First primary-care visit of the newborn and its implications for breastfeeding

First primary-care visit of the newborn and its implications for breastfeeding | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article First primary-care visit of the newborn and its implications for breastfeeding Paloma Comino-Vázquez, Marta Carballal-Mariño, Josep Vicent Balaguer-Martínez, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5939006/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Aug, 2025 Read the published version in International Breastfeeding Journal → Version 1 posted 6 You are reading this latest preprint version Abstract Background The first primary-care visit of the newborn (FPCVNB) aims to assess neonatal feeding, promote breastfeeding, and identify potential health issues. This study examines the relationship between the timing of the FPCVNB and the prevalence of exclusive breastfeeding (EBF) at one month of life. Methods This prospective, observational, analytical study was conducted through a paediatric research network. Data were collected from newborns attending both the FPCVNB and the one-month check-up during the study period. Selected variables were compared to those from a 2014 study by the same research network to identify rates of EBF at the time of the FPCVNB. The main outcome, EBF prevalence at one month, was measured with data from 2024. Results A total of 1952 cases were collected in 2024, with the FPCVNB occurring at 9.3 ± 6.1 days after hospital discharge, compared to 2047 cases in 2014, where it occurred at 10.7 ± 6.3 days. The EBF prevalence at FPCVNB was 63.1% in 2014 and 62.6% in 2024. The EBF prevalence at one month in 2024 was 55.0% (95% CI: 52.7–57.3). Performing the newborn’s first primary care visit within 72 hours of discharge is significantly associated with higher rates of EBF at one month (ORa: 0.63; 95% CI: 0.41–0.98). Furthermore, EBF was positively associated with prior breastfeeding experience (ORa: 1.77; 95% CI: 1.41–2.21). Conclusions The FPCVNB occurs late in Spain. Rates of EBF have declined over the past decade, highlighting the need for targeted interventions that address modifiable determinants. Evidence suggests that performing an FPCVNB within 72 hours of hospital discharge is an effective intervention that significantly improves breastfeeding rates. newborn breast feeding postnatal care primary health care ambulatory care facilities Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background The first primary-care visit of the newborn (FPCVNB) aims to assess newborn nutrition, promote breastfeeding, prevent and detect health problems, supervise adaptation to family life, and ensure access to health resources( 1 – 4 ). Recommendations regarding the timing of the FPCVNB vary across countries according to their differing strategies and public health plans ( 5 – 10 ). The World Health Organization (WHO) recommends that the FPCVNB be performed between 24 and 72 hours of life ( 6 ), whereas the Baby-Friendly Hospital Initiative proposes the visit between 2–4 days after hospital discharge ( 9 ). Furthermore, the American Academy of Pediatrics offers individualized recommendations depending on the duration of hospital stay: for stays of less than 48 hours, the FPCVNB should be performed within 2 days after hospital discharge, and for stays of more than 48 hours, the visit should be performed 3–5 days after hospital discharge ( 7 ). In Spain, the Ministerio de Salud (Spanish Ministry of Health) recommends the FPCVNB between 48 and 72 hours after hospital discharge ( 5 ), and the Comité de Lactancia of the Asociación Española de Pediatría (Spanish Paediatrics Association Lactation Committee) recommends that the visit occur within 24–48 hours after hospital discharge ( 11 ). However, at the regional level, some autonomous communities recommend simply that the FPCVNB be performed before 10 days of life ( 12 ). Considering this variability, further research is needed to determine the optimal timing of the FPCVNB ( 13 ). The length of hospital stays after delivery has progressively decreased in recent decades ( 14 , 15 ), further highlighting the importance of the FPCVNB. In Spain, the normal hospital stay for healthy newborns is 24–48 hours for vaginal deliveries and at least 72–96 hours for caesarean deliveries ( 5 ). Given the ample evidence regarding the benefits of breastfeeding—including improving the mother and newborn’s health and offering substantial economic savings for health systems ( 16 , 17 ) — support for breastfeeding should be considered a universal public health intervention ( 18 ). However, the promotion of exclusive breastfeeding (EBF) is often limited to the hospital setting with few interventions in primary care ( 9 ). Moreover, although primary care is an optimal context for effective intervention, few studies have assessed the programs aimed at prolonging the duration of breastfeeding ( 11 , 19 – 22 ). According to the 2017 report from the Instituto Nacional de Estadística in Spain (Spanish National Institute of Statistics) ( 23 ), the EBF prevalence at 6 months was 39%, similar to the 35% 6-month EBF prevalence reported in the LAyDI study ( 24 ). However, these numbers still fall far from achieving the WHO’s 2030 a global EBF prevalence of at least 70% at 6 months ( 25 ). Furthermore, Spain has a public and universal healthcare system, nonetheless primary care and hospital practices have developed independently, often with little communication between them. As a result, the FPCVNB may be delayed or not performed at an optimal time for detecting health problems or breastfeeding difficulties ( 5 ). In addition, health competencies are the responsibility of the autonomous communities and therefore organizational differences in newborn care may be present despite the national, scientific evidence-based, regulations ( 5 , 11 , 26 , 27 ). The main objective of this study was to determine whether the time between hospital discharge and the FPCVNB is related to the prevalence of breastfeeding at one month of life. Further objectives included data comparison between 2024 and 2014 to determine if the FPCVNB is performed within the recommended timeframes, if the time to the FPCVNB has decreased over the last ten years, and if there are differences in the FPCVNB between neonates born in public versus private hospitals. Methods Data source and design This research was based on an observational, prospective, analytical design. Data collection was conducted between November 1, 2023, and January 31, 2024, through a network specifically designed for paediatric research. Study participants were newborns under one month of age who attended initial appointments with collaborating paediatricians distributed nationally. To ensure that the sample was nationally representative, the sample size for the current data collection process was based on 2022 data (329 251 newborns born in Spain), the most recent data available during the study design process. Thus, it was determined that a sample size of 980 individuals would be considered representative, based on a confidence of 95%, an estimated prevalence of breastfeeding at 15 days of 85% ( 23 , 28 ), a precision of 0.025 and a potential loss of 20%. The inclusion criteria were completion of the initial primary care appointment (FPCVNB), a one-month visit with a collaborating paediatrician during the study period, and age of less than one month at the time of the first appointment. The exclusion criteria were premature birth before 36 weeks, birth weight under 2,200 g ( 29 ), maternal and/or neonatal stay for more than 5 days before hospital discharge, syndromes, metabolic diseases or congenital malformations that may affect food-related decisions during the study period, and home or out-of-hospital delivery. Data collection was carried using a dynamic database created ad hoc in REDCap (version 10.6.15, 2023, Vanderbilt University) by collaborating paediatricians in the Red de Investigación en Pediatría de Atención Primaria (PAPenRED) (Primary Care Paediatrics Research Network). This network, founded in 2013, operates in all Spanish autonomous communities through the Asociación Española de Pediatria de Atención Primaria (AEPap) (Primary Care Paediatrics Association of Spain). Proportional numbers of paediatricians in each autonomous community ensures that data obtained through the network are nationally representative. Data for this study was collected during the FPCVNB at the primary care facility after signed parental consent. Current data was compared with other data obtained 10 years ago—collected between October 1, 2014, and December 31, 2014—by the same network of paediatricians (PAPenRED). Identical inclusion and exclusion criteria were applied at both data collection times. Variables The main variable assessed in the 2024 study was the prevalence of EBF at one month of age. EBF was defined as receiving only breast milk as food in the last 24 hours. The main independent variable was the time elapsed, in days, from birth to the FPCVNB performed by paediatricians or paediatric nurses. The other variables analysed are detailed in Table 1 . Table 1 Variables and definitions of terms. Variables related to birth Weeks of gestation 37–38, 39–40, > 40 Type of delivery Spontaneous vaginal with epidural, spontaneous vaginal without epidural, instrumental (vacuum extraction, forceps, caesarean section, others) Type of hospital management Public, private, joint* Birth weight In grams Apgar (1 minute, 5 minutes) 0–10 Type of breastfeeding on the first day of life EBF, mixed feeding, exclusive formula feeding Newborn age at hospital discharge In days Type of breastfeeding at hospital discharge EBF, mixed feeding, exclusive formula feeding Siblings 0, 1, 2, 3 or more Mother with previous experience in breastfeeding Yes, no, unknown Attention received before primary care appointment Previous evaluation by a PC midwife Yes, no, unknown Metabolic screenign performed at the hospital Yes, no, unknown Prior visit performed elsewhere Yes (hospital emergencies, primary care emergencies, private practice, hospital of birth, other), no, unknown Received some indication about when to attend PC appointment at hospital discharge Yes (8 days, not specified), no, unknown Variables related to FPCVNB Age at FPCVNB In days Newborn weight at FPCVNB In grams Type of breastfeeding and FPCVNB and 24 hours before EBF, mixed feeding, exclusive formula feeding Trusting the paediatrician that an earlier visit would have been better Yes, no, unknown One-month primary care visit Type of breastfeeding at the visit and 24 hours before EBF, mixed feeding, exclusive formula feeding Previous symptoms Apnoea, respiratory distress, fever, jaundice, urinary tract infection, difficulty feeding, infection risk, other. Hospitalisation required after FPCVNB Yes, no, unknown FPCVNB: first primary-care visit of the newborn EBF: exclusive breastfeeding PC: primary care *“Joint” refers to publicly funded and privately run institutions [insert Table 1 about here] The same variables were used in both the 2014 and 2024 study periods with the exception of the following, which were only registered in 2024: Apgar test (1 and 5 minutes), type of feeding on the first day of life, newborn age at hospital discharge, type of feeding at hospital discharge, mother with previous experience in breastfeeding, type of feeding at the visit and 24 hours before, and hospitalisation required after FPCVNB. Statistical analyses Univariate and multivariate analyses were performed with SPSS 25.0. A descriptive study of the collected variables was conducted. The frequency distributions of qualitative variables are reported as percentages. The quantitative variables are presented as central tendency and dispersion measures, either mean and standard deviation for median and interquartile