Baby Friendly Initiative in Neonatal Care

Ms Mabel Wong
Advanced Practice Nurse (Paed) & Lactation Consultant (IBCLC)
Neonatal Intensive Care Unit, Hong Kong Children’s Hospital

The Baby Friendly Initiative, as a global programme of the UNICEF and World Health Organization, has brought huge improvement in the routine care of mothers and babies.So far in Hong Kong, the Queen Elizabeth Hospital, Queen Mary Hospital and Prince of Wales Hospital have been designated “Baby Friendly Hospitals” by the Baby Friendly Hospital Initiative Hong Kong Association (BFHIHKA), while the rest of Hospital Authority’s birthing hospitals are making big strides towards designation. Nevertheless, practices in neonatal units are only included as part of the standards of maternity units, focusing around early skin-to-skin contact, expressing breastmilk and breastfeeding. Physical separation of mothers and babies, due to admission of babies into special care or intensive care unit, creates difficulties for these babies in obtaining the best of nutrition and establishing a loving and responsive relationship with parents at the very start of life.

 

The establishment of the new neonatal service at the Hong Kong Children’s Hospital (HKCH) has put emphasis in providing a baby-friendly family-centred environment. As there is no maternity unit in the HKCH, all babies are transferred from other birthing hospitals. Most of these babies have surgical conditions or complex medical diseases requiring multi-disciplinary and subspecialty care. These very sick babies face issues resulting from the inevitable and sometimes prolonged physical separation from parents.

Family-friendly Approach to Neonatal Care

Specific evidence-based standards are needed to address the myriad of issues faced by very sick babies in the neonatal unit.

Encompassing the concept of holistic care of families, the UK UNICEF Baby Friendly Initiative has devised standards¹ on:

             1. Building close and loving relationships between family and the baby
             2. Enabling breastmilk feeding and breastfeeding as much as possible

             3. Supporting parents as partners in care
......

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Conclusion

Family-centred care should be integrated into the organization and functions of the neonatal ward. Core concepts of family-centred care are dignity and respect, information sharing, participation and collaboration. Baby care is transferred gradually to the parents, beginning as soon as possible after birth, with freedom of choice regarding the performance of caregiving tasks and adequate instruction and support. Parents may also designate other members of their social network as their substitutes. Moreover, the neonatal ward should provide an individualized and developmentally supportive environment that is appropriate for babies and parents, offering them adequate privacy and facilitating breastfeeding. Ideally, a family-friendly neonatal ward should be able to provide practical support for parents to stay with their babies at the cot side as well as a place to eat close to the neonatal ward. The HKCH is heading towards implementing the ideal of child-centred and family-friendly care.

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在新生兒護理病房中實踐「愛嬰行動」

 

黃敏妤護士

香港兒童醫院，新生兒深切治療部
兒科資深護師、母乳餵哺顧問 (國際認證哺乳顧問)

 

「愛嬰行動」是聯合國兒童基金會和世界衞生組織協作的一項全球計劃，為母親和新生兒護理帶來了莫大的改善。到目前為止，伊利沙伯醫院、瑪麗醫院及威爾斯親王醫院已獲認證為「愛嬰醫院」，其餘醫管局轄下設有產科的醫院也正朝着愛嬰醫院香港協會的認證邁進。 然而，目前新生兒病房的做法僅被視為產科實務標準的一部分，側重於早期肌膚接觸、手擠母乳和母乳餵哺。嬰兒如需要特殊護理及深切治療，留院會帶來母親和嬰兒分隔，令嬰兒有困難去盡早獲得最佳營養及與父母建立關愛和互動的關係。

香港兒童醫院（HKCH）建立了新生兒服務，著重於提供嬰兒友善及以家庭為中心的環境。 香港兒童醫院沒有產科服務，因此所有嬰兒均從其他醫院轉來。這些嬰兒大多數有外科或複雜的內科疾病，需要跨學科及專業的診治和護理。這些病重的嬰兒往往要面對與父母長時間分離所產生的問題。

「家庭友善」新生兒護理

我們需要以具體的循證標準來處理新生兒病房的情況。為涵蓋以家庭為
本的整全護理概念，英國聯合國兒童基金會的「愛嬰倡議」制定了以下
標準¹：

          1. 在家庭和嬰兒之間建立親密和愛的關係

          2. 盡可能讓母親以母乳餵養

          3. 支援父母作為照顧嬰兒的合作夥伴

(***以下為本文章節錄版本，如欲閱讀更多，請 按此 觀看PDF全文版本及參考文獻***)

總而言之，以家庭為本的護理應被納入新生兒病房的組織和功能。其核心概念是尊嚴 (dignity) 和尊重 (respect) 、資訊共享 (Information sharing) 、參與 (Participation) 和協作 (Collaboration) 。在出生後盡早給予適當的指導和支持，讓父母自由選擇照顧病兒的工作，然後讓他們逐漸掌握更多的病兒護理。香港兒童醫院新生兒深切治療部病房，能夠提供適合家庭使用的環境和設施，例如扶手躺椅和寬闊的空間，保持隱私，促進母乳餵養。另外醫院範圍可讓父母以幾分鐘步行的路程便到達地面便利店或一樓咖啡座購買食物或進食。香港兒童醫院正致力實現以兒童為本及家庭友善為核心價值的護理目標。

 
Key Messages 文章撮要

Views expressed in this article are the author's and do not necessarily reflect the opinion or position of the BFHIHKA.   
作者在本文章表達的見解，未必代表愛嬰醫院香港協會的意見或立場

Editor-in-Chief: Dr Shirley Leung
Photo credited to: Ms Mabel Wong

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