{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T07:01:05Z","timestamp":1780124465431,"version":"3.54.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Partially founded by Italian Ministry of Health, Current Research IRCCS"},{"DOI":"10.13039\/100012352","name":"Universit\u00e0 degli Studi di Milano","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012352","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Breastfeeding is recognized as the optimal source of nutrition in the first months of life. Pediatric Intensive Care Units (PICUs) play a crucial role in ensuring breastfeeding continuity for hospitalized infants in a critical care setting. However, despite the proven numerous benefits of breast milk in promoting the psychological well-being and short- and long-term health of hospitalized children, data on breastfeeding support in PICUs are sparse. This study aimed to assess the presence of written protocols and related clinical practices supporting breastfeeding in Italian PICUs. A cross-sectional survey with a 44-item questionnaire was conducted among the 26 Italian PICUs, collecting data on structural characteristics, breastfeeding policies, and parental involvement. Given the small sample size, Fisher\u2019s exact tests, rather than chi-square tests, were used for comparisons. Logistic regression was performed to explore predictors of policy adoption. All the Italian PICUs participated. Results showed that only 27% of PICUs had written breastfeeding protocols, mainly covering infant feeding guidance, donor human milk use, and milk expression\/storage, and 23% provided mandatory training for healthcare staff. While most units (96.1%) allowed at least one parent to remain with the child 24\u00a0h a day or to leave only for short periods, only 38.4% enabled maternal hospitalization in the same ward to support breastfeeding. Additionally, 57.6% actively promoted maintenance of maternal breast milk supply by providing breast pumps in the ward, while 61.5% considered offering donor human milk. Logistic regression analysis found no significant predictors of breastfeeding policy adoption, suggesting that institutional commitment and leadership engagement may be more influential than structural factors alone. These findings indicate that breastfeeding support in Italian PICUs is limited and inconsistent, underscoring the need for standardized national policies, written protocols, mandatory staff training, and improved infrastructure.<\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    : These findings indicate that breastfeeding support in Italian PICUs is limited and inconsistent, underscoring the need for standardized national policies, written protocols, mandatory staff training, and improved infrastructure.\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is known:<\/jats:bold>\n                              \u2022\u00a0\n                              <jats:italic>Breastfeeding offers important nutritional, immunological, and psychological benefits for critically ill infants, but intensive care hospitalization can compromise its continuity.<\/jats:italic>\n                              \u2022\u00a0\n                              <jats:italic>Although breastfeeding support has been widely studied in NICUs, evidence on policies and practices in PICUs is still very limited.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is new:<\/jats:bold>\n                              \u2022\u00a0\n                              <jats:italic>This nationwide Italian survey shows that breastfeeding support in PICUs remains heterogeneous, with limited use of formal protocols, staff training, and dedicated maternal support measures.<\/jats:italic>\n                              \u2022\u00a0\n                              <jats:italic>The absence of clear structural predictors suggests that local leadership and unit culture may play a central role in shaping breastfeeding practices.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-06896-5","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:45:37Z","timestamp":1777398337000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Breastfeeding support in Italian Pediatric Intensive Care Units: a nationwide survey on protocols, practices, and challenges"],"prefix":"10.1007","volume":"185","author":[{"given":"Daniela","family":"Morniroli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Daverio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Davanzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guglielmo","family":"Salvatori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Agostoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Lorella","family":"Giann\u00ec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Amigoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregorio Paolo","family":"Milani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the MILPIC Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Perrotta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Bottari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezio","family":"Bonanomi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"L\u2019Erario","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Chidini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Nettuno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Biban","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Alaimo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Pallotto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaela","family":"Sagredini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Mondardini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Binotti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Ferrario","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Giannini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clelia","family":"Zanaboni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Montaguti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giusi","family":"Stancanelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Moggia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Chiusolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Vitale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiana","family":"Cito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Immacolata","family":"Rulli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Poletto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Azzari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enzo","family":"Picconi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"6896_CR1","unstructured":"UNICEF