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Association between early essential newborn care and breastfeeding outcomes in eight countries in Asia and the Pacific: a cross-sectional observational study

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Zhao Li, Priya Mannava, John Charles Scott Murray, Howard Lawrence Sobel, Annie Jatobatu, Anthony Calibo, Baldan Tsevelmaa, Bounnack Saysanasongkham, Divinal Ogaoga, Edward Joseph Waramin, Elizabeth Mary Mason, Hiromi Obara, Hoang Thi Tran, Hoang Anh Tuan, Jacqueline Kitong, Jessica Mara Yaipupu, Kannitha Cheang, Maria Asuncion Silvestre, Outhevanh Kounnavongsa, Pamela Putney, Pham Thi Quynh Nga, Rathavy Tung, Sano Phal, Shogo Kubota, Sidonn Krang, Simon Burggraaf, Sommana Rattana, Tao Xu, Tuohong Zhang, Ulziikhutag Enkhmaa, Vanya Delgermaa, Y Meng Chhour, Western Pacific Region Early Essential Newborn Care Working Group


Objective To explore the association between early essential newborn care (EENC) policy, practice and environmental interventions and breastfeeding outcomes.

Design Cross-sectional observational study.

Setting 150 national, provincial and district hospitals implementing EENC in eight countries in East Asia and the Pacific.

Participants 1383 maternal interviews, chart reviews and environmental assessments during 2016 and 2017.

Main outcome measures Exclusive breastfeeding (EBF), that is, feeding only breastmilk without other food or fluids since birth and before discharge, and, early breastfeeding initiation, that is, during skin-to-skin contact (SSC) with the mother without separation.

Results Fifty-nine per cent of newborns initiated breastfeeding early and 83.5% were EBF. Duration of SSC showed a strong dose–response relationship with early breastfeeding initiation. SSC of at least 90 min was associated with 368.81 (95% CI 88.76 to 1532.38, p<0.001) times higher early breastfeeding. EBF was significantly associated with SSC duration of 30–59 min (OR 3.54, 95% CI 1.88 to 6.66, p<0.001), 60–89 min (OR 5.61, 95% CI 2.51 to 12.58, p<0.001) and at least 90 min (OR 3.78, 95% CI 2.12 to 6.74, p<0.001) regardless of delivery mode. Non-supine position (OR 2.80, 95% CI 1.90 to 4.11, p<0.001), rooming-in (OR 5.85, 95% CI 3.46 to 9.88, p<0.001), hospital breastfeeding policies (OR 2.82, 95% CI 1.97 to 4.02, p<0.001), quality improvement mechanisms (OR 1.63, 95% CI 1.07 to 2.49, p=0.02) and no formula products (OR 17.50, 95% CI 5.92 to 51.74, p<0.001) were associated with EBF.

Conclusion EENC policy, practice and environmental interventions were associated with breastfeeding outcomes. To maximise the likelihood of early and EBF, newborns, regardless of delivery mode, should receive immediate and uninterrupted SSC for at least 90 min.