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Methodist Dallas
Medical Center
Neonatal Admission Nurse (NAN) Plan:
The Path to Baby-Friendly Designation




                Jaclyn L. Budet RNC-OB
 The University of Texas at Arlington College of Nursing
      In partial fulfillment of the requirements of
 N5339 Roles and Functions of the Nurse Administrator
         Dorothy C. Foglia, PhD, RN, NEA-BC
                   November 28, 2012
Baby-Friendly: Ten Steps to
           Successful Breastfeeding
   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.
   Help mothers initiate breastfeeding within one hour of birth.
   Show mothers how to breastfeed and how to maintain lactation, even if they are
    separated from their infants.
   Give newborn infants no food or drink other than breast-milk, unless medically
    indicated.
   Practice “rooming in”—allow mothers and infants to remain together 24 hours a
    day.
   Encourage breastfeeding on demand.
   Give no pacifiers or artificial nipples to breastfeeding infants.
   Foster the establishment of breastfeeding support groups and refer mothers to
    them on discharge from the hospital or clinic.
MDMC Neonatal Admission
             Nurse (NAN) Plan
 Current immediate post delivery process: Eventual
     separation of mother and infant.
 MDMC NAN plan goal is to promote maternal bonding
     with infant by providing the same level of care to the
     infant in the location where the mother is.
 Process plan: Understand the evidence-based research
     that supports the NAN plan.
1.   Define roles and responsibilities of the NAN staff member.

2.   Define roles and responsibilities of the staff member present at
     delivery.

3.   Determine and obtain necessary equipment for NAN staff member to
     complete work.
Evidence-Based Research
 Skin-to-skin (STS): Involves a naked infant lying prone on
     a mother’s bare chest, with the infant’s back covered by a
     blanket (Hung and Berg, 2011).
1.   Early STS improves breastfeeding and supports infant temperature stabilization and
     neurobehavioral development (Hung and Berg, 2011).
2.   Benefits of STS include reduced crying, improved mother-infant interaction, warmer
     babies, increased sleep, decreased apnea and bradycardia, improved respiration and
     oxygen saturation, and accelerated weight gain (Reeg and Lott, 2012).
3.   The American Academy of Pediatrics recommends STS contact as a strategy to
     increase breast milk supply and breastfeeding success (Bagby and Bowen, 2012).

 Rooming-in: Allow mothers and infants to remain together
     24 hours a day(www.nichq.org).
1.   Rooming-in promotes skin to skin contact, adequate maternal milk supply, feeding on
     demand and exclusive breastfeeding (www.nichq.org).

2.   Rooming-in facilitates the infant’s transition to extrauterine life, reduces risk of hospital
     acquired infection, and prepares parents to care for their infant at home (www.nichq.org).
Evidence-Based Research
    Breastfeeding: Help mothers initiate breastfeeding within one hour of
     birth (www.nichq.org).
1.   Breast milk is the best source of nutrition for young children and provides both short
     and long-term benefits. Infants who are breastfed are less likely to experience a variety
     of infections and to develop chronic conditions later in life (Perrine, Scanlon, Li, Odom, and
     Grummer-Strawn, 2012).

2.   The World Health Organization and American Academy of Pediatrics recommend that
     mothers breastfeed exclusively for about the first 6 months of their infant’s life (Perrine et
     al., 2012).

3.   Joint Commission recently recommended exclusive breast milk feeding during an
     infant’s entire hospital stay (Brown and Redmon, 2012).

4.   Breastfeeding within one hour of birth promotes infant’s transition to extrauterine
     life, the infant is most alert within one hour after birth, and it promotes maternal
     oxytocin to decrease bleeding. Early breastfeeding will facilitate effective breastfeeding
     with no supplementation (www.nichq.org).
Evidence-Based Research
 Delay of procedures: The removal of “timed” or “by the clock”
     clinical practices (Penny-MacGillivray, 1996).
1.   Infant Bathing: Implementation of bath delay showed that regardless of
     gestational age, the incidence of newborns experiencing hypothermia and
     hypoglycemia during the transitional period was reduced by changing the focus
     of unnecessary interventions (Lipka and Schulz, 2012).
Delay infant baths at least 2 to 4 hours to establish thermoregulation and decrease
    negative side effects of hypothermia, including increased oxygen
    consumption, respiratory distress, and hypoglycemia (Lipka and Schulz, 2012).
2.   Vitamin K and Erythromycin: Texas State Code requires 0.5% erythromycin
     ophthalmic solution or ointment to be applied, to the infant’s eyes within 2 hours after
     birth (Texas Department of State Health Services, 2012).
     Vitamin K should be given to all newborns as a single, intramuscular dose of 0.5 to 1
     mg soon after delivery (American Academy of Pediatrics, 2003).
3.   Dubowitz Assessment: Postnatal assessment of gestational age by external Ballard
     examination performed poorly compared with early ultrasound and last menstrual
     period (Taylor, Denison, Beyai, and Owens, 2010).
4.   Hypoglycemia Protocol: Evaluation and treatment of late-preterm infants and term
     infants considered “at-risk”: those who are small for gestational age, large for
     gestational age and infants of diabetic mothers. Only address the at-risk infants, not
     the healthy term babies (Rucoba, 2011).
References
American Academy of Pediatrics, Committee on Fetus and Newborn. (2003). Controversies
    concerning vitamin K and the newborn. Pediatrics, 112(1), 191-192.

