BFHI AND WARM CHAIN PPT.pptx

BFHI AND WARM CHAIN

1. Baby-Friendly Hospital Initiative 1

2. Introduction Baby friendly Hospital Initiative was launched in 1992 in INDIA. The Innocenti declaration on the promoting, protection and support of breastfeeding was produced and adapted by participants at the WHO/ UNICEF policy maker’s meeting on breast feeding in 1990s. 2

3. 3 Cont…introduction The Global initiative was co- sponsored by the USAID (United States Agency for International Development ) and SIDA (The Swedish International Development Cooperation Agency . ) The baby friendly hospital campig n was launched by the WHO/ UNICEF in mid 1991 in Ankara to boost the breastfeeding practices and to counter the t rends of b ottle f eeding

4. 4 Since its launching BFHI has grown, with more than 152 countries around the world implementing the initiative. The initiative has measurable and proven impact, increasing the likelihood of babies being exclusively breastfed for the first six months.

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6. 6 The programme, launched in Kerala in March 1993, is hospital . O f the 1,372 baby friendly hospitals in India 65 per cent are in Tamil Nadu and Kerala. Dr Elsie Philip, state co-ordinator of BFHI, said the rates of breast-feeding initiation within a day is 92 per cent in Kerala (compared to 78.7 percent in Tamil Nadu and the national average of 37.1 per cent)

7. 7 Cont…introduction Baby friendly hospital are required to adopted breast feeding policy and follow the “ ten step of Successful breastfeeding” as recommended by code of practice of WHO/ UNICEF

8. 8 Have a written breastfeeding policy that is routinely communicated to all health care staff. Train all health care staff in skills necessary to implement this policy. Inform all pregnant women about the benefits and management of breastfeeding.

9. 9 Cont…BHIF Policies Help mothers initiate breastfeeding within one half-hour of birth. Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants. Give newborn infants no food or drink other than breast milk, unless medically indicated.

10. 10 Practice rooming in - that is, allow mothers and infants to remain together 24 hours a day. Encourage breastfeeding on demand. Give no artificial nipples or pacifiers (soothers) to breastfeeding infants. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

11. 11 Ten steps to successful breastfeeding (revised 2018)- WHO

12. 12 Critical management procedures 1a. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions. 1b. Have a written infant feeding policy that is routinely communicated to staff and parents. 1c. Establish ongoing monitoring and data-management systems. 2. Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding.

13. 13 Ten steps to successful breastfeeding (revised 2018)- WHO Key clinical practices 3. Discuss the importance and management of breastfeeding with pregnant women and their families. 4. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth. 5. Support mothers to initiate and maintain breastfeeding and manage common difficulties. 6. Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated.

14. 14 Ten steps to successful breastfeeding (revised 2018)- WHO Key clinical practices 7. Enable mothers and their infants to remain together and to practise rooming-in 24 hours a day. 8. Support mothers to recognize and respond to their infants’ cues for feeding. 9. Counsel mothers on the use and risks of feeding bottles, teats and pacifiers. 10. Coordinate discharge so that parents and their infants have timely access to ongoing support and care.

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19. R Dh@ker, Asst. Professor, RCN 19

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23. R Dh@ker, Asst. Professor, RCN 23

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25. 25 Indian hospital s are s till in early stages of joining this movement. The National BFHI task force was formed , in 1992, towards the efforts to improve the breastfeeding practices.

26. 26 The task force comprising of Govt. of INDIA, UNICEF, WHO and P rofessional O rganization ( TNAI, BPNI, NNF, IMA, FOGSI, IAP, CMAI, CHAI, IBFAN, ACASH ) is working for evaluation of breastfeeding practices in the hospitals and appropriate certification as “ Baby Friendly Hospital” .

