Journal of Perinatology https://doi.org/10.1038/s41372-020-00822-9 ARTICLE The impact of the Baby Friendly Hospital Initiative on neonatal hypoglycemia Marina S. Oren 1 ● Whittney D. Barkhuff 1,2 ● Andrei Stefanescu 3 ● Beatrice M. Stefanescu 1,4 ● Tara L. DuPont 1,5 Received: 10 March 2020 / Revised: 17 August 2020 / Accepted: 10 September 2020 © The Author(s), under exclusive licence to Springer Nature America, Inc. 2020 Abstract Objective To assess Neonatal Intensive Care Unit (NICU) admissions for hypoglycemia after the introduction of the Baby Friendly Hospital Initiative (BFHI), followed by implementation of American Academy of Pediatrics recommended hypoglycemia guidelines. Study design Retrospective review of NICU admissions for hypoglycemia. Eligible subjects were healthy infants >35 weeks gestation transferred to a NICU for hypoglycemia. Infants admitted with other pathologies were excluded. NICU admissions from 3 different 18-month epochs (1 = pre-BFHI; 2 = post-BFHI; 3 = post-BFHI+hypoglycemia guidelines) were compared. Results After implementation of BFHI there was a statistically significant increase in admissions for hypoglycemia (Epoch 2 = 1.23% vs Epoch 1 = 0.55%, p < 0.001). Followed by a decrease in admissions after the implementation of hypoglycemia guidelines (Epoch 2 = 1.23% vs Epoch 3 = 0.76%, p = 0.03). Conclusion NICU admissions for hypoglycemia increased with the BFHI. Hypoglycemia guidelines decreased NICU admissions, but not to the pre-BFHI baseline. Introduction Neonatal hypoglycemia is a common metabolic condition that accounts for ~17% of all admissions to the Neonatal Intensive Care Unit (NICU) [1, 2]. Conditions such as maternal diabetes, late prematurity, and birth weights greater than the 90th and less than the 10th percentiles increase the risk of hypoglycemia significantly [3]. There is substantial financial burden associated with hypoglycemia, as the cost of management of one infant with the condition can be as high as $5500 [4, 5]. In addition, separation of the mother–baby dyad to accommodate for treatment of hypo- glycemia can impact the establishment of breastfeeding [6]. There is strong evidence that breastmilk is the optimal nutrition for newborn infants [7]. The Baby-Friendly Hos- pital Initiative (BFHI) was introduced by the World Health Organization and UNICEF in 1991 to support breastfeeding in healthcare facilities that provide maternal and newborn services. The BFHI is a guideline that promotes “Ten Steps to Successful Breastfeeding” [8]. The BFHI has provided significant progress in maternal education on the benefits of breastfeeding, provision of lactation support, and decreased commercial bias in feeding method. There is also good evidence to support the effectiveness of BFHI for increasing breastfeeding initiation rates and exclusivity [9]. However, some BFHI steps have a direct impact on infant feeding, specifically “No food or drink other than breastmilk, unless medically indicated” and “Give no pacifiers or artificial nipples to breastfeeding infants.” These steps may affect the initial treatment for neonatal hypoglycemia, as supple- menting an infant with formula or dextrose gel is more effective at increasing blood glucose levels than breast- feeding or supplementing with expressed breast milk [10]. * Tara L. DuPont Tara.dupont@hsc.utah.edu 1 Department of Pediatrics, Division of Neonatology, University of New Mexico School of Medicine, Albuquerque, NM, USA 2 Department of Pediatrics, Division of Neonatology, University of Vermont, Burlington, VT, USA 3 Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA 4 Department of Pediatrics, Division of Neonatology, Indiana University School of Medicine, Indianapolis, IN, USA 5 Department of Pediatrics, Division of Neonatology University of Utah Health Science Center, Salt Lake City, UT, USA 1234567890();,: 1234567890();,: