Health professional

Any type of promotion of breastmilk substitutes, bottles and teats should be completely prohibited at health care facilities, as established by the International Code of Marketing of Human Milk Substitutes and subsequent relevant resolutions of the World Health Assembly. In addition, no free or subsidized donations of breast milk substitutes or other products, gifts or samples may be given to health workers at any health system facility.

Regarding the administration of feeding the premature newborns in intensive care areas, the written breastfeeding policy should explicit issues related to the:

If the newborn’s clinical condition is favorable, skin-to-skin contact should be initiated immediately after birth.

The vital signs of mother and baby should be checked regularly to monitor their well-being. The person accompanying the patient, family member, doula or health care staff should monitor the woman’s wakefulness to protect the newborn’s safety in this vulnerable period.

The International Code of Marketing of Human Milk Substitutes requires appropriate actions to enforce its principles and objectives, including the adoption of national laws and regulations or other relevant measures. All actions should be made public. Since the code is a minimum requirement, governments can adopt additional measures - potentially more stringent than those set out in the code - and make them legally binding.

Necrotizing enterocolitis (NEC) is one of the most serious morbidities in preterm infants (PTNB). It is an inflammatory disease of the bowel that can cause perforation of the gut and peritonitis. Its underlying cause would be multifactorial. Some theories blame intestinal mucosal injury, inflammation and the presence of abnormal gut colonization.

Feeding PTNBs with human milk (HM) seems to have a preponderant role in the reduction of NEC, even if the supply of HM is partial.

As efforts to improve the outcomes of neonatal survival are scaled up, there is an increased demand for access to safe and effective transport.

Improving the procedures related to neonatal transport and the quality of care in critical conditions requires evidence-based technical guidelines as a reference for agencies, facilities, and health professionals responsible for setting health system priorities and policies around newborn transport.

Regionalization poses the challenge of defining where to assign resources to intensive care, transport or prevention and primary care.

Neonatal transport should be seen in the context of regionalized perinatal care, which encompasses the care of the pregnant woman and her fetus, the mother-to-be and her baby.

Interventions to support responsive caregiving during the postnatal period should focus on promoting positive interactions and strengthening the caregiver/infant relationship.

Health care workers should encourage mothers, fathers, and other caregivers to be aware and responsive, responding to the child's needs, cues, clues, behaviors, and desires.

It is important to encourage caregivers to develop skills in the contexts of play, communication and feeding, such as breastfeeding on demand.

Universal newborn hearing screening (UNHS) with otoacoustic emissions (OAE) or automated auditory brainstem evoked potentials (ABEP-A) testing is recommended for early detection of permanent bilateral hearing loss (PBHL). UNHS should be accompanied by diagnostic and treatment services for infants in whom hearing loss is detected.

It is important to close the gap in the possibilities that women have to breastfeed their children since breastfeeding can act as a factor of equality in society.

Human milk is the best nutrition for children at a time when the epigenetic foundations for health and development are being established. Everyone has the right to access breast milk.

It is essential that no one is left behind, especially vulnerable mothers who may need additional support to reduce inequalities in the ability to breastfeed.