“All too often, breastfeeding is overlooked as a key lifesaving intervention, especially in emergencies. At the first-ever World Humanitarian Summit in Istanbul, we must make sure that breastfeeding is top of mind among all those involved in funding, planning and implementing an emergency response.” Dr Francesco Branca, WHO Director of Nutrition for Health and Development, and Mr Werner Schultink, Chief of Nutrition, UNICEF

Breastfeeding becomes even more critical for survival in humanitarian emergencies. Whether caused by conflict or natural disasters, emergencies jeopardize the health of populations, and young children are among the most vulnerable. Overcrowding, food insecurity, unsafe water, poor sanitation, and overburdened health systems all contribute to a more dangerous situation for infants and children. Failure to fully protect breastfeeding in these circumstances dramatically worsens the situation.

Admitting and caring for infants that are exclusively formula fed with absolute risks of diarrhoeal diseases, pneumonia and undernutrition might lead to these sick infants not being adequately cared for in hospitals due to health care worker shortages, especially now with the Corona Virus outbreak and our health systems being seriously overburdened.

Breastmilk and the novel coronavirus SARS

Breast milk is the optimum source of nutrition for babies, yet the emergence of COVID-19 has raised questions both about the safety of breastfeeding and human milk banking.

Although there is much unknown about COVID-19, the following organisations: the Center for Disease Control and Preventions (CDC) in the USA, UNICEF, the Human Milk Banking Association of North America (HMBANA), the European Milk Bank Association and the Academy of Breastfeeding Medicine (AMB), all agree breastfeeding should be continued.

According to the CDC, to date the virus has not been isolated in the breastmilk of infected women. Neither is there evidence at this stage, that the virus can be transmitted through breastmilk. Although the virus was not found in the breastmilk of infected women, (High 5 to Breastmilk!!!) antibodies against SARS-CoV were detected in one sample. (Center for Disease Control and Prevention [CDC], 2020)

No evidence of the virus was found in breastmilk, cord blood, amniotic fluid or throat swabs of newborns whose mothers had tested positive for the virus (Chen et al., 2020).

UNICEF ARE ENCOURAGING MOTHERS INFECTED WITH COVID-19 TO CONTINUE BREASTFEEDING

Editor-in-Chief of Breastfeeding Medicine, Arthur Eidelman, states: “Given the reality that mothers infected with coronavirus have probably already colonized their nursing infant, continued breastfeeding has the potential of transmitting protective maternal antibodies to the infant via the breast milk. Thus, breastfeeding should be continued with the mother carefully practicing handwashing and wearing a mask while nursing, to minimize additional viral exposure to the infant” (Liebert, 2020).

The Infant and Young Child Feeding in the Context of the COVID-19 Pandemic Eastern, Central and Southern Africa March 26, 2020 joint note aims to consolidate the current recommendations on Infant and Young Child Feeding in the context of the COVID-19 pandemic in Eastern, Central and Southern Africa.

Their recommendations are:

Breastfeeding protects against morbidity and death in the post-neonatal period and throughout

infancy and childhood. The protective effect is particularly strong against infectious diseases that are prevented through both direct transfer of antibodies, other anti-infective factors and long-lasting transfer of immunological competence and memory.

In settings where diarrhea, respiratory infections and infectious morbidity are common in infants, any possible risk of transmission of COVID-19 through breastfeeding (not reported to date) is outweighed by the known risks associated with replacement feeding.

Every year, 30 million newborn’s born to soon or to small are at risk for death and disability. Globally, we are still far from reaching the Sustainable Development Goal of neonatal mortality of 12/1000 live births by 2030. An estimated 2.5 million newborn’s die within the neonatal period and a further estimated one million small and sick newborn’s survives with long-term adverse sequela such as disability. These disabilities place a financial, psychological and social burden on families, communities and countries.

Every newborn has the right to survive and thrive, and hence UNICEF and the WHO brought out the following report: Survive & Thrive: Transforming care for every small and sick newborn. It focuses on inpatient care of the small, sick and vulnerable newborn. This report highlights the need for accurate and reliable data to provide guidance in terms of planning, outcomes measures and the impact of health care.

Key messages are:

Surviving. More than 2.5 million babies died in 2017 from preventable causes, most notably prematurity, complications around the time of birth, infections and congenital conditions. Some died because the care they received was of poor quality; others because they received no health care at all. In order to meet the SDG 3.2 target for newborn and child survival, countries need to transform newborn care.

Thriving. Every year, 30 million newborns require specialized or intensive care in a hospital; those who survive often do so with preventable conditions and disabilities that will affect them for life. These newborns can and will thrive as productive members of our societies, provided they are given high-quality inpatient care at the right time and in the right place, including follow-up care.