range. The associations between qualitative variables were assessed via the chi-square test, and between quantitative variables via the T-test. Binary logistic regression models were used to estimate the odds ratios (ORs) of variables potentially associated with EBF at one month of life. With the variables that showed significant differences in the crude analysis of the ORs, the adjusted ORs were calculated. Statistical significance was considered when p < 0.05. Ethical considerations The PAPenRED project was approved by the regional ethics committee of Aragón (favourable opinion, 19/2013; CP-CI PI13/00154). For the second phase of the study (2024), approval was granted by the respective ethics committees of the Hospital Virgen Macarena and the Hospital Vigen del Rocío (CEI_06/2023; CP RN-2023 and CI 0921-N-23). In addition, permission was granted by the ethics committees of each autonomous community. Results In the 2024 data collection process, an initial 1952 cases were registered by 242 collaborating paediatricians. A total of 43 patients (2.1%) were excluded for not meeting the inclusion criteria, and 25 patients were lost to follow-up at one month, resulting in a final sample of 1884 patients for analysis (Fig. 1). [insert Fig. 1 about here] Table 2 presents a comprehensive summary of all variables collected during the two study periods (2014 and 2024), while Table 3 provides an overview of the variables incorporated specifically in the 2024 study period. Table 2 Summary of all variables collected during the two study periods (2014–2024). Variable Label 2014 n = 2010 2024 n = 1884 p Weeks of gestation 37–38 39–40 > 40 499 (24.8%) 920 (45.8%) 591 (29.4%) 461 (24.5%) 1127 (59.8%) 296 (15.7%) < 0.001 Type of delivery Spontaneous vaginal with epidural Spontaneous vaginal without epidural Instrumental (vacuum extraction, forceps, caesarean section, others) 861 (42.8%) 395 (19.7%) 754 (37.5%) 969 (51.5%) 187 (9.9%) 728 (38.6%) < 0.001 Type of hospital management Public Private or joint* 1656 (82.4%) 354 (17.6%) 1536 (81.5%) 348 (18.5%) 0.486 Birth weight Grams ߂ = 3264.5 (450.7 SD) ߂ = 3283.2 (422.9 SD) 0.182 Siblings Yes 845 (42.0%) 917 (48.7%) < 0.001 Previous evaluation by a PC midwife Yes 480 (23.9%) 590 (32.0%) < 0.001 Metabolic screening performed at the hospital Yes 1507 (75.0%) 1774 (94.5%) < 0.001 Prior visit performed elsewhere Yes 336 (16.7%) 374 (19.9%) 0.016 Receipt of some indication about when to attend PC consultation at hospital discharge Yes 998 (62.7%) 1088 (74.0%) < 0.001 Age at FPCVNB Days ߂ = 10.7 (6.3 SD) ߂ = 9.3 (6.1 SD) < 0.001 Newborn weight at FPCVNB Grams ߂ = 3378.6 (1121.4 SD) ߂ = 3351.7 (502.1 SD) 0.340 Type of feeding and FPCVNB and 24 hours before Exclusive breastfeeding Mixed feeding Exclusive formula feeding 1268 (63.1) 429 (21.3) 313 (15.6) 1162 (62.6%) 414 (22.3%) 279 (15.0%) 0.730 Trusting the paediatrician that an earlier visit would have been better Yes 507 (25.2) 310 (16.5%) FPCVNB: first primary-care visit of the newborn EBF: exclusive breastfeeding SD: standard deviation IQR: interquartile range PC: primary care *“Joint” refers to publicly funded and privately run institutions Table 3 Variables added in the 2024 study period. Variable Label 2024 n = 1884 Apgar 1 minute 0–10 Me = 9 (9–9 IQR) Apgar 5 minutes 0–10 Me = 10 (10–10 IQR) Newborn age at hospital discharge Days ߂ = 2.4 (0.8 SD) Type of feeding on the first day of life Exclusive breastfeeding Mixed feeding Exclusive formula feeding 1373 (72.6%) 293 (15.7%) 218 (11.7%) Type of feeding at hospital discharge Exclusive breastfeeding Mixed feeding Exclusive formula feeding 1211 (64.3%) 430 (22.8%) 244 (12.9%) Mother with previous experience in breastfeeding Yes 741 (39.4%) Type of feeding at the visit and 24 hours before Exclusive breastfeeding Mixed feeding Exclusive formula feeding 1036 (55.0%) 486 (25.8%) 362 (19.2%) Hospitalisation required after FPCVNB Yes 70 (3.7%) FPCVNB: first primary-care visit of the newborn IQR: interquartile range Me: median SD: standard deviation [insert Table 2 about here] [insert Table 3 about here] Figure 2 shows the number of newborns stratified according to the day of the FPCVNB after hospital discharge. [insert Fig. 2 about here] Figures 3 and 4 show the feeding type at the FPCVNB, stratified by the week of the visit and compared to 2014 data. [insert Figs. 3 about here] [insert Fig. 4 about here] Binary logistic regression models were used to estimate the odds ratios (ORs) of variables potentially associated with EBF at one month of life. With the variables that showed significant differences in the crude analysis of the ORs, the adjusted ORs were calculated. Statistical significance was considered when p < 0.05. Table 4 shows relationships between different variables and the presence of EBF at one month of life. Table 4 Relationships between different variables and the presence of EBF at one month of life (2024). Variable OR* 95% CI p** ORa*** 95% CI p** Type of delivery (Ref: non-instrumental, vaginal, epidural) Non-instrumental, vaginal, no epidural Instrumental (vacuum extraction, forceps, caesarean section) 1.395 0.997–1.953 0.052 1.293 0.873–1.916 0.199 0.626 0.515–0.761 < 0.001 1.033 0.470–2.271 0.936 Type of instrumental delivery (Ref: non-instrumental delivery) Vacuum extraction Forceps Caesarean section 0.560 0.412–0.762 < 0.001 0.603 0.261–1.397 0.238 0.646 0.379-1.100 0.107 0.657 0.246–1.758 0.403 0.592 0.474–0.741 < 0.001 0.650 0.291–1.453 0.294 Type of hospital management (2 categories) (Public vs. Private/Joint) 0.754 0;596-0.954 0.019 1.009 0.760–1.340 0.951 Breastfeeding in siblings (Ref: No) 2.085 1.720–2.526 < 0.001 1.768 1.413–2.211 < 0.001 Hospital indication for primary care visit in 1st week of life (Ref: No) 1.304 1.032–1.649 0.026 1.239 0.972–1.580 0.083 Prior consultation by midwife (Ref: No) 1.178 0.965–1.438 0.107 1.198 0.946–1.516 0.133 Prior consultation during hospital emergency (Ref: No) 0.532 0.370–0.763 0.001 0.539 0.360–0.807 0.003 Prior consultation during primary care emergency (Ref: No) 0.581 0.308–1.096 0.094 0.352 0.160–0.774 0.009 Administrative difficulty with primary care visit (Ref: No) 0.749 0.542–1.035 0.080 0.774 0.570–1.068 0.074 1st visit within 1–7 days of life (Ref: No) 1.202 1.000-1.444 0.050 1.049 0.833–1.321 0.686 1st visit within 72 hours after hospital discharge (Ref: No) 1.108 0.912–1.345 0.301 0.634 0.409–0.984 0.042 * OR = odds catio ** Significant at p < 0.05. Values with statistically significant differences are in bold. *** ORa = Adjusted odds ratio. Adjustment made with the variables that show statistically significant differences in the crude OR analysis. 1 “Joint” refers to publicly funded and privately run institutions [insert Table 4 about here] Table 5 shows the relationships between different variables and the presence of any type of breastfeeding, i.e., EBF and mixed lactation (breastfeeding + formula feeding) at one month of life (2024). Table 5 Relationships between variables and type of breastfeeding (EBF + mixed lactation) at one month of life (2024). Variable OR* 95% CI p** ORa*** 95% CI p** Type of delivery (Ref: non-instrumental, vaginal, epidural) Non-instrumental, vaginal, no epidural Instrumental (vacuum extraction, forceps, caesarean section) 1.090 0.708–1.677 0.697 1.128 0.653–1.949 0.666 0.737 0.578–0.940 0.014 1.165 0.389–3.493 0.785 Type of instrumental delivery (Ref: non-instrumental delivery) Vacuum extraction Forceps Caesarean section 0.628 0.438–0.901 0.012 0.672 0.214–2.112 0.496 0.977 0.485–1.967 0.948 0.937 0.247–3.556 0.924 0.764 0.579–1.008 0.057 0.859 0.281–2.624 0.790 Type of hospital management (2 categories) (Public vs. Private/Joint 1 ) 0.682 0.516–0.902 0.007 0.901 0.633–1.285 0.566 Breastfeeding in siblings (Ref: No) 2.625 2.008–3.432 < 0.001 2.716 1.966–3.751 < 0.001 Hospital indication for primary care visit in 1st week of life (Ref: No) 1.441 1.060–1.959 0.020 1.709 1.257–2.323 0.001 Prior consultation by midwife (Ref: No) 1.352 1.040–1.757 0.024 1.563 1.141–2.142 0.005 Prior consultation during hospital emergency (Ref: No) 0.658 0.389–1.115 0.120 0.745 0.460–1.206 0.231 Prior consultation during primary care emergency (Ref: No) 0.779 0.370–1.639 0.510 0.718 0.304–1.698 0.451 Administrative difficulty with primary care visit (Ref: No) 0.928 0.621–1.387 0.716 0.790 0.503–1.239 0.305 1st visit within 1–7 days of life (Ref: No) 1.194 0.947–1.506 0.134 1.184 0.874–1.604 0.276 1st visit within 72 hours after hospital discharge (Ref: No) 1.266 0.984–1.628 0.067 0.797 0.444–1.430 0.447 * OR = Odds Ratio ** Significant at p < 0.05. Values with statistically significant differences are in bold. *** ORa = Adjusted Odds Ratio. Adjustment made with the variables that show statistically significant differences in the crude OR analysis. 1 “Joint” refers to publicly funded and privately run institutions [insert Table 5 about here] Figure 5 shows the prevalence of EBF, ML and FF at one month according to the week in which the FPCVNB was performed. [insert Fig. 5about here] Discussion The results of our study indicate that performing the first newborn primary care visit within 72 hours after discharge is significantly associated with higher rates of exclusive breastfeeding at one month of age. In addition, a clear decreasing trend in EBF prevalence with later FPCVNB was observed. These findings highlight the importance of performing this first visit within 72 hours after hospital discharge, given that the first days of life constitute a window of opportunity for the correct establishment and maintenance of breastfeeding. The WHO recommends breastfeeding promotion across the spectrum of maternal and child health care ( 9 ), especially in the prenatal and puerperal periods. Primary care centres are an ideal place for this initiative. The 2024 data shows that the PCVNB is performed at an average of 9.3 ± 6 days following hospital discharge, which is considerably later than the timelines recommended by national guidelines and most international organizations ( 3 , 5 ). By comparison, the 2014 study reported a mean time of 10.7 ± 6.3 days to the FPCVNB. Although the time to FPCVNB has decreased by an average of 1.4 days, there is still substantial room for improvement to reach the recommended standards. This decrease may be attributed to the fact that more hospitals now recommend attending the FPCVNB within the first week of life (74% of hospitals in 2024 compared with 62.7% in 2014). A significant relationship was identified between hospitals recommending the FPCVNB within the first week of life and higher rates of breastfeeding (both EBF and mixed lactation) at one month of life. No significant differences were found between public and private institutions. Having consulted the healthcare system, either in hospital emergency departments or primary care centres, shows significant statistical association with better exclusive breastfeeding rates at one month of age. This supports the idea that intervention by a health professional in the first days of life improves breastfeeding rates. Despite the reduction in the recommended time elapsed before for the FPCVNB, our data shows a decline of 0.5 percentage points in the overall rates of exclusive breastfeeding at the FPCVNB. This decline may be attributable to a variety of factors, as there are many determinants that influence breastfeeding at one month of age, including biological, social, and health-related factors ( 24 , 30 – 32 ). This decrease in breastfeeding rates is of interest and requires further investigation, especially considering the complex interplay among all other factors. Maternal experience, age, education level, attendance of prenatal classes, contact with support groups, emotional support and self-efficacy have been identified as key factors in the initiation and duration of breastfeeding ( 28 , 33 – 37 ). Newborns whose mothers had previous breastfeeding experience showed statistically significant differences in favour of breastfeeding maintenance at one month of life. Prior research by Hackman et al ( 37 ) supports this finding, reporting that, compared with primiparous mothers, multiparous mothers had a longer duration of EBF and significantly greater rates of EBF at 2 weeks and 2 months of life ( 38 ). The prevalence of EBF on the first day of life was 72.6%, which decreased to 64% at the time of hospital discharge. These values reflect a relatively low initial prevalence compared with other European countries, such as Germany where the EBF prevalence at birth is 97% ( 39 ). The results of our study show a 55% EBF prevalence in the first month of life, which is much lower than the 73.9% EBF prevalence at 6 weeks of life reported by the most recent (2017) survey published by the Instituto Nacional de Estadística (National Institute of Statistics of Spain) ( 23 ). Our results are more similar to those published in the LAyDI study ( 24 ), showing an EBF prevalence of 62.3% at the first month and 35.2% at six months of life. Considering that the WHO has established a goal of a global EBF prevalence of 50% at six months of life in 2025 and 70% in 2030 ( 25 , 40 ), the 55% EBF prevalence at one month indicates that Spain is far from reaching that goal. Regarding breastfeeding promotion, early neonatal visits represent direct economic government savings. Specifically, increasing breastfeeding rates at hospital discharge and at 6 months postpartum (from 85%/15–95% /50%, respectively) is estimated to save the Spanish health system at least 197 million euros per year ( 41 ). Breastfeeding also generates indirect savings based on the intellectual, social and emotional benefits ( 42 , 43 ). Given these positive benefits, breastfeeding research should be a public health priority. Furthermore, breastfeeding promotion and support are needed to address the advantages for both the mother and child, and for society in general. This study has many strengths, such as the use of a considerably large sample which thus increases the statistical power and the ability to detect statistically significant associations. In addition, data collection through a network specifically designed for paediatric research (PAPenRED)— which has a wide variety of patients throughout the country with different geographical, socioeconomic and cultural contexts—enabled us to obtain a nationally representative sample. Nonetheless, this study has certain limitations. Selection bias may have occurred due to the pressure associated with limited time to provide care during appointments, which may have influenced sample recruitment. To minimize this bias, all newborns delivered during the study period were consecutively registered. Another possible selection bias is the voluntary participation of the paediatricians in PAPenRED. This bias was addressed by including a large number of collaborating researchers, which strengthens data validity. In addition, this study exhibits the typical limitations of an observational study, which does not allow the direct establishment of cause‒effect relationships. In summary, performing the FPCVNB within 72 hours of discharge is significantly associated with higher rates of exclusive breastfeeding at one month of age. However, as our study has shown, the FPCVNB occurs late in Spain, at 9.3 ± 6 days after hospital discharge. Although this value has improved by 1.4 days compared to 2014, substantial efforts are still needed to reach the national and international recommendations. In addition, EBF rates at the time of the first primary-care visit have declined over the last 10 years, from 63.1% in 2014 to 62.6% in 2024. Therefore, future research should examine what modifiable determinants can promote early FPCVNB, given that the data indicates a positive influence on breastfeeding overall and enhanced EBF rates. Furthermore, research into which specific primary care interventions influence EBF during the first year of infancy (e.g., FPCVNB within the indicated time frame, a specialized breastfeeding service, hospital recommendations for FPCVNB, etc.) could strengthen the role of primary care as a pillar in the promotion and support of breastfeeding, consequentially improving health outcomes. Abbreviations FPCVNB: first primary-care visit of the newborn EBF: exclusive breastfeeding BFHI: Baby-Friendly Hospital Initiative PAPenRED: La Red de Investigación Pediatría de Atención Primaria (Spanish Primary Care Pediatrics Research Network) AEPap: Asociación Española de Pediatría de Atención Primaria (Spanish Primary Care Pediatrics Association) MF: mixed feeding FF: formula feeding WHO: World Health Organization Declarations Ethics approval and consent to participate The PAPenRED project was approved by regional ethics committee of Aragón (favourable opinion, 19/2013; CP-CI PI13/00154). For the 2024 study, approval was obtained from the respective ethics committees of the Hospital Virgen Macarena and Hospital Virgen del Rocío (CEI_06/2023; CP RN-2023 and CI 0921-N-23, respectively). In addition, permission was obtained from the ethics committees in each autonomous community in Spain. Consent for publication Not applicable Availability of data and materials Data are available from the corresponding author upon request. Competing interests The authors declare that they have no competing interests. Funding This study received a 3000 € research grant from the Asociación Andaluza de Pediatría de Atención Primaria (Andalusian Association of Primary Care Paediatrics). Authors' contributions PCV is the principal investigator of the study. All the authors participated in the study design, data collection and manuscript writing. MCM and CGV coordinated the research network. JVBM contributed to the statistical analysis. CGV coordinated the 2014 study. JMLA participated in the 2014 study. All the authors read and approved the final manuscript. Acknowledgements We thank Jorge Suances Hernández for his statistical analysis. We thank Ian Scionti for his translation and review of the manuscript. We thank all the collaborating paediatricians of PAPenRED for their data collection: Guadalupe Castillo-Aguas, Ana Gallego-Iborra, Ana Lorente García-Mauriño, Tatiana Menéndez-Bada, Ramona Mínguez-Verdejo, Manuela Sánchez-Echenique, Laura Somalo-Hernández, Beatriz Abad-Balaguer, Elia Acitores-Suz, Beatriz Acosta-Navas, Sonia Albadalejo-Beltran, Vega Almazán-Fernández-De-Bobadilla, Noelia Álvarez-Zallo, Julia Álvarez-Gómez, Irene Álvarez-González, Elena Álvarez-Vázquez, Ana Paula Amadeus-Da-Costa, Dolors Anfreu-I-Duat, María Eugenia Angulo-Moreno, María Antuña-Fernandez, María Aparicio-Rodrigo, Esther Apolinar-Valiente, María José Arconada-Martín, Josefa Ares-Álvarez, Sonia Arias-Álvarez, Rosa Arranz-Sanjuan, María Teresa Arroyo-Romo, Natalia Arza-Méndez, María Teresa Asensi-Monzo, María Astiz-Blanco, Amalia Ayechu-Díaz, Ernestina Azor-Martínez, Lucia Barahona-Robdon, Ana María Barbero-Rodríguez, Elisa María Barrios-González, Alberto Bercedo-Sanz, Mercè Bernad-Albareda, Esther Bernal-Vañó, Mireia Biosca-Pàmies, Javier Blanco-González, Alicia Bonet-Garrosa, Belén Botella-Serrano, Xavier Bruna-Pérez, Ana María Burgaleta-Sagasea, Silvia Burgaya-Subirena, María José Bustos-Prados, María Elena Cabezas-Tapia, María Águeda Campos-Nieto, Pedro Ca Nadell-Villaret, Cristina Cañavate-González, Purificación Cárdenas-Guerrero, Cristina Carrasco-Gimenez, Marta Carrera-Polanco, María Laura Casado-Sánchez, Elena Cascón-Criado, Isabel Castilla-Pedregosa, Edurne Ciriza-Barea, Zerezade Coello-Torres, Nayra Coello-Torres, Marina Colom-Segui, Patricia Margarita Company-Maciá, Cristóbal Coronel-Rodríguez, Sara Corral-Muñoz, Marta Crespo-Medina, Ignacio Cruz-Navarro, María Angustias De-Haro-López, Ana Isabel Díaz-Cirujano, Olga Díez-Zaera, Catalina Durán-Iglesias, María José Edo-Jimeno, Aurora Egea, Yolanda Escanciano-García, Carla Escribano-García, María Jesús Escribano-Romero, Rosario Espejo-Moreno, Oscar Espinazo-Ramos, Blanca Espínola-Docio, Jessica Noelia Esquivel-Ojeda, Vanesa Fernández-Días, Ramona Fernández-Fernández, María Fernández-Francés, Rosa Fernández-González, Antonia Fernández-León, María Elena Fernández-Segura, Esther Fernández-Tardáguila, Miguel Fernández-Cuesta, Laia Ferré- Moragues, Carlos Bernardo Ferriz-Mas, Catarina Fervenza-Cortegoso, Beatriz Flores-Méndez, Nerea Gallego-Mingo, Inmaculada García-Arroyo, Miriam García-García, Águeda García-Merino, Ana García-Ruiz, Natalia García-Sánchez, Juan Antonio García-Sánchez, Ana María García-Sánchez, Beatriz Garrido, Mercedes Garrido-Redondo, Anna Gatell-Carbó, Carles Gatius-Tonda, Inmaculada Gavilan-García, María Josefa Gellioda-Royo, Inmaculada Gil-Alexandres, Raquel Gómez-Casares, Raquel Gómez-García, María Isabel Gómez-Martín, Marta Gómez-Verdugo, María Victoria González-Cortés, Alicia González-De-Eusebio, Mariana González-Del-Castillo, Miriam González-Herrero, Antonio Javier González-Martínez, María Paz González-Rodríguez, Ana González-Sala, Ana Isabel Grau-García, Enrique Guerra-Vilches, Beatriz Guillot-Roselló, Carmelo Gutiérrez-Abad, Sofía Hernández-Cáceres, Carmen Hernández-Marqués, María Yolanda Hernández-Ortiz, Antonio Iofrío-De-Arce, Dolores Jaramillo-Hidalgo, Juan Manuel Jiménez -Hereza, Júlia Jové-Naval, Blanca Juanes-De-Toledo, Silke Bianca Kirch Schläger-Nieto, Alfonso Lendínez-Jurado, María del Prado Leo-Canzobre, Patricia LLeixá-Daga, Pilar Lobera-Navaz, Aranzazu López-Martínez, Elena López-Vargas, Rosario María Guerrero, Irene Marín-Berruezo, Sara Marquina-Cintora, Sara Martí-Martí, Itziar Martín-Ibañez, María José Martín-Sierra, Carmen Martínez-Antequera, María Martínez-Barahona, Laura Martínez-Espligares, María Teresa Martínez-Rivera, José Medina-Pomares, Guadalupe Membrillo-Lucena, Susana Méndez- Gallego, Paula Ivonne Mendoza-Álamo, José Mengual-Gil, María Inmaculada Merino-Marcos, Judith Montañez-Arteaga, David Montero-Vázquez, Ana Isabel Monzón-Bueno, Cristina Morales-Carpi, Esther Moreno-Medínilla, María Rosario Muñoz-Núñez, Carmen Mustieles-Moreno, Guiomar Navarro-Cabañas, Carmen Navas-Heredia, Ana María Nocea-Pulfer, Jorge Olivares-Ortiz, José María Olmos-García, Inmaculada Ortells-Ramón, María Luisa Padilla-Esteban, María Candelaria Padilla-Sánchez, María Belén Panizo-Santos, Remedios Parejo-Carranza, Cristina Pato- Fernández, María Rosa Pavo-García, Susana Peñarroja-Peirats, Mª Luz Peralta-Ibáñez, Isabel Pérez-García, Lucia Pérez-Gómez, Roxanne Laura Pérez-Nygaard, Helena Pérez-Tato, Patricia Pernas-Gómez, Míriam Poblet-Puig, Eloy Pozuelo-Lima, Silvia Prado-Muñoz, Paula Prim-Jaurrieta, Carmen Puig-García, Maribel Quintanilla-Sánchez, Rosa María Ramírez-Gavira, Africa Raventós-Canet, Consuelo Rey-Del-Castillo, Mónica Reyes-Medina, Marina Rico -Santori, Ana Ripoll-Lozano, Anna Maria Ristol-Perxés, Natalia Rivas-Abrales, Gisela Roca-Gardeñas, Diana Rodà-Goula, Francisco Javier Rodríguez-Álvarez, Mª Dolores Rodríguez-Baz, Francisco Javier Rodríguez-Contreras, Juan Rodríguez- Delgado, Sandra Rodríguez-Fernández, Rosa María Rodríguez-Parada, Yessica Rodríguez-Santana, Isabel María Rodríguez-Toro, Gloria Angélica Rodríguez-López-Márquez, Begoña Rodríguez-Moldes-Vázquez, Marcos Romero-García, Julia Ruiz-Jiménez, Ana Saenz-De-Urturi, Amaia Sáez-De-Lafuente-Arriazu, Olga Salvado-Juncosa, Felicidad Sanantonio -Valdearcos, Elena Sánchez-Almeida, María Teresa Sánchez-Andrés, Nieves Sánchez-Cordero, María Sánchez-Moreno, María Concepción Sánchez-Pina, Silvia Sánchez-Precioso, Almudena Sánchez-Vázquez, María Isabel Sánchez-Prieto-Emmanuel, María Isabel Sancho-Madrid, María Teresa Santos-García-Cuellar, Mercedes Sarmiento-Martínez, Miriam Coromoto Sequera-Bolívar, Catalina Isabel Servera-Ginard, Andrea Soriano-Marco, Omar Suárez-Gómez, Beatriz Suárez-Traba, Marta Suau-Anechina, Mª Fernanda Taboas-Ledo, Clara Téllez-Labao, María Valls-Inglá, María Vaquerizo-Pollino, María Salomé Vega-Pérez, María Vegas-Carrón, Elena Vegues-Veguillas, Olga Vera-Estrada, Marta Viver-Gómez, Susana Patricia Zardoña- Santos, and Elia 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Clin Ther; 2022 [Consulted 26 Mar 2025];44(2). Available from: https://pubmed.ncbi.nlm.nih.gov/34906370/ Mildon A, Francis J, Stewart S, Underhill B, Ng YM, Richards E, et al. Effect on breastfeeding practices of providing in-home lactation support to vulnerable women through the Canada Prenatal Nutrition Program: protocol for a pre/post intervention study. Int Breastfeed J. 2021;16(1):49. D’Hollander CJ, McCredie VA, Uleryk EM, Kucab M, Le RM, Hayosh O et al. Breastfeeding Support Provided by Lactation Consultants: A Systematic Review and Meta-Analysis. JAMA Pediatrics [Internet]. 2025 [Consulted 26 Mar 2025]; Available from: https://doi.org/10.1001/jamapediatrics.2024.6810 Hackman NM, Schaefer EW, Beiler JS, Rose CM, Paul IM. Breastfeeding Outcome Comparison by Parity. Breastfeed Med. 2015;10(3):156. Theurich MA, Davanzo R, Busck-Rasmussen M, Díaz-Gómez NM, Brennan C, Kylberg E, et al. Breastfeeding Rates and Programs in Europe: A Survey of 11 National Breastfeeding Committees and Representatives. J Pediatr Gastroenterol Nutr. 2019;68(3):400–7. Metas mundiales de nutrición. 2025: documento normativo sobre lactancia materna [Global nutrition targets 2025: breastfeeding policy brief ]. Ginebra: Organización Mundial de la Salud; 2017 (WHO/NMH/NHD/14.7). Licencia: CC BY-NC-SA 3.0 IGO. Quesada JA, Méndez I, Martín-Gil R. The economic benefits of increasing breastfeeding rates in Spain. Int Breastfeed J. 2020;15(1):34. Relaksana R, Akbar A, Sihaloho ED, Ferdian D, Siregar AY. The financial need of feeding infants for the first six months of life in West Java Province of Indonesia and the implications of socioeconomic and mental health factors. Int Breastfeed J. 2023;18(1):26. Chambers A, Emmott E, Myers S, Page A. Emotional and informational social support from health visitors and breastfeeding outcomes in the UK. Int Breastfeed J. 2023;18(1):14. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Aug, 2025 Read the published version in International Breastfeeding Journal → Version 1 posted Editorial decision: Revision requested 20 Apr, 2025 Reviews received at journal 19 Apr, 2025 Reviewers agreed at journal 06 Apr, 2025 Reviewers invited by journal 05 Apr, 2025 Submission checks completed at journal 02 Apr, 2025 First submitted to journal 29 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5939006","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":439098101,"identity":"2848d42e-a613-4387-8f33-bb92e9934b78","order_by":0,"name":"Paloma 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16:10:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2528468,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5939006/v1/339ee86c-3525-4642-acf3-05dbdb93a937.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFirst primary-care visit of the newborn and its implications for breastfeeding\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eThe first primary-care visit of the newborn (FPCVNB) aims to assess newborn nutrition, promote breastfeeding, prevent and detect health problems, supervise adaptation to family life, and ensure access to health resources(\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Recommendations regarding the timing of the FPCVNB vary across countries according to their differing strategies and public health plans (\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe World Health Organization (WHO) recommends that the FPCVNB be performed between 24 and 72 hours of life (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), whereas the Baby-Friendly Hospital Initiative proposes the visit between 2\u0026ndash;4 days after hospital discharge (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Furthermore, the American Academy of Pediatrics offers individualized recommendations depending on the duration of hospital stay: for stays of less than 48 hours, the FPCVNB should be performed within 2 days after hospital discharge, and for stays of more than 48 hours, the visit should be performed 3\u0026ndash;5 days after hospital discharge (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Spain, the Ministerio de Salud (Spanish Ministry of Health) recommends the FPCVNB between 48 and 72 hours after hospital discharge (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), and the Comit\u0026eacute; de Lactancia of the Asociaci\u0026oacute;n Espa\u0026ntilde;ola de Pediatr\u0026iacute;a (Spanish Paediatrics Association Lactation Committee) recommends that the visit occur within 24\u0026ndash;48 hours after hospital discharge (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, at the regional level, some autonomous communities recommend simply that the FPCVNB be performed before 10 days of life (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Considering this variability, further research is needed to determine the optimal timing of the FPCVNB (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe length of hospital stays after delivery has progressively decreased in recent decades (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), further highlighting the importance of the FPCVNB. In Spain, the normal hospital stay for healthy newborns is 24\u0026ndash;48 hours for vaginal deliveries and at least 72\u0026ndash;96 hours for caesarean deliveries (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the ample evidence regarding the benefits of breastfeeding\u0026mdash;including improving the mother and newborn\u0026rsquo;s health and offering substantial economic savings for health systems (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) \u0026mdash; support for breastfeeding should be considered a universal public health intervention (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, the promotion of exclusive breastfeeding (EBF) is often limited to the hospital setting with few interventions in primary care (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Moreover, although primary care is an optimal context for effective intervention, few studies have assessed the programs aimed at prolonging the duration of breastfeeding (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the 2017 report from the Instituto Nacional de Estad\u0026iacute;stica in Spain (Spanish National Institute of Statistics) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), the EBF prevalence at 6 months was 39%, similar to the 35% 6-month EBF prevalence reported in the LAyDI study (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). However, these numbers still fall far from achieving the WHO\u0026rsquo;s 2030 a global EBF prevalence of at least 70% at 6 months (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, Spain has a public and universal healthcare system, nonetheless primary care and hospital practices have developed independently, often with little communication between them. As a result, the FPCVNB may be delayed or not performed at an optimal time for detecting health problems or breastfeeding difficulties (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In addition, health competencies are the responsibility of the autonomous communities and therefore organizational differences in newborn care may be present despite the national, scientific evidence-based, regulations (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe main objective of this study was to determine whether the time between hospital discharge and the FPCVNB is related to the prevalence of breastfeeding at one month of life. Further objectives included data comparison between 2024 and 2014 to determine if the FPCVNB is performed within the recommended timeframes, if the time to the FPCVNB has decreased over the last ten years, and if there are differences in the FPCVNB between neonates born in public versus private hospitals.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData source and design\u003c/h2\u003e \u003cp\u003eThis research was based on an observational, prospective, analytical design. Data collection was conducted between November 1, 2023, and January 31, 2024, through a network specifically designed for paediatric research. Study participants were newborns under one month of age who attended initial appointments with collaborating paediatricians distributed nationally.\u003c/p\u003e \u003cp\u003eTo ensure that the sample was nationally representative, the sample size for the current data collection process was based on 2022 data (329 251 newborns born in Spain), the most recent data available during the study design process. Thus, it was determined that a sample size of 980 individuals would be considered representative, based on a confidence of 95%, an estimated prevalence of breastfeeding at 15 days of 85% (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), a precision of 0.025 and a potential loss of 20%.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were completion of the initial primary care appointment (FPCVNB), a one-month visit with a collaborating paediatrician during the study period, and age of less than one month at the time of the first appointment. The exclusion criteria were premature birth before 36 weeks, birth weight under 2,200 g (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), maternal and/or neonatal stay for more than 5 days before hospital discharge, syndromes, metabolic diseases or congenital malformations that may affect food-related decisions during the study period, and home or out-of-hospital delivery.\u003c/p\u003e \u003cp\u003eData collection was carried using a dynamic database created \u003cem\u003ead hoc\u003c/em\u003e in REDCap (version 10.6.15, 2023, Vanderbilt University) by collaborating paediatricians in the Red de Investigaci\u0026oacute;n en Pediatr\u0026iacute;a de Atenci\u0026oacute;n Primaria (PAPenRED) (Primary Care Paediatrics Research Network). This network, founded in 2013, operates in all Spanish autonomous communities through the Asociaci\u0026oacute;n Espa\u0026ntilde;ola de Pediatria de Atenci\u0026oacute;n Primaria (AEPap) (Primary Care Paediatrics Association of Spain). Proportional numbers of paediatricians in each autonomous community ensures that data obtained through the network are nationally representative. Data for this study was collected during the FPCVNB at the primary care facility after signed parental consent. Current data was compared with other data obtained 10 years ago\u0026mdash;collected between October 1, 2014, and December 31, 2014\u0026mdash;by the same network of paediatricians (PAPenRED). Identical inclusion and exclusion criteria were applied at both data collection times.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003eThe main variable assessed in the 2024 study was the prevalence of EBF at one month of age. EBF was defined as receiving only breast milk as food in the last 24 hours. The main independent variable was the time elapsed, in days, from birth to the FPCVNB performed by paediatricians or paediatric nurses. The other variables analysed are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVariables and definitions of terms.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eVariables related to birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeeks of gestation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u0026ndash;38, 39\u0026ndash;40, \u0026gt; 40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpontaneous vaginal with epidural, spontaneous vaginal without epidural, instrumental (vacuum extraction, forceps, caesarean section, others)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType of hospital management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePublic, private, joint*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBirth weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn grams\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApgar (1 minute, 5 minutes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType of breastfeeding on the first day of life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEBF, mixed feeding, exclusive formula feeding\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNewborn age at hospital discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn days\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType of breastfeeding at hospital discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEBF, mixed feeding, exclusive formula feeding\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSiblings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0, 1, 2, 3 or more\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother with previous experience in breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, no, unknown\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAttention received before primary care appointment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevious evaluation by a PC midwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, no, unknown\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMetabolic screenign performed at the hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, no, unknown\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrior visit performed elsewhere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes (hospital emergencies, primary care emergencies, private practice, hospital of birth, other), no, unknown\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReceived some indication about when to attend PC appointment at hospital discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes (\u0026lt;\u0026thinsp;3 days, 4\u0026ndash;7 days, in the first week of life,\u0026gt;8 days, not specified), no, unknown\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eVariables related to FPCVNB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge at FPCVNB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn days\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNewborn weight at FPCVNB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn grams\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType of breastfeeding and FPCVNB and 24 hours before\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEBF, mixed feeding, exclusive formula feeding\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrusting the paediatrician that an earlier visit would have been better\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, no, unknown\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eOne-month primary care visit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType of breastfeeding at the visit and 24 hours before\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEBF, mixed feeding, exclusive formula feeding\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevious symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eApnoea, respiratory distress, fever, jaundice, urinary tract infection, difficulty feeding, infection risk, other.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospitalisation required after FPCVNB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, no, unknown\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eFPCVNB: first primary-care visit of the newborn\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eEBF: exclusive breastfeeding\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003ePC: primary care\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*\u0026ldquo;Joint\u0026rdquo; refers to publicly funded and privately run institutions\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[insert Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e about here]\u003c/p\u003e \u003cp\u003eThe same variables were used in both the 2014 and 2024 study periods with the exception of the following, which were only registered in 2024: Apgar test (1 and 5 minutes), type of feeding on the first day of life, newborn age at hospital discharge, type of feeding at hospital discharge, mother with previous experience in breastfeeding, type of feeding at the visit and 24 hours before, and hospitalisation required after FPCVNB.\u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eUnivariate and multivariate analyses were performed with SPSS 25.0. A descriptive study of the collected variables was conducted. The frequency distributions of qualitative variables are reported as percentages. The quantitative variables are presented as central tendency and dispersion measures, either mean and standard deviation for median and interquartile range. The associations between qualitative variables were assessed via the chi-square test, and between quantitative variables via the T-test. Binary logistic regression models were used to estimate the odds ratios (ORs) of variables potentially associated with EBF at one month of life. With the variables that showed significant differences in the crude analysis of the ORs, the adjusted ORs were calculated. Statistical significance was considered when p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e The PAPenRED project was approved by the regional ethics committee of Arag\u0026oacute;n (favourable opinion, 19/2013; CP-CI PI13/00154). For the second phase of the study (2024), approval was granted by the respective ethics committees of the Hospital Virgen Macarena and the Hospital Vigen del Roc\u0026iacute;o (CEI_06/2023; CP RN-2023 and CI 0921-N-23). In addition, permission was granted by the ethics committees of each autonomous community.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn the 2024 data collection process, an initial 1952 cases were registered by 242 collaborating paediatricians. A total of 43 patients (2.1%) were excluded for not meeting the inclusion criteria, and 25 patients were lost to follow-up at one month, resulting in a final sample of 1884 patients for analysis (Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e[insert Fig.\u0026nbsp;1 about here]\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents a comprehensive summary of all variables collected during the two study periods (2014 and 2024), while Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e provides an overview of the variables incorporated specifically in the 2024 study period.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of all variables collected during the two study periods (2014\u0026ndash;2024).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLabel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;2010\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;1884\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeeks of gestation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u0026ndash;38\u003c/p\u003e \u003cp\u003e39\u0026ndash;40\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e499 (24.8%)\u003c/p\u003e \u003cp\u003e920 (45.8%)\u003c/p\u003e \u003cp\u003e591 (29.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e461 (24.5%)\u003c/p\u003e \u003cp\u003e1127 (59.8%)\u003c/p\u003e \u003cp\u003e296 (15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpontaneous vaginal with epidural\u003c/p\u003e \u003cp\u003eSpontaneous vaginal without epidural\u003c/p\u003e \u003cp\u003eInstrumental (vacuum extraction, forceps, caesarean section, others)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e861 (42.8%)\u003c/p\u003e \u003cp\u003e395 (19.7%)\u003c/p\u003e \u003cp\u003e754 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e969 (51.5%)\u003c/p\u003e \u003cp\u003e187 (9.9%)\u003c/p\u003e \u003cp\u003e728 (38.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of hospital management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic\u003c/p\u003e \u003cp\u003ePrivate or joint*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1656 (82.4%)\u003c/p\u003e \u003cp\u003e354 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1536 (81.5%)\u003c/p\u003e \u003cp\u003e348 (18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e߂\u003c/em\u003e = 3264.5 (450.7 SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e߂\u003c/em\u003e = 3283.2 (422.9 SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSiblings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e845 (42.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e917 (48.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious evaluation by a PC midwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e480 (23.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e590 (32.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetabolic screening performed at the hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1507 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1774 (94.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior visit performed elsewhere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e336 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e374 (19.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceipt of some indication about when to attend PC consultation at hospital discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e998 (62.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1088 (74.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at FPCVNB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDays\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e߂\u003c/em\u003e = 10.7 (6.3 SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e߂\u003c/em\u003e = 9.3 (6.1 SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNewborn weight at FPCVNB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e߂\u003c/em\u003e = 3378.6 (1121.4 SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e߂\u003c/em\u003e = 3351.7 (502.1 SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of feeding and FPCVNB and 24 hours before\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExclusive breastfeeding\u003c/p\u003e \u003cp\u003eMixed feeding\u003c/p\u003e \u003cp\u003eExclusive formula feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1268 (63.1)\u003c/p\u003e \u003cp\u003e429 (21.3)\u003c/p\u003e \u003cp\u003e313 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1162 (62.6%)\u003c/p\u003e \u003cp\u003e414 (22.3%)\u003c/p\u003e \u003cp\u003e279 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.730\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrusting the paediatrician that an earlier visit would have been better\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e507 (25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e310 (16.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eFPCVNB: first primary-care visit of the newborn\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eEBF: exclusive breastfeeding\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSD: standard deviation\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIQR: interquartile range\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003ePC: primary care\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*\u0026ldquo;Joint\u0026rdquo; refers to publicly funded and privately run institutions\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVariables added in the 2024 study period.