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Response to: “Proposed guidelines for skin-to-skin care and rooming-in should be more inclusive”

Journal of Perinatology volume 38, page 1279 (2018)Cite this article

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We thank you for the opportunity to respond to the comments provided by Feldman-Winter et al. [1]. As stated in our article [2], Table 2 provides a suggested order set that merged the recommendations given by the AAP [3] and Davanzo et al. [4] In the table, we recommend that infants identified as high risk should be evaluated (not stabilized) in a warmer by a Nursery Nurse. In our experience, this assessment (normal VS, O2 Sats > 93%, vigorous and no respiratory distress) takes less than 3 min after which the infant will be placed in SSC. We agree that infants with meconium staining and late preterm infants can receive SSC; however, we strongly believe an adequate evaluation is needed before proceeding. Per the AAP, high risk situations may include “late preterm and early term (37–39 weeks’ gestation) infants” [3]. We disagree with the statement that the frequency of the observations suggested is impractical as they are “observations”; therefore SSC is not interrupted. We do not recommend the use of continuous pulse oximetry. We do agree that the table does not point out the step-by-step procedures for rooming-in; however, we provided recommendations as to when rooming-in or SSC should be discontinued. As stated, we agree that there is little evidence (not negative) that rooming-in improves breastfeeding outcomes. However, we recommend that rooming-in should be encouraged in a safe environment [2]. We strongly support that when rooming-in is accepted and safely implemented, patient satisfaction increases; however, we strongly disagree that in order to comply with the numbers for the BFHI certification, hospitals forces mothers to do rooming-in when they choose not to.

An updated Ten Steps for Successful Breastfeeding has been released by WHO/UNICEF with a revision and modification of the original Ten Steps [5]. Such modifications are aligned to most of the issues pointed out in our article [2]. Important changes includes: staff training focused on competences and not a fixed curriculum; increased focus on the education regarding potential breastfeeding difficulties and; elimination of the restriction for the use of feeding bottles, teats, and pacifiers. The new guideline endorses the promotion of breastfeeding being integrated with other local or national initiatives and recognizes, as well as recommends that BF designation should not be the goal. The new guideline also states that the wishes and preferences of mothers and families regarding feeding choices must be respected and facilities need to provide unbiased and quality information regarding infant feeding.

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References

  1. Feldman-Winter L, Goodstein MH, Hauck FR, Darnall RA, Moon RY, American Academy of Pediatrics Task Force on SIDS. Proposed guidelines for skin-to-skin care and rooming-in should be more inclusive. J Perinatol. 2018. https://doi.org/10.1038/s41372-018-0175-y

  2. Gomez-Pomar E,Blubaugh R, The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature. J Perinatol. 2018;38(6):623–32.

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  3. Feldman-Winter L, Goldsmith JP, Committee on fetus and newborn; task force on sudden infant death syndrome. Safe sleep and skin-to-skin care in the neonatal period for healthy term newborns. Pediatrics. 2016;168:pii: e20161889.

  4. Davanzo R, De Cunto A, Paviotti G, Travan L, Inglese S, Brovedani P, et al. Making the first days of life safer: preventing sudden unexpected postnatal collapse while promoting breastfeeding. J Hum Lact. 2015;31:47–52.

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  5. WHO, UNICEF Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services – the revised Baby-friendly Hospital Initiative. Geneva: World Health Organization; 2018.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, USA

    Enrique Gomez-Pomar

  2. Neonatal Intensive Care Unit Medical Director, Rush Foundation Hospital, Meridian, MS, USA

    Robert Blubaugh

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  1. Enrique Gomez-Pomar
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  2. Robert Blubaugh
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Correspondence to Enrique Gomez-Pomar.

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The authors declare that they have no conflict of interest.

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Gomez-Pomar, E., Blubaugh, R. Response to: “Proposed guidelines for skin-to-skin care and rooming-in should be more inclusive”. J Perinatol 38, 1279 (2018). https://doi.org/10.1038/s41372-018-0181-0

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  • DOI: https://doi.org/10.1038/s41372-018-0181-0

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