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.
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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 campign was
launched by the WHO/ UNICEF in mid 1991
in Ankara to boost the breastfeeding practices
and to counter the trends of bottle feeding

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• 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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• The programme, launched in Kerala in March 1993,
is hospital .
• Of 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)

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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

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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.

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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.

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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.

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Ten steps to successful
breastfeeding
(revised 2018)- WHO

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• Critical management procedures
– 1a. Comply fully with the International Code of
Marketing of Breast-milk Substitutes and relevantWorld
Health Assemblyresolutions.
– 1b. Have a written infant feeding policy that isroutinely
communicated to staff and parents.
– 1c. Establish ongoing monitoring anddata-management
systems.
– 2. Ensure that staff have sufficient knowledge,
competence and skills to supportbreastfeeding.

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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 foodor
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 remaintogether
and to practise rooming-in 24 hours aday.
– 8. Support mothers to recognize and respond totheir
infants’ cues forfeeding.
– 9. Counsel mothers on the use and risks offeeding
bottles, teats and pacifiers.
– 10. Coordinate discharge so that parents and their infants
have timely access to ongoing support andcare.

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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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• Indian hospitals are still in early stages of
joining this movement. The National BFHI task
force was formed, in 1992, towards the efforts
to improve the breastfeeding practices.

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• The task force comprising of Govt. of INDIA,
UNICEF, WHO and Professional Organization
( 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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• 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

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

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Cont…
• 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
(97.8-99.5degree 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 birthweight

34. Risk factors:
-Incorrectcare of the baby immediately after birth.
-Separation of mother from baby afterbirth.
-The weight and gestational age of the infant.
-The place of the delivery and environmental conditions.
-Inadequate warming procedures beforeand during transport
of theinfant.
-Asphyxia, hypoxia, other illness of thebaby,
-Inadequate warming procedureduring resuscitation

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

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 anda slow heart rate (bradycardia) corresponding
to the degree of fall in bodytemperature.
3.Hypoglycemia and metabolic acidosismay develop.
4.There is a real risk ofdeath
5.The face and extremities may have a bright red color while the
rest of body is pale; central cyanosis may bepresent.
6.Sclerema, a hardening of the skin, associated with reddening
and edemais seen mainly on the back and the limbs but may
cover the wholebody.

37. Thereare fourwaysa newborn may
lose heat to theenvironment:-
(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 deliveryroom
 (2) Immediatedrying
 (3) Skin-to-skin contact
 (4) Breast-feeding
 (5) Postpone bathing and weighing of the
newborn
 (6) Appropriate clothing andbedding
 (7) Keeping mother and babytogether
 (8) Warmresuscitation
 (9) Training andawareness

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 thenormal
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, therisk of hypothermia is greatlyreduced.
•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
preventionand management of hypothermia in thenewborn

42. Thank you