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLabel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1884\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApgar 1 minute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eMe\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9 (9\u0026ndash;9 IQR)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApgar 5 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eMe\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10 (10\u0026ndash;10 IQR)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNewborn age at hospital discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDays\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e߂\u003c/em\u003e = 2.4 (0.8 SD)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of feeding on the first day of life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExclusive breastfeeding\u003c/p\u003e \u003cp\u003eMixed feeding\u003c/p\u003e \u003cp\u003eExclusive formula feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1373 (72.6%)\u003c/p\u003e \u003cp\u003e293 (15.7%)\u003c/p\u003e \u003cp\u003e218 (11.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of feeding at hospital discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExclusive breastfeeding\u003c/p\u003e \u003cp\u003eMixed feeding\u003c/p\u003e \u003cp\u003eExclusive formula feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1211 (64.3%)\u003c/p\u003e \u003cp\u003e430 (22.8%)\u003c/p\u003e \u003cp\u003e244 (12.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother with previous experience in breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e741 (39.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of feeding at the visit and 24 hours before\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExclusive breastfeeding\u003c/p\u003e \u003cp\u003eMixed feeding\u003c/p\u003e \u003cp\u003eExclusive formula feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1036 (55.0%)\u003c/p\u003e \u003cp\u003e486 (25.8%)\u003c/p\u003e \u003cp\u003e362 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalisation required after FPCVNB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eFPCVNB: first primary-care visit of the newborn\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eIQR: interquartile range\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eMe: median\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eSD: standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[insert Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e about here]\u003c/p\u003e \u003cp\u003e[insert Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e about here]\u003c/p\u003e \u003cp\u003eFigure 2 shows the number of newborns stratified according to the day of the FPCVNB after hospital discharge.\u003c/p\u003e \u003cp\u003e[insert Fig.\u0026nbsp;2 about here]\u003c/p\u003e \u003cp\u003eFigures 3 and 4 show the feeding type at the FPCVNB, stratified by the week of the visit and compared to 2014 data.\u003c/p\u003e \u003cp\u003e[insert Figs.\u0026nbsp;3 about here]\u003c/p\u003e \u003cp\u003e[insert Fig.\u0026nbsp;4 about here]\u003c/p\u003e \u003cp\u003eBinary logistic regression models were used to estimate the odds ratios (ORs) of variables potentially associated with EBF at one month of life. With the variables that showed significant differences in the crude analysis of the ORs, the adjusted ORs were calculated. Statistical significance was considered when p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows relationships between different variables and the presence of EBF at one month of life.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationships between different variables and the presence of EBF at one month of life (2024).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep**\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eORa***\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep**\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eType of delivery (Ref: non-instrumental, vaginal, epidural)\u003c/p\u003e \u003cp\u003eNon-instrumental, vaginal, no epidural\u003c/p\u003e \u003cp\u003eInstrumental (vacuum extraction, forceps, caesarean section)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.997\u0026ndash;1.953\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.873\u0026ndash;1.916\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.626\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.515\u0026ndash;0.761\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.470\u0026ndash;2.271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.936\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eType of instrumental delivery (Ref: non-instrumental delivery)\u003c/p\u003e \u003cp\u003eVacuum extraction\u003c/p\u003e \u003cp\u003eForceps\u003c/p\u003e \u003cp\u003eCaesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.560\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.412\u0026ndash;0.762\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.261\u0026ndash;1.397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.646\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.379-1.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.246\u0026ndash;1.758\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.403\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.592\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.474\u0026ndash;0.741\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.291\u0026ndash;1.453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of hospital management (2 categories) (Public vs. Private/Joint)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.754\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0;596-0.954\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.760\u0026ndash;1.340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreastfeeding in siblings (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.085\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.720\u0026ndash;2.526\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.768\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.413\u0026ndash;2.211\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital indication for primary care visit in 1st week of life (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.304\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.032\u0026ndash;1.649\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.972\u0026ndash;1.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior consultation by midwife (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.965\u0026ndash;1.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.946\u0026ndash;1.516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior consultation during hospital emergency (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.532\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.370\u0026ndash;0.763\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.539\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.360\u0026ndash;0.807\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior consultation during primary care emergency (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.308\u0026ndash;1.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.352\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.160\u0026ndash;0.774\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdministrative difficulty with primary care visit (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.542\u0026ndash;1.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.570\u0026ndash;1.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st visit within 1\u0026ndash;7 days of life (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.000-1.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.833\u0026ndash;1.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.686\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st visit within 72 hours after hospital discharge (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.912\u0026ndash;1.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.634\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.409\u0026ndash;0.984\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.042\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* OR\u0026thinsp;=\u0026thinsp;odds catio\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e** Significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Values with statistically significant differences are in bold.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*** ORa\u0026thinsp;=\u0026thinsp;Adjusted odds ratio. Adjustment made with the variables that show statistically significant differences in the crude OR analysis.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003e1\u003c/sup\u003e \u0026ldquo;Joint\u0026rdquo; refers to publicly funded and privately run institutions\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[insert Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e about here]\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the relationships between different variables and the presence of any type of breastfeeding, i.e., EBF and mixed lactation (breastfeeding\u0026thinsp;+\u0026thinsp;formula feeding) at one month of life (2024).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationships between variables and type of breastfeeding (EBF\u0026thinsp;+\u0026thinsp;mixed lactation) at one month of life (2024).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep**\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eORa***\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep**\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eType of delivery (Ref: non-instrumental, vaginal, epidural)\u003c/p\u003e \u003cp\u003eNon-instrumental, vaginal, no epidural\u003c/p\u003e \u003cp\u003eInstrumental (vacuum extraction, forceps, caesarean section)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.708\u0026ndash;1.677\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.653\u0026ndash;1.949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.737\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.578\u0026ndash;0.940\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.389\u0026ndash;3.493\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.785\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eType of instrumental delivery (Ref: non-instrumental delivery)\u003c/p\u003e \u003cp\u003eVacuum extraction\u003c/p\u003e \u003cp\u003eForceps\u003c/p\u003e \u003cp\u003eCaesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.628\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.438\u0026ndash;0.901\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.214\u0026ndash;2.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.496\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.485\u0026ndash;1.967\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.937\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.247\u0026ndash;3.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.924\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.579\u0026ndash;1.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.281\u0026ndash;2.624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.790\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of hospital management (2 categories) (Public vs. Private/Joint\u003csup\u003e1\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.682\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.516\u0026ndash;0.902\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.633\u0026ndash;1.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.566\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreastfeeding in siblings (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.625\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.008\u0026ndash;3.432\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.716\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.966\u0026ndash;3.751\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital indication for primary care visit in 1st week of life (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.441\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.060\u0026ndash;1.959\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.709\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.257\u0026ndash;2.323\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior consultation by midwife (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.352\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.040\u0026ndash;1.757\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.141\u0026ndash;2.