WHO (2003) Global strategy for infant and young child feeding. World Health Organization, Geneva"},{"issue":"12","key":"6896_CR2","doi-asserted-by":"publisher","first-page":"e809","DOI":"10.1542\/neo.21-12-e809","volume":"21","author":"L Young","year":"2020","unstructured":"Young L, McGuire W (2020) Immunologic properties of human milk and clinical implications in the neonatal population. NeoReviews 21(12):e809\u2013e816. https:\/\/doi.org\/10.1542\/neo.21-12-e809","journal-title":"NeoReviews"},{"issue":"2","key":"6896_CR3","doi-asserted-by":"publisher","DOI":"10.3390\/nu13020694","volume":"13","author":"D Morniroli","year":"2021","unstructured":"Morniroli D, Consales A, Crippa BL et al (2021) The antiviral properties of human milk: a multitude of defence tools from mother nature. Nutrients 13(2):694. https:\/\/doi.org\/10.3390\/nu13020694","journal-title":"Nutrients"},{"issue":"2","key":"6896_CR4","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.13103","volume":"30","author":"LR Sorce","year":"2025","unstructured":"Sorce LR, Asaro LA, Curley MAQ (2025) Infant feeding and criticality in children. Nurs Crit Care 30(2):e13103. https:\/\/doi.org\/10.1111\/nicc.13103","journal-title":"Nurs Crit Care"},{"key":"6896_CR5","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1007\/978-1-4615-1371-1_27","volume":"501","author":"ES Buescher","year":"2001","unstructured":"Buescher ES (2001) Anti-inflammatory characteristics of human milk: how, where, why. Adv Exp Med Biol 501:207\u2013222. https:\/\/doi.org\/10.1007\/978-1-4615-1371-1_27","journal-title":"Adv Exp Med Biol"},{"issue":"4","key":"6896_CR6","doi-asserted-by":"publisher","first-page":"2124","DOI":"10.1097\/MS9.0000000000001829","volume":"86","author":"B Ghosh","year":"2024","unstructured":"Ghosh B, Sripathi S, Nuthalapati BS et al (2024) Effects of breastfeeding in postoperative complication in pediatric population: a systematic review. Ann Med Surg 86(4):2124\u20132129. https:\/\/doi.org\/10.1097\/MS9.0000000000001829","journal-title":"Ann Med Surg"},{"issue":"2","key":"6896_CR7","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13489","volume":"19","author":"L Hookway","year":"2023","unstructured":"Hookway L, Brown A, Grant A (2023) Breastfeeding sick children in hospital: exploring the experiences of mothers in UK paediatric wards. Matern Child Nutr 19(2):e13489. https:\/\/doi.org\/10.1111\/mcn.13489","journal-title":"Matern Child Nutr"},{"issue":"3","key":"6896_CR8","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1177\/0890334412451055","volume":"29","author":"R Davanzo","year":"2013","unstructured":"Davanzo R, Monasta L, Ronfani L, Brovedani P, Demarini S (2013) Breastfeeding at NICU discharge: a multicenter Italian study. J Hum Lact 29(3):374\u2013380. https:\/\/doi.org\/10.1177\/0890334412451055","journal-title":"J Hum Lact"},{"issue":"10","key":"6896_CR9","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.46730","volume":"15","author":"A Modak","year":"2023","unstructured":"Modak A, Ronghe V, Gomase KP (2023) The psychological benefits of breastfeeding: fostering maternal well-being and child development. Cureus 15(10):e46730. https:\/\/doi.org\/10.7759\/cureus.46730","journal-title":"Cureus"},{"key":"6896_CR10","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-024-01581-5","volume":"50","author":"R Davanzo","year":"2024","unstructured":"Davanzo R, Travan L, Giann\u00ec ML et al (2024) Current hospital policies on breastfeeding: a survey from Italy. Ital J Pediatr 50:21. https:\/\/doi.org\/10.1186\/s13052-024-01581-5","journal-title":"Ital J Pediatr"},{"issue":"10","key":"6896_CR11","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1089\/bfm.2023.0158","volume":"19","author":"S Wakeham","year":"2024","unstructured":"Wakeham S, Pronska P, Fucile S (2024) An examination of the benefits of lactation consultant services in NICUs for mothers and their newborn: a systematic review. Breastfeed Med 19(10):768\u2013778. https:\/\/doi.org\/10.1089\/bfm.2023.0158","journal-title":"Breastfeed Med"},{"issue":"2","key":"6896_CR12","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-084746P","volume":"15","author":"NG Dymek","year":"2025","unstructured":"Dymek NG, Jaschke J, Stirner AK et al (2025) Structured lactation support for mothers of very low birthweight preterm infants and establishment of human donor milk banks in German NICUs (Neo-MILK): protocol for a hybrid type 1 effectiveness-implementation cluster-randomised controlled trial. BMJ Open 15(2):e084746. https:\/\/doi.org\/10.1136\/bmjopen-2024-084746P","journal-title":"BMJ Open"},{"key":"6896_CR13","unstructured":"Centri TIP. TIPNET.org. https:\/\/tipnet.org\/home\/. Accessed May 4, 2025"},{"issue":"1","key":"6896_CR14","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-024-01793-9","volume":"50","author":"R Davanzo","year":"2024","unstructured":"Davanzo R, Salvatori G, Baldassarre M et al (2024) Promotion of breastfeeding in Italian maternity hospitals: a pre-intervention study. Ital J Pediatr 50(1):219. https:\/\/doi.org\/10.1186\/s13052-024-01793-9","journal-title":"Ital J Pediatr"},{"issue":"4","key":"6896_CR15","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17041298","volume":"17","author":"S Foligno","year":"2020","unstructured":"Foligno