Baby-Friendly USA. (2012). Baby-Friendly Hospital Initiative. Retrieved October 4, 2012
    from http://www.babyfriendlyusa.org/eng/index.html

Bagby, K., and Bowen, S. (2012). Kangaroo care increases breastfeeding rates. Journal of
    Obstetric, Gynecologic, and Neonatal Nurses, 41, S1-S118.

Brown, T. and Redmon, M. (2012). Supporting breastfeeding in the hospital: A better start.
    Journal of Obstetric, Gynecologic, and Neonatal Nurses, 41, S1-S118.

Hung, K. J., and Berg, O. (2011). Early skin-to-skin after cesarean to improve
    breastfeeding. The American Journal of Maternal/Child Nursing, 36(5), 318-324.

NICHQ. (2012). Best Fed Beginnings. Retrieved November 20, 2012 from
    http://www.nichq.org/our_projects/cdcbreastfeeding.html
References
Lipka, D., and Schulz, M. (2012). “Wait for Eight”: Implementation of newborn outcomes by the
     implementation of newborn bath delay. Journal of Obstetric, Gynecologic, and Neonatal
     Nurses, 41, S1-S118.

Penny-MacGillivray, T. (1996). A newborn’s first bath: When? Journal of
    Obstetric, Gynecologic, and Neonatal Nurses, 25, 481-487

Perrine, C. G., Scanlon, K. S., Li, R., Odom, E., Grummer-Strawn, L. M. (2012). Baby-Friendly
      hospital practices and meeting exclusive breastfeeding intention. Pediatrics, 130, 54-60.

Reeg, J. L., and Lott, T. (2012). Implementing skin-to-skin care in a baby-friendly community
    hospital. Journal of Obstetric, Gynecologic, and Neonatal Nurses, 41, S1-S118.

Rucoba, R. J. (2011). Algorithm is key resource on screening, management of neonatal
    hypoglycemia in at-risk infants. AAP News, 32(3), 20-21.

Taylor, R. A. M., Denison, F. C., Beyai, S., and Owens, S. (2010). The external ballard
     examination does not accurately assess the gestational age of infants born at home in a
     rural community of the Gambia. Annals of Tropical Paediatrics, 30, 197-204.

Texas Department of State Health Services. (2012). Communicable diseases. Retrieved on
     November 20, 2012 from www.texinfo.library.unt.edu