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior consultation during hospital emergency (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.389\u0026ndash;1.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.460\u0026ndash;1.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior consultation during primary care emergency (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.779\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.370\u0026ndash;1.639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.304\u0026ndash;1.698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdministrative difficulty with primary care visit (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.621\u0026ndash;1.387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.716\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.790\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.503\u0026ndash;1.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st visit within 1\u0026ndash;7 days of life (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.947\u0026ndash;1.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.874\u0026ndash;1.604\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st visit within 72 hours after hospital discharge (Ref: No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.984\u0026ndash;1.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.444\u0026ndash;1.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.447\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* OR\u0026thinsp;=\u0026thinsp;Odds Ratio\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e** Significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Values with statistically significant differences are in bold.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*** ORa\u0026thinsp;=\u0026thinsp;Adjusted Odds Ratio. Adjustment made with the variables that show statistically significant differences in the crude OR analysis.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e1 \u0026ldquo;Joint\u0026rdquo; refers to publicly funded and privately run institutions\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[insert Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e about here]\u003c/p\u003e \u003cp\u003eFigure 5 shows the prevalence of EBF, ML and FF at one month according to the week in which the FPCVNB was performed.\u003c/p\u003e \u003cp\u003e[insert Fig.\u0026nbsp;5about here]\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of our study indicate that performing the first newborn primary care visit within 72 hours after discharge is significantly associated with higher rates of exclusive breastfeeding at one month of age. In addition, a clear decreasing trend in EBF prevalence with later FPCVNB was observed. These findings highlight the importance of performing this first visit within 72 hours after hospital discharge, given that the first days of life constitute a window of opportunity for the correct establishment and maintenance of breastfeeding. The WHO recommends breastfeeding promotion across the spectrum of maternal and child health care (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), especially in the prenatal and puerperal periods. Primary care centres are an ideal place for this initiative.\u003c/p\u003e \u003cp\u003eThe 2024 data shows that the PCVNB is performed at an average of 9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6 days following hospital discharge, which is considerably later than the timelines recommended by national guidelines and most international organizations (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). By comparison, the 2014 study reported a mean time of 10.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3 days to the FPCVNB. Although the time to FPCVNB has decreased by an average of 1.4 days, there is still substantial room for improvement to reach the recommended standards.\u003c/p\u003e \u003cp\u003eThis decrease may be attributed to the fact that more hospitals now recommend attending the FPCVNB within the first week of life (74% of hospitals in 2024 compared with 62.7% in 2014). A significant relationship was identified between hospitals recommending the FPCVNB within the first week of life and higher rates of breastfeeding (both EBF and mixed lactation) at one month of life. No significant differences were found between public and private institutions.\u003c/p\u003e \u003cp\u003eHaving consulted the healthcare system, either in hospital emergency departments or primary care centres, shows significant statistical association with better exclusive breastfeeding rates at one month of age. This supports the idea that intervention by a health professional in the first days of life improves breastfeeding rates.\u003c/p\u003e \u003cp\u003eDespite the reduction in the recommended time elapsed before for the FPCVNB, our data shows a decline of 0.5 percentage points in the overall rates of exclusive breastfeeding at the FPCVNB. This decline may be attributable to a variety of factors, as there are many determinants that influence breastfeeding at one month of age, including biological, social, and health-related factors (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis decrease in breastfeeding rates is of interest and requires further investigation, especially considering the complex interplay among all other factors. Maternal experience, age, education level, attendance of prenatal classes, contact with support groups, emotional support and self-efficacy have been identified as key factors in the initiation and duration of breastfeeding (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan additionalcitationids=\"CR34 CR35 CR36\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNewborns whose mothers had previous breastfeeding experience showed statistically significant differences in favour of breastfeeding maintenance at one month of life. Prior research by Hackman et al (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) supports this finding, reporting that, compared with primiparous mothers, multiparous mothers had a longer duration of EBF and significantly greater rates of EBF at 2 weeks and 2 months of life (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of EBF on the first day of life was 72.6%, which decreased to 64% at the time of hospital discharge. These values reflect a relatively low initial prevalence compared with other European countries, such as Germany where the EBF prevalence at birth is 97% (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The results of our study show a 55% EBF prevalence in the first month of life, which is much lower than the 73.9% EBF prevalence at 6 weeks of life reported by the most recent (2017) survey published by the Instituto Nacional de Estad\u0026iacute;stica (National Institute of Statistics of Spain) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Our results are more similar to those published in the LAyDI study (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), showing an EBF prevalence of 62.3% at the first month and 35.2% at six months of life. Considering that the WHO has established a goal of a global EBF prevalence of 50% at six months of life in 2025 and 70% in 2030 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), the 55% EBF prevalence at one month indicates that Spain is far from reaching that goal.\u003c/p\u003e \u003cp\u003eRegarding breastfeeding promotion, early neonatal visits represent direct economic government savings. Specifically, increasing breastfeeding rates at hospital discharge and at 6 months postpartum (from 85%/15\u0026ndash;95% /50%, respectively) is estimated to save the Spanish health system at least 197\u0026nbsp;million euros per year (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Breastfeeding also generates indirect savings based on the intellectual, social and emotional benefits (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Given these positive benefits, breastfeeding research should be a public health priority. Furthermore, breastfeeding promotion and support are needed to address the advantages for both the mother and child, and for society in general.\u003c/p\u003e \u003cp\u003eThis study has many strengths, such as the use of a considerably large sample which thus increases the statistical power and the ability to detect statistically significant associations. In addition, data collection through a network specifically designed for paediatric research (PAPenRED)\u0026mdash; which has a wide variety of patients throughout the country with different geographical, socioeconomic and cultural contexts\u0026mdash;enabled us to obtain a nationally representative sample.\u003c/p\u003e \u003cp\u003eNonetheless, this study has certain limitations. Selection bias may have occurred due to the pressure associated with limited time to provide care during appointments, which may have influenced sample recruitment. To minimize this bias, all newborns delivered during the study period were consecutively registered. Another possible selection bias is the voluntary participation of the paediatricians in PAPenRED. This bias was addressed by including a large number of collaborating researchers, which strengthens data validity. In addition, this study exhibits the typical limitations of an observational study, which does not allow the direct establishment of cause‒effect relationships.\u003c/p\u003e \u003cp\u003eIn summary, performing the FPCVNB within 72 hours of discharge is significantly associated with higher rates of exclusive breastfeeding at one month of age. However, as our study has shown, the FPCVNB occurs late in Spain, at 9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6 days after hospital discharge. Although this value has improved by 1.4 days compared to 2014, substantial efforts are still needed to reach the national and international recommendations. In addition, EBF rates at the time of the first primary-care visit have declined over the last 10 years, from 63.1% in 2014 to 62.6% in 2024.\u003c/p\u003e \u003cp\u003eTherefore, future research should examine what modifiable determinants can promote early FPCVNB, given that the data indicates a positive influence on breastfeeding overall and enhanced EBF rates. Furthermore, research into which specific primary care interventions influence EBF during the first year of infancy (e.g., FPCVNB within the indicated time frame, a specialized breastfeeding service, hospital recommendations for FPCVNB, etc.) could strengthen the role of primary care as a pillar in the promotion and support of breastfeeding, consequentially improving health outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFPCVNB: first primary-care visit of the newborn\u003c/p\u003e\n\u003cp\u003eEBF: exclusive breastfeeding\u003c/p\u003e\n\u003cp\u003eBFHI: Baby-Friendly Hospital Initiative\u003c/p\u003e\n\u003cp\u003ePAPenRED: La Red de Investigaci\u0026oacute;n Pediatr\u0026iacute;a de Atenci\u0026oacute;n Primaria (Spanish Primary Care Pediatrics Research Network)\u003c/p\u003e\n\u003cp\u003eAEPap: Asociaci\u0026oacute;n Espa\u0026ntilde;ola de Pediatr\u0026iacute;a de Atenci\u0026oacute;n Primaria (Spanish Primary Care Pediatrics Association)\u003c/p\u003e\n\u003cp\u003eMF: mixed feeding\u003c/p\u003e\n\u003cp\u003eFF: formula feeding\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe PAPenRED project was approved by regional ethics committee of Aragón (favourable opinion, 19/2013; CP-CI PI13/00154).