27. The Breastfeeding Promotion Network of India- BPNI The National Neonatology Forum – NNF Indian Medical Association- IMA Federation of Obstetric & Gynaecological Societies of India- FOGSI Indian Academy of Paediatrics - IAP Christian Medical Association of India- CMAI Catholic Health Association of India- CHAI International Baby Foods Action Network- IBFAN  Association for consumers' action on safety and health - ACASH

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29. 29 The certificate needs re-recognition on every two years to ensure the standard and quality for successful breastfeeding. Beside promotion of breastfeeding, BFHI in INDIA also proposed to provide:- Improved antenatal care Mother friendly delivery services. Diarrhea management

30. 30 Standardize institution support of immunization Promotion of healthy growth and good nutrition Widespread availability and adoption of family planning

31. 31 C o n t … Govt. of India has made significantly efforts to promote and protect breastfeeding by enacting a law “The Infant Milk Substitutes, Feeding Bottles and Infant Food Act,1992”. The act prohibits advertizing of infant milk substitutes (IMS) and feeding bottles to public, free sampling, hospital promotion and gifts of samples of IMS to health workers.

32. Hypothermia: Hypothermia occurs when the body temperature drops below 36.5degree Celsius (97.7 degree F), the lower limit of normal range of 36.5 - 37.5 degree Celsius (97.8-99.5 degree F.

33. Incidence: Neonatal cold injury occurs throughout the world, even in warm climates. In one hospital during an 8-year study in Ethiopia, 67% of low birth weight and high-risk infants admitted to a special care unit from outside were hypothermic. In a large series of births in the provinces in China the incidence of sclerema was 6.7 per thousand. High - risk factors were prematurity and low birth weight

34. Risk factors: -Incorrect care of the baby immediately after birth. -Separation of mother from baby after birth. -The weight and gestational age of the infant. -The place of the delivery and environmental conditions. -Inadequate warming procedures before and during transport of the infant. -Asphyxia, hypoxia, other illness of the baby, -Inadequate warming procedure during resuscitation

35. Signs of hypothermia: Early clinical signs which should arouse suspicion of cold stress due to hypothermia are: 1.The feet are cold to the touch and become cold before the body is cold; 2.Weak sucking ability. 3.Reduction in activity-lethargy; and 4.A weak cry.

36. If hypothermia persists it leads to 1. there is a risk of neonatal cold injury 2. the infant usually becomes lethargic, with slow, shallow and irregular respiration and a slow heart rate ( bradycardia ) corresponding to the degree of fall in body temperature. 3. Hypoglycemia and metabolic acidosis may develop. 4. There is a real risk of death 5.The face and extremities may have a bright red color while the rest of body is pale; central cyanosis may be present. 6. Sclerema, a hardening of the skin, associated with reddening and edema is seen mainly on the back and the limbs but may cover the whole body .

37. There are four ways a newborn may lose heat to the environment:- (1) Radiation (2) Convection (3) Conduction (4) Evaporation

38. The “warm chain ” is a concept introduced to describe a set of interlinked procedures, which will minimize the likelihood of hypothermia. Failure to implement any one of them will break the chain and increase the possibility of undesirable cooling of the infant.

39. The link in the “warm chain” includes: (1) Warm delivery room (2) Immediate drying (3) Skin-to-skin contact (4) Breast-feeding (5) Postpone bathing and weighing of the newborn (6) Appropriate clothing and bedding (7) Keeping mother and baby together (8) Warm resuscitation (9) Training and awareness

40. Role of a nurse: An important objective of appropriate care of the newborn is to avoid hypothermia from the moment of birth, by using procedures that will prevent heat loss and maintain the temperature within the normal range, thus conserving the infant’s energy for growth and development.

41. Conclusion: If all newborn infants, including preterm and small infants are carefully dried and given to their mother in skin-to-skin contact immediately after delivery, the risk of hypothermia is greatly reduced. There is sufficient evidences to conclude that immediate post delivery hypothermia is harmful to newborn, increasing the risk of morbidity and mortality. The information presented here provides a basis from which managers and health care providers can develop their own plans and procedures for the prevention and management of hypothermia in the newborn

42. Thank you