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Mdmc research project

  • 1. Methodist Dallas Medical Center Neonatal Admission Nurse (NAN) Plan: The Path to Baby-Friendly Designation Jaclyn L. Budet RNC-OB The University of Texas at Arlington College of Nursing In partial fulfillment of the requirements of N5339 Roles and Functions of the Nurse Administrator Dorothy C. Foglia, PhD, RN, NEA-BC November 28, 2012
  • 2. Baby-Friendly: Ten Steps to Successful Breastfeeding  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.  Help mothers initiate breastfeeding within one hour of birth.  Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.  Give newborn infants no food or drink other than breast-milk, unless medically indicated.  Practice “rooming in”—allow mothers and infants to remain together 24 hours a day.  Encourage breastfeeding on demand.  Give no pacifiers or artificial nipples to breastfeeding infants.  Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
  • 3. MDMC Neonatal Admission Nurse (NAN) Plan  Current immediate post delivery process: Eventual separation of mother and infant.  MDMC NAN plan goal is to promote maternal bonding with infant by providing the same level of care to the infant in the location where the mother is.  Process plan: Understand the evidence-based research that supports the NAN plan. 1. Define roles and responsibilities of the NAN staff member. 2. Define roles and responsibilities of the staff member present at delivery. 3. Determine and obtain necessary equipment for NAN staff member to complete work.
  • 4. Evidence-Based Research  Skin-to-skin (STS): Involves a naked infant lying prone on a mother’s bare chest, with the infant’s back covered by a blanket (Hung and Berg, 2011). 1. Early STS improves breastfeeding and supports infant temperature stabilization and neurobehavioral development (Hung and Berg, 2011). 2. Benefits of STS include reduced crying, improved mother-infant interaction, warmer babies, increased sleep, decreased apnea and bradycardia, improved respiration and oxygen saturation, and accelerated weight gain (Reeg and Lott, 2012). 3. The American Academy of Pediatrics recommends STS contact as a strategy to increase breast milk supply and breastfeeding success (Bagby and Bowen, 2012).  Rooming-in: Allow mothers and infants to remain together 24 hours a day(www.nichq.org). 1. Rooming-in promotes skin to skin contact, adequate maternal milk supply, feeding on demand and exclusive breastfeeding (www.nichq.org). 2. Rooming-in facilitates the infant’s transition to extrauterine life, reduces risk of hospital acquired infection, and prepares parents to care for their infant at home (www.nichq.org).
  • 5. Evidence-Based Research  Breastfeeding: Help mothers initiate breastfeeding within one hour of birth (www.nichq.org). 1. Breast milk is the best source of nutrition for young children and provides both short and long-term benefits. Infants who are breastfed are less likely to experience a variety of infections and to develop chronic conditions later in life (Perrine, Scanlon, Li, Odom, and Grummer-Strawn, 2012). 2. The World Health Organization and American Academy of Pediatrics recommend that mothers breastfeed exclusively for about the first 6 months of their infant’s life (Perrine et al., 2012). 3. Joint Commission recently recommended exclusive breast milk feeding during an infant’s entire hospital stay (Brown and Redmon, 2012). 4. Breastfeeding within one hour of birth promotes infant’s transition to extrauterine life, the infant is most alert within one hour after birth, and it promotes maternal oxytocin to decrease bleeding. Early breastfeeding will facilitate effective breastfeeding with no supplementation (www.nichq.org).
  • 6. Evidence-Based Research  Delay of procedures: The removal of “timed” or “by the clock” clinical practices (Penny-MacGillivray, 1996). 1. Infant Bathing: Implementation of bath delay showed that regardless of gestational age, the incidence of newborns experiencing hypothermia and hypoglycemia during the transitional period was reduced by changing the focus of unnecessary interventions (Lipka and Schulz, 2012). Delay infant baths at least 2 to 4 hours to establish thermoregulation and decrease negative side effects of hypothermia, including increased oxygen consumption, respiratory distress, and hypoglycemia (Lipka and Schulz, 2012). 2. Vitamin K and Erythromycin: Texas State Code requires 0.5% erythromycin ophthalmic solution or ointment to be applied, to the infant’s eyes within 2 hours after birth (Texas Department of State Health Services, 2012). Vitamin K should be given to all newborns as a single, intramuscular dose of 0.5 to 1 mg soon after delivery (American Academy of Pediatrics, 2003). 3. Dubowitz Assessment: Postnatal assessment of gestational age by external Ballard examination performed poorly compared with early ultrasound and last menstrual period (Taylor, Denison, Beyai, and Owens, 2010). 4. Hypoglycemia Protocol: Evaluation and treatment of late-preterm infants and term infants considered “at-risk”: those who are small for gestational age, large for gestational age and infants of diabetic mothers. Only address the at-risk infants, not the healthy term babies (Rucoba, 2011).
  • 7. References American Academy of Pediatrics, Committee on Fetus and Newborn. (2003). Controversies concerning vitamin K and the newborn. Pediatrics, 112(1), 191-192. Baby-Friendly USA. (2012). Baby-Friendly Hospital Initiative. Retrieved October 4, 2012 from http://www.babyfriendlyusa.org/eng/index.html Bagby, K., and Bowen, S. (2012). Kangaroo care increases breastfeeding rates. Journal of Obstetric, Gynecologic, and Neonatal Nurses, 41, S1-S118. Brown, T. and Redmon, M. (2012). Supporting breastfeeding in the hospital: A better start. Journal of Obstetric, Gynecologic, and Neonatal Nurses, 41, S1-S118. Hung, K. J., and Berg, O. (2011). Early skin-to-skin after cesarean to improve breastfeeding. The American Journal of Maternal/Child Nursing, 36(5), 318-324. NICHQ. (2012). Best Fed Beginnings. Retrieved November 20, 2012 from http://www.nichq.org/our_projects/cdcbreastfeeding.html
  • 8. References Lipka, D., and Schulz, M. (2012). “Wait for Eight”: Implementation of newborn outcomes by the implementation of newborn bath delay. Journal of Obstetric, Gynecologic, and Neonatal Nurses, 41, S1-S118. Penny-MacGillivray, T. (1996). A newborn’s first bath: When? Journal of Obstetric, Gynecologic, and Neonatal Nurses, 25, 481-487 Perrine, C. G., Scanlon, K. S., Li, R., Odom, E., Grummer-Strawn, L. M. (2012). Baby-Friendly hospital practices and meeting exclusive breastfeeding intention. Pediatrics, 130, 54-60. Reeg, J. L., and Lott, T. (2012). Implementing skin-to-skin care in a baby-friendly community hospital. Journal of Obstetric, Gynecologic, and Neonatal Nurses, 41, S1-S118. Rucoba, R. J. (2011). Algorithm is key resource on screening, management of neonatal hypoglycemia in at-risk infants. AAP News, 32(3), 20-21. Taylor, R. A. M., Denison, F. C., Beyai, S., and Owens, S. (2010). The external ballard examination does not accurately assess the gestational age of infants born at home in a rural community of the Gambia. Annals of Tropical Paediatrics, 30, 197-204. Texas Department of State Health Services. (2012). Communicable diseases. Retrieved on November 20, 2012 from www.texinfo.library.unt.edu