\u003c/p\u003e\n\u003cp\u003eFor the 2024 study, approval was obtained from the respective ethics committees of the Hospital Virgen Macarena and Hospital Virgen del Rocío (CEI_06/2023; CP RN-2023 and CI 0921-N-23, respectively). In addition, permission was obtained from the ethics committees in each autonomous community in Spain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received a 3000 € research grant from the Asociación Andaluza de Pediatría de Atención Primaria (Andalusian Association of Primary Care Paediatrics).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePCV is the principal investigator of the study.\u003c/p\u003e\n\u003cp\u003eAll the authors participated in the study design, data collection and manuscript writing.\u003c/p\u003e\n\u003cp\u003eMCM and CGV coordinated the research network. JVBM contributed to the statistical analysis.\u003c/p\u003e\n\u003cp\u003eCGV coordinated the 2014 study. JMLA participated in the 2014 study.\u003c/p\u003e\n\u003cp\u003eAll the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Jorge Suances Hernández for his statistical analysis.\u003c/p\u003e\n\u003cp\u003eWe thank Ian Scionti for his translation and review of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe thank all the collaborating paediatricians of PAPenRED for their data collection:\u003c/p\u003e\n\u003cp\u003eGuadalupe Castillo-Aguas, Ana Gallego-Iborra, Ana Lorente García-Mauriño, Tatiana Menéndez-Bada, Ramona Mínguez-Verdejo, Manuela Sánchez-Echenique, Laura Somalo-Hernández, Beatriz Abad-Balaguer, Elia Acitores-Suz, Beatriz Acosta-Navas, Sonia Albadalejo-Beltran, Vega Almazán-Fernández-De-Bobadilla, Noelia Álvarez-Zallo, Julia Álvarez-Gómez, Irene Álvarez-González, Elena Álvarez-Vázquez, Ana Paula Amadeus-Da-Costa, Dolors Anfreu-I-Duat, María Eugenia Angulo-Moreno, María Antuña-Fernandez, María Aparicio-Rodrigo, Esther Apolinar-Valiente, María José Arconada-Martín, Josefa Ares-Álvarez, Sonia Arias-Álvarez, Rosa Arranz-Sanjuan, María Teresa Arroyo-Romo, Natalia Arza-Méndez, María Teresa Asensi-Monzo, María Astiz-Blanco, Amalia Ayechu-Díaz, Ernestina Azor-Martínez, Lucia Barahona-Robdon, Ana María Barbero-Rodríguez, Elisa María Barrios-González, Alberto Bercedo-Sanz, Mercè Bernad-Albareda, Esther Bernal-Vañó, Mireia Biosca-Pàmies, Javier Blanco-González, Alicia Bonet-Garrosa, Belén Botella-Serrano, Xavier Bruna-Pérez, Ana María Burgaleta-Sagasea, Silvia Burgaya-Subirena, María José Bustos-Prados, María Elena Cabezas-Tapia, María Águeda Campos-Nieto, Pedro Ca Nadell-Villaret, Cristina Cañavate-González, Purificación Cárdenas-Guerrero, Cristina Carrasco-Gimenez, Marta Carrera-Polanco, María Laura Casado-Sánchez, Elena Cascón-Criado, Isabel Castilla-Pedregosa, Edurne Ciriza-Barea, Zerezade Coello-Torres, Nayra Coello-Torres, Marina Colom-Segui, Patricia Margarita Company-Maciá, Cristóbal Coronel-Rodríguez, Sara Corral-Muñoz, Marta Crespo-Medina, Ignacio Cruz-Navarro, María Angustias De-Haro-López, Ana Isabel Díaz-Cirujano, Olga Díez-Zaera, Catalina Durán-Iglesias, María José Edo-Jimeno, Aurora Egea, Yolanda Escanciano-García, Carla Escribano-García, María Jesús Escribano-Romero, Rosario Espejo-Moreno, Oscar Espinazo-Ramos, Blanca Espínola-Docio, Jessica Noelia Esquivel-Ojeda, Vanesa Fernández-Días, Ramona Fernández-Fernández, María Fernández-Francés, Rosa Fernández-González, Antonia Fernández-León, María Elena Fernández-Segura, Esther Fernández-Tardáguila, Miguel Fernández-Cuesta, Laia Ferré- Moragues, Carlos Bernardo Ferriz-Mas, Catarina Fervenza-Cortegoso, Beatriz Flores-Méndez, Nerea Gallego-Mingo, Inmaculada García-Arroyo, Miriam García-García, Águeda García-Merino, Ana García-Ruiz, Natalia García-Sánchez, Juan Antonio García-Sánchez, Ana María García-Sánchez, Beatriz Garrido, Mercedes Garrido-Redondo, Anna Gatell-Carbó, Carles Gatius-Tonda, Inmaculada Gavilan-García, María Josefa Gellioda-Royo, Inmaculada Gil-Alexandres, Raquel Gómez-Casares, Raquel Gómez-García, María Isabel Gómez-Martín, Marta Gómez-Verdugo, María Victoria González-Cortés, Alicia González-De-Eusebio, Mariana González-Del-Castillo, Miriam González-Herrero, Antonio Javier González-Martínez, María Paz González-Rodríguez, Ana González-Sala, Ana Isabel Grau-García, Enrique Guerra-Vilches, Beatriz Guillot-Roselló, Carmelo Gutiérrez-Abad, Sofía Hernández-Cáceres, Carmen Hernández-Marqués, María Yolanda Hernández-Ortiz, Antonio Iofrío-De-Arce, Dolores Jaramillo-Hidalgo, Juan Manuel Jiménez -Hereza, Júlia Jové-Naval, Blanca Juanes-De-Toledo, Silke Bianca Kirch Schläger-Nieto, Alfonso Lendínez-Jurado, María del Prado Leo-Canzobre, Patricia LLeixá-Daga, Pilar Lobera-Navaz, Aranzazu López-Martínez, Elena López-Vargas, Rosario María Guerrero, Irene Marín-Berruezo, Sara Marquina-Cintora, Sara Martí-Martí, Itziar Martín-Ibañez, María José Martín-Sierra, Carmen Martínez-Antequera, María Martínez-Barahona, Laura Martínez-Espligares, María Teresa Martínez-Rivera, José Medina-Pomares, Guadalupe Membrillo-Lucena, Susana Méndez- Gallego, Paula Ivonne Mendoza-Álamo, José Mengual-Gil, María Inmaculada Merino-Marcos, Judith Montañez-Arteaga, David Montero-Vázquez, Ana Isabel Monzón-Bueno, Cristina Morales-Carpi, Esther Moreno-Medínilla, María Rosario Muñoz-Núñez, Carmen Mustieles-Moreno, Guiomar Navarro-Cabañas, Carmen Navas-Heredia, Ana María Nocea-Pulfer, Jorge Olivares-Ortiz, José María Olmos-García, Inmaculada Ortells-Ramón, María Luisa Padilla-Esteban, María Candelaria Padilla-Sánchez, María Belén Panizo-Santos, Remedios Parejo-Carranza, Cristina Pato- Fernández, María Rosa Pavo-García, Susana Peñarroja-Peirats, Mª Luz Peralta-Ibáñez, Isabel Pérez-García, Lucia Pérez-Gómez, Roxanne Laura Pérez-Nygaard, Helena Pérez-Tato, Patricia Pernas-Gómez, Míriam Poblet-Puig, Eloy Pozuelo-Lima, Silvia Prado-Muñoz, Paula Prim-Jaurrieta, Carmen Puig-García, Maribel Quintanilla-Sánchez, Rosa María Ramírez-Gavira, Africa Raventós-Canet, Consuelo Rey-Del-Castillo, Mónica Reyes-Medina, Marina Rico -Santori, Ana Ripoll-Lozano, Anna Maria Ristol-Perxés, Natalia Rivas-Abrales, Gisela Roca-Gardeñas, Diana Rodà-Goula, Francisco Javier Rodríguez-Álvarez, Mª Dolores Rodríguez-Baz, Francisco Javier Rodríguez-Contreras, Juan Rodríguez- Delgado, Sandra Rodríguez-Fernández, Rosa María Rodríguez-Parada, Yessica Rodríguez-Santana, Isabel María Rodríguez-Toro, Gloria Angélica Rodríguez-López-Márquez, Begoña Rodríguez-Moldes-Vázquez, Marcos Romero-García, Julia Ruiz-Jiménez, Ana Saenz-De-Urturi, Amaia Sáez-De-Lafuente-Arriazu, Olga Salvado-Juncosa, Felicidad Sanantonio -Valdearcos, Elena Sánchez-Almeida, María Teresa Sánchez-Andrés, Nieves Sánchez-Cordero, María Sánchez-Moreno, María Concepción Sánchez-Pina, Silvia Sánchez-Precioso, Almudena Sánchez-Vázquez, María Isabel Sánchez-Prieto-Emmanuel, María Isabel Sancho-Madrid, María Teresa Santos-García-Cuellar, Mercedes Sarmiento-Martínez, Miriam Coromoto Sequera-Bolívar, Catalina Isabel Servera-Ginard, Andrea Soriano-Marco, Omar Suárez-Gómez, Beatriz Suárez-Traba, Marta Suau-Anechina, Mª Fernanda Taboas-Ledo, Clara Téllez-Labao, María Valls-Inglá, María Vaquerizo-Pollino, María Salomé Vega-Pérez, María Vegas-Carrón, Elena Vegues-Veguillas, Olga Vera-Estrada, Marta Viver-Gómez, Susana Patricia Zardoña- Santos, and Elia Zoido-Garrote.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMoon RY, Carlin RF, Hand I. 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Int Breastfeed J. 2023;18(1):14.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-breastfeeding-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ibfj","sideBox":"Learn more about [International Breastfeeding Journal](http://internationalbreastfeedingjournal.biomedcentral.com/)","snPcode":"13006","submissionUrl":"https://submission.nature.com/new-submission/13006/3","title":"International Breastfeeding Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"newborn, breast feeding, postnatal care, primary health care, ambulatory care facilities","lastPublishedDoi":"10.21203/rs.3.rs-5939006/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5939006/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe first primary-care visit of the newborn (FPCVNB) aims to assess neonatal feeding, promote breastfeeding, and identify potential health issues. This study examines the relationship between the timing of the FPCVNB and the prevalence of exclusive breastfeeding (EBF) at one month of life.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis prospective, observational, analytical study was conducted through a paediatric research network. Data were collected from newborns attending both the FPCVNB and the one-month check-up during the study period. Selected variables were compared to those from a 2014 study by the same research network to identify rates of EBF at the time of the FPCVNB. The main outcome, EBF prevalence at one month, was measured with data from 2024.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 1952 cases were collected in 2024, with the FPCVNB occurring at 9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1 days after hospital discharge, compared to 2047 cases in 2014, where it occurred at 10.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3 days. The EBF prevalence at FPCVNB was 63.1% in 2014 and 62.6% in 2024. The EBF prevalence at one month in 2024 was 55.0% (95% CI: 52.7\u0026ndash;57.3). Performing the newborn\u0026rsquo;s first primary care visit within 72 hours of discharge is significantly associated with higher rates of EBF at one month (ORa: 0.63; 95% CI: 0.41\u0026ndash;0.98). Furthermore, EBF was positively associated with prior breastfeeding experience (ORa: 1.77; 95% CI: 1.41\u0026ndash;2.21).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe FPCVNB occurs late in Spain. Rates of EBF have declined over the past decade, highlighting the need for targeted interventions that address modifiable determinants. Evidence suggests that performing an FPCVNB within 72 hours of hospital discharge is an effective intervention that significantly improves breastfeeding rates.\u003c/p\u003e","manuscriptTitle":"First primary-care visit of the newborn and its implications for breastfeeding","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-10 06:55:06","doi":"10.21203/rs.3.rs-5939006/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-20T11:55:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-19T09:18:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338123159626167156085772612404907339777","date":"2025-04-06T17:44:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-05T12:58:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-02T05:05:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Breastfeeding Journal","date":"2025-03-29T22:51:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-breastfeeding-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ibfj","sideBox":"Learn more about [International Breastfeeding Journal](http://internationalbreastfeedingjournal.biomedcentral.com/)","snPcode":"13006","submissionUrl":"https://submission.nature.com/new-submission/13006/3","title":"International Breastfeeding Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7a81dea6-125c-4f09-93eb-61f29700e2b7","owner":[],"postedDate":"April 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T16:10:03+00:00","versionOfRecord":{"articleIdentity":"rs-5939006","link":"https://doi.org/10.1186/s13006-025-00758-w","journal":{"identity":"international-breastfeeding-journal","isVorOnly":false,"title":"International Breastfeeding Journal"},"publishedOn":"2025-08-30 15:57:26","publishedOnDateReadable":"August 30th, 2025"},"versionCreatedAt":"2025-04-10 06:55:06","video":"","vorDoi":"10.1186/s13006-025-00758-w","vorDoiUrl":"https://doi.org/10.1186/s13006-025-00758-w","workflowStages":[]},"version":"v1","identity":"rs-5939006","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5939006","identity":"rs-5939006","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}