Avaliação da prescrição e oferta de substitutos do leite materno, segundo critérios da Iniciativa Hospital Amigo da Criança

Abstract

The objective of this study was to evaluate the offer and prescription of breast milk substitutes (BM) according to criteria of the Baby Friendly Hospital Initiative (BFHI) as well as the percentage of breastfeeding in the first hour of life. This is a cross-sectional, descriptive study with a quantitative approach, carried out with pairs of adult mothers and full-term newborns (NB) treated in the obstetric sector of the Hospital Regional Dr. Mariano Coelho due to childbirth. Data on socioeconomic profile, prenatal care, breastfeeding and aspects related to the prescription and supply of BM substitutes according to the BFHI were collected, via interviews with the mothers, the pregnant woman's booklet and medical records (mother and newborn). The information was tabulated in an Excel spreadsheet and analyzed using SPSS version 21 statistical software. The results were presented in absolute and relative frequencies, measures of central tendency and dispersion. The final sample consisted of 108 participants (54 pairs of mothers and newborns). Most participants claimed to have breastfed the NB in its 1st hour of life (n=33; 61.1%). The BM replacement was prescribed for 70.4% (n=38) of the NBs at some point in the post-birth hospitalization (1st and/or 2nd prescription), with part of these prescriptions initially recorded in the medical record as “if necessary” (1st prescription: n=28; 51.9%; 2nd prescription: n=21; 38.9% of the total number of neonates). Of the total number of newborns, 53.7% (n=29) had reasons considered justifiable, according to BFHI criteria, to receive a BM substitute, such as hypoglycemia, being children of mothers with Gestational Diabetes Mellitus (GDM), small or large for gestational age (PIG or GIG). However, when evaluating the justifications recorded in medical records at the time these substitutes were offered, the main reasons were hypoglycemia, decreased oral reflexes, milk production and nipple anatomy, although not all of them are part of the criteria established by the BFHI. The study draws attention to the need for more criticality and clarity in recording information in medical records related to the prescription and provision of BM substitutes, as well as the need for protocols on the provision of these substitutes. It also points to the need to constantly strengthen the promotion, support and protection of breastfeeding (BF) in primary health care and hospital settings in order to avoid early weaning and its negative consequences for the mother-infant group.