile-de-France and Trent, successful feeding from the breast was achieved before discharge, although this was seen as a factor that could prolong hospitalisation and discourage continued breastfeeding for some women. Conclusions: Targeted health promotion policies in the NICU are necessary to increase the number of infants receiving their mother's milk and to support mothers with transfer of the infant to the breast. Integrating knowledge about the different approaches to lactation and breastfeeding in European NICUs could improve the relevance of recommendations in multiple cultural settings.

Gadzinowski J.,Poznan University of Medical Sciences | Mazela J.,Poznan University of Medical Sciences | Papiernik E.,University of Paris Descartes | Draper E.S.,University of Leicester | And 3 more authors.
NeoReviews | Year: 2010

Regionalized level III perinatal care was implemented in Poland in 1998, but no comparative analyses of neonatal mortality and morbidity between other European regions and Poland are yet available. Given the large differences in policy and organization of health care between European countries, studying clinical outcomes within this context provides an opportunity to explore the effectiveness of regionalized care. The aim of this analysis was to compare the specific position of neonatal care in Poland with that of other European regions participating in the Models of OrganiSing Access to Intensive Care for very preterm babies (MOSAIC) project. In 1988, there were 18,798 live births in the 11 neonatal units in the Wielkopolska region; in 2003, there were 42,619 live births in the MOSAIC program from 53 neonatal units in the Wielkopolska and Lubuskie regions. There was no change in the rate of very preterm live births between 1988 and 2003, but the mortality rate among infants between 27 and 31 weeks of gestation differed significantly. The inhospital mortality rate in the two Polish regions was higher in 2003 compared with other MOSAIC participants (35.3% and 17.3%, respectively). There was also a higher rate of congenital malformations, intraventricular hemorrhage, and periventricular leukomalacia. There were also clear differences in organization of perinatal care, with fewer level III centers per 10,000 deliveries in Polish regions compared with other European regions (0.25 and 1.33, respectively) and longer distances of neonatal transport (97 km and 29 km, respectively). © 2010 by the American Academy of Pediatrics.

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