A new study published this week in the Journal of Pediatrics shows increased rates of implementation of the Baby-Friendly Hospital Initiative (BFHI) are associated with decreased rates of infant deaths in the first 6 days after birth, dispelling speculation that hospital-based breastfeeding initiatives might increase infant death.
The authors examined trends in the percentage of births in Baby-Friendly designated hospitals between 2004 and 2016, as well as the implementation of skin-to-skin care in the first hour after birth in both the US population and in Massachusetts. They then compared these to trends in Sudden Unexplained Infant Deaths (SUID), including deaths by asphyxia, in the first 6 days after birth, during the same time period.
While there were marked increases in both the percentage of newborns being delivered in Baby-Friendly designated facilities and in the percentage of newborns experiencing skin-to-skin care during this period, there was a significant decrease in deaths due to SUID within the first 6 days after birth.
“Increased implementation rates for skin-to-skin care and the Baby-Friendly Hospital Initiative are associated with a decrease in SUIDs, both nationally and in Massachusetts. This association may not be causal, but these data also suggest that breastfeeding interventions and skin-to-skin care do not contribute to perinatal deaths on a population level,” the authors state.
Dr. Melissa Bartick, lead author of the study and internist at Cambridge Health Alliance and Assistant Professor of Medicine at Harvard Medical School, said: “These data come as welcome news and should reassure us that these initiatives are not resulting in any increase in infant deaths – that in fact, just the opposite is true.”
Widespread speculation arose that such interventions could be deadly after a popular opinion piece citing Massachusetts infant mortality data was published in the medical literature in 2016, followed by a national study in 2018. These controversial publications and their related mainstream media attention characterized such deaths as being relatively common.
This new study found that fewer than 1% of sudden unexpected infant deaths during the first month of life actually occur during those first 6 days. The authors note that the peak occurrence for SIDS is in the first 2-4 months of life. Rates of skin-to-skin care rose to nearly 100% in Massachusetts, yet there were zero deaths from suffocation or asphyxia.
Dr. Lori Feldman-Winter, another author of the study and professor of pediatrics at Cooper Medical School of Rowan University, said: “We now recognize that evidence-based maternity care practices to support breastfeeding are associated with a decreased risk of neonatal death.”
The authors also note that skin-to-skin care is now routine for all infants, regardless of feeding method and remind us that “skin-to-skin requires increased surveillance in the first hours or days after birth.”
An additional significant finding of the study is that deaths in the first 6 days of life occurred disproportionately among Black infants, indicating the racial disparity in infant mortality begins as early as the first 6 days after birth.