Theory of Infants' Transition Management from the Neonatal Intensive Care Unit to Home: a Qualitative Study

Background: Infant's transition is a challenge for parents and the health system that requires ongoing assessment and management to improve each newborn`s growth and development. The purpose of this study was to explore the management of infant` transition from neonatal intensive care unit (NICU) to home.Materials and Methods: We used a grounded theory study to explore and describe the management of infants’ transition from the NICU to the home. Interviews were conducted with 31 professionals and 20 family members, and participant observations were made in hospitals, clinics, and one physician office. MAXQDA was utilized for coding and categorizing data.Results: The theory illustrated six phenomena: An unexpected separation; A crisis situation; Mother-infant rebonding; Protection of the infant’s health; Promotion of growth and development; and Inadequate management causing disability. Together, these formed a three-phase process consisting of: A threat to the infant's life, Efforts to save the infant's life, and Continuation of life. Conclusion: Development of the theory of  infants transition provides a three phases process ( A threat to the infant’s life, Efforts to save the infant’s life, and Continuation of life), that  can yield   guidelines to  manage  the infant` transition in prevent mother–infant separation, support parents in their role as primary caregivers, and follow up with individual home visits by nurses

Expansion of the Baby-Friendly Hospital Initiative Ten Steps to Successful Breastfeeding into Neonatal Intensive Care: Expert Group Recommendations

In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother's own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding. Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up