S, Finocchi A, Brindisi G et al (2020) Evaluation of mother\u2019s stress during hospitalization can influence the breastfeeding rate. Experience in intensive and non intensive departments. Int J Environ Res Public Health 17(4):1298. https:\/\/doi.org\/10.3390\/ijerph17041298","journal-title":"Int J Environ Res Public Health"},{"issue":"5","key":"6896_CR16","doi-asserted-by":"publisher","first-page":"410","DOI":"10.4278\/0890-1171-21.5.410","volume":"21","author":"BC Castrucci","year":"2007","unstructured":"Castrucci BC, Hoover KL, Lim S, Maus KC (2007) Availability of lactation counseling services influences breastfeeding among infants admitted to to neonatal intensive care units. Am J Health Promot 21(5):410\u2013415. https:\/\/doi.org\/10.4278\/0890-1171-21.5.410","journal-title":"Am J Health Promot"},{"key":"6896_CR17","unstructured":"Gruppo di lavoro multidisciplinare - Ministero della salute. La continuit\u00e0 del rapporto madre-bambino e il mantenimento dell\u2019allattamento in caso di ricovero ospedaliero. https:\/\/www.salute.gov.it\/imgs\/C_17_pubblicazioni_3091_allegato.pdf.\u00a0Accessed April 30, 2025"},{"key":"6896_CR18","doi-asserted-by":"publisher","unstructured":"Marcuz JC, Emidio SCD, Carmona EV (2021) Aleitamento materno em pacientes admitidos em unidade de terapia intensiva pedi\u00e1trica. REME Rev Min Enferm\u00a025(1). https:\/\/doi.org\/10.5935\/1415.2762.20210007","DOI":"10.5935\/1415.2762.20210007"},{"issue":"4","key":"6896_CR19","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13182","volume":"17","author":"L Hookway","year":"2021","unstructured":"Hookway L, Lewis J, Brown A (2021) The challenges of medically complex breastfed children and their families: a systematic review. Matern Child Nutr 17(4):e13182. https:\/\/doi.org\/10.1111\/mcn.13182","journal-title":"Matern Child Nutr"},{"issue":"4","key":"6896_CR20","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1177\/08903344241273450","volume":"40","author":"A Eerdekens","year":"2024","unstructured":"Eerdekens A, Debeer A (2024) Barriers and facilitators in lactation support for the preterm mother\u2013infant dyad: an integrated approach. J Hum Lact 40(4):539\u2013549. https:\/\/doi.org\/10.1177\/08903344241273450","journal-title":"J Hum Lact"},{"issue":"2","key":"6896_CR21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0245273","volume":"16","author":"R Maastrup","year":"2021","unstructured":"Maastrup R, Rom AL, Walloee S, Sandfeld HB, Kronborg H (2021) Improved exclusive breastfeeding rates in preterm infants after a neonatal nurse training program focusing on six breastfeeding-supportive clinical practices. PLoS One 16(2):e0245273. https:\/\/doi.org\/10.1371\/journal.pone.0245273","journal-title":"PLoS One"},{"issue":"6","key":"6896_CR22","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1097\/ANC.0000000000000962","volume":"22","author":"A Br\u00f8dsgaard","year":"2022","unstructured":"Br\u00f8dsgaard A, Andersen BL, Skaaning D, Petersen M (2022) From expressing human milk to breastfeeding\u2014an essential element in the journey to motherhood of mothers of prematurely born infants. Adv Neonatal Care 22(6):560. https:\/\/doi.org\/10.1097\/ANC.0000000000000962","journal-title":"Adv Neonatal Care"},{"issue":"1","key":"6896_CR23","doi-asserted-by":"publisher","DOI":"10.1186\/s13006-022-00499-0","volume":"17","author":"SA van Dellen","year":"2022","unstructured":"van Dellen SA, Wisse B, Mobach MP (2022) Effects of lactation room quality on working mothers\u2019 feelings and thoughts related to breastfeeding and work: a randomized controlled trial and a field experiment. Int Breastfeed J 17(1):57. https:\/\/doi.org\/10.1186\/s13006-022-00499-0","journal-title":"Int Breastfeed J"},{"issue":"3","key":"6896_CR24","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1542\/peds.2004-1636","volume":"116","author":"A Merewood","year":"2005","unstructured":"Merewood A, Mehta SD, Chamberlain LB, Philipp BL, Bauchner H (2005) Breastfeeding rates in US baby-friendly hospitals: results of a national survey. Pediatrics 116(3):628\u2013634. https:\/\/doi.org\/10.1542\/peds.2004-1636","journal-title":"Pediatrics"},{"issue":"10375","key":"6896_CR25","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1016\/S0140-6736(22)01931-6","volume":"401","author":"N Rollins","year":"2023","unstructured":"Rollins N, Piwoz E, Baker P et al (2023) Marketing of commercial milk formula: a system to capture parents, communities, science, and policy. Lancet 401(10375):486\u2013502. https:\/\/doi.org\/10.1016\/S0140-6736(22)01931-6","journal-title":"Lancet"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-06896-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-026-06896-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-06896-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T06:02:05Z","timestamp":1780120925000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-026-06896-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":25,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["6896"],"URL":"https:\/\/doi.org\/10.1007\/s00431-026-06896-5","relation":{},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]},"assertion":[{"value":"22 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 January 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"G.P.M. is one of the Editors of EJPE.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This survey does not involve the collection of personal data and is limited to investigating the organizational aspects of healthcare facilities. For this reason, approval by an ethics committee was not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants"}},{"value":"This survey does not involve the collection of personal data and is limited to investigating the organizational aspects of healthcare facilities. For this reason, informed consent was not required.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}],"article-number":"312"}}