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Comment & Response
March 2017

The Importance of the Baby-Friendly Hospital Initiative

Author Affiliations
  • 1University of North Carolina, Chapel Hill
  • 2University of California, Davis
JAMA Pediatr. 2017;171(3):304-305. doi:10.1001/jamapediatrics.2016.4823

To the Editor In a recent Viewpoint, Bass et al1 implicate full compliance with the Baby-Friendly Hospital Initiative (BFHI) as a risk factor for sudden unexpected postnatal collapse (SUPC).1 We are surprised by this conclusion because it is not supported by current evidence.2 Studies reporting the prevalence of SUPC since implementation of BFHI are inconsistent, and a growing body of research has identified biological causes of SUPC, such as congenital heart malformations and infections, that are potentially preventable.2 These underlying genetic propensities and conditions likely interact during critical developmental windows with environmental factors, such as prone-position sleeping, which is not a recommendation in BFHI. Indeed, the overarching recommendation to prevent SUPC by Herlenius and Kuhn,2 the review that Bass et al heavily cite,1 is to improve surveillance of newborns, ensuring consistent and adequate clinical coverage, particularly during “(1) safe early skin-to-skin care (SSC) in the delivery room, (2) safe breastfeeding establishment in the first days of life, and (3) secure positioning of the infant during sleep.”2(p245)

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