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Current breastfeeding guidelines promote initiating breastfeeding ≤1 h after birth to establish long-term breastfeeding. Previous studies dichotomized initiation to ≤1 h versus subsequent hours combined. There are limited data evaluating the effect of initiation in each subsequent hour on breastfeeding duration. Our objective was to evaluate the association between breastfeeding initiated at ≤1 h versus the subsequent 23 hours after birth and outpatient breastfeeding duration.In this retrospective cohort study, we analyzed real-time, discretely documented electronic health record (EHR) breastfeeding data for 3315 infants born at a university center and followed to age ≥12 mo at 27 university primary care clinics. The primary outcome was breastfeeding duration. The exposure variable was hour of breastfeeding initiation within 24 h postnatally. Data were analyzed by univariable and multivariable linear regression separately for infants born by vaginal versus cesarean delivery.In adjusted models, initiating breastfeeding during each hour from age1 to ≤6 h and during ages6 to ≤24 h was not associated with decreased breastfeeding duration versus initiating breastfeeding at ≤1 h after birth for infants born via vaginal or cesarean delivery.Delaying breastfeeding initiation to1 to ≤24 h after birth is not associated with decreased breastfeeding duration compared with initiating breastfeeding at ≤1 h after birth. Integration of breastfeeding measures into inpatient and outpatient EHR discrete data fields may clarify best practices that support long-term breastfeeding as a public health imperative.

Objective To determine whether the 2011 guidelines for universal routine screening for dyslipidemia in children aged 9 to 11 years, published by the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents and National Heart, Lung, and Blood Institute, are being followed by pediatric primary-care providers. Methods Retrospective data were obtained for 63,951 well-child visits (WCV) in children aged 9 to 11 years from 2 health care systems and 1 insurance program from 2009 to 2015. The proportion of WCV that had a lipid panel or total cholesterol test performed within 1 year of the visit was compared for 2009–2011 versus 2013–2015. Associations between demographic variables and lipid screening were evaluated with logistic regression. The frequency of tested children who had abnormal lipid results was evaluated. Results Only 3.5% of 9- to 11-year WCV had lipid tests performed in association with the visit before and after the guidelines. Of those tested, 43% had an abnormal lipid result. Conclusions Utah clinicians rarely follow guidelines for universal lipid screening of children aged 9 to 11. This represents a missed opportunity to identify children at risk for early-onset cardiovascular disease.