Changes in breastfeeding support practices in Spanish neonatal units

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apoyo a la lactancia materna en unidades neonatales españolas Dear Editor, Breastfeeding (BF) offers multiple short-and long-term health benefits to preterm and ill infants.Therefore, BF support should be apriority in neonatal intensive care units (NICUs).The European Standards of Care for Newborn Health 1 and the Eight principles for patient-centred and family-centred care for newborns in the neonatal intensive care unit have been published recently.2 Both documents include BF support as an essential intervention.In addition, they highlight the need to establish enteral feeding with human milk early on, supporting mothers before, during and after the hospital stay in adherence with the 3 guiding principles and the 10 steps of the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI).3 On the other hand, the rate of BF at discharge from the neonatal unit is considered a key indicator of the quality of care.4 In order to assess the current situation and the progress in recent years in the introduction of specific measures for BF support in NICUs in Spain, we compared the responses given by level III NICUs in 2 nationwide surveys carried out in 2013 5 and 2018.The questionnaires included questions regarding: (1) BFHI accreditation (any phase); ( 2) systematic training of health care staff on BF; (3) antenatal information provided to hospitalised pregnant women (generally); (4) recommended timing to start breast milk pumping (<6 hours); (5) initiation of feedings in very preterm infants (<6 hours); 6) protocol for handling of human milk; (7) availability of freezers in the NICU.The response rate was 97% (77/79) in 2013 and 87% (65/77) in 2018, and 65 NICUs responded in both periods.We compared the responses at each time point of the NICUs

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