Transforming. Cost–effective solutions exist for the main causes of neonatal death and disability. In line with the drive to achieve UHC, there must be innovation, people centred care, locally designed technologies, financial protection, and parent power and partnership. Ensuring the recruitment, training and retention of skilled nurses is particularly crucial. Social norms also need to be transformed: neonatal mortality should not be considered inevitable.

Investing fairly. 1.7 million newborn lives could be saved each year by investing in access to quality care for every newborn, everywhere, including in humanitarian settings. While essential newborn care would benefit small and sick newborns, adding special and intensive care services for them would reduce neonatal mortality by almost 50%. It would also promote child development and foster economic productivity.

Counting. Accelerating change requires improving routine collection of data, with a stronger focus on coverage, quality and outcomes. Existing data need to be better used

The provision of continuous quality care and universal health coverage is key in working towards achieving the SDG targets. We need to ensure that our vulnerable newborn’s, not only survive but also thrive to become the best adults they can possibly be.

Find the links to this fantastic report based on research and evidence below.

Full report:

https://apps.who.int/iris/bitstream/handle/10665/326495/9789241515887-eng.pdf?ua=1

Key findings:

https://apps.who.int/iris/bitstream/handle/10665/276655/WHO-FWC-MCA-18.11-eng.pdf?ua=1

We experience very strange times due to the COVID-19 pandemic and we see various responses to it. We see some conflicting and confusing approaches such as in some NICUs where parent’s visitation is limited while others still embrace the concept of ‘no separation’.

There are also questions such as:

  • Should the parents wear masks when communicating with their baby?
  • Should they touch the baby?
  • Should both parents be allowed in the NICU?
  • What post-discharge information should we give them regarding Covid-19 and the care of their baby?
  • And many more.

The Covid-19 pandemic appears to have divided neonatal healthcare workers into 2 groups promoting either:

  • Maximum protection against the risk of Covid-19 infection for mother, baby and healthcare workers OR
  • Maximum protection of the newborn’s long term outcomes.

Decisions on how to approach neonatal care amidst the Covid-19 pandemic are based on balancing these 2 objectives and trying to determine which carry the most weight or benefit.

Optimal long term developmental outcomes, that need protection, are based on the provision /development of:

  • Facial recognition
  • Skin-to-skin care
  • Breastfeeding
  • And especially bonding and attachment.

In order to provide the above, the following would need to be included in Neonatal COVID-19 management policy:

  • Zero-separation of mother and baby
  • Access for both parents to the NICU
  • Encouragement  of breastfeeding and skin-to-skin contact
  • Parents to have no masks on while making eye-contact with their baby.

WHO has attempted to bridge this gap and provide some much needed guidance on managing neonates during this Pandemic.

 “Can I touch and hold my newborn baby if I have COVID-19?

WHO: “Yes. Close contact and early, exclusive breastfeeding helps a baby to thrive. You should be supported to breastfeed safely, with good respiratory hygiene; hold your newborn skin-to-skin, and share a room with your baby. You should wash your hands before and after touching your baby, and keep all surfaces clean.”

Find more details by clicking the link below.

(https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-on-covid-19-pregnancy-and-childbirth)

As neonatal nurses we need to advocate for the protection of the babies and their families, and that means in the short term to prevent the spread of the coronavirus, but also to optimise long term outcomes. This may require some compromise in implementation of infection prevention measures in order to balance the importance of bonding and attachment between the babies and their parents.

Keep safe

Carin Maree

Hungry Delegates

The Eastern Cape NNASA branch is made of 5 Hospitals 2 Public and 3 Private Hospitals in the Nelson Mandela Bay District. We held our annual workshop on the 22nd November at Dora Nginza Hospital, Port Elizabeth.

It was clear nurses are hungry for information as attendance was excellent with 100 delegates attending including doctors from District Hospitals, advanced midwifery students from Lilitha College P E campus and neonatal nurses from around the Eastern Cape.

Thanks to generous support from our trade partners we were able to offer the workshop without a registration fee.

Part of the trade exhibition

Delegates were welcomed by CEO Mr M.P Tsibolane of Dora Nginza Regional Hospital and then followed a packed program with many fascinating topics.

We had varied presenters including et al an ophthalmologist, neonatologist and cardiac specialist. Sr Arna Jenkins from Tygerberg Hospital presented on reducing CLABSI infections and we had Cleft Friends and many more.

The ‘Topic of the Day’ was the Golden Hour by Dr. S Maharaj as it is the starting point for our Neonatal care.

One of our excellent presenters in action.

We were so excited to have 20 delegates signing up as new members of NNASA.

Delegates left having been well fed both physically and intellectually.

Having the workshop so close to World Prematurity Day, in theory, was a good plan but in reality was hectic, as we were all busy with facility celebrations for the day. The plan for 2020, therefore, is to have our next workshop in June after our national NNASA conference in Gauteng (For those who aren’t lucky enough to be able to attend the national conference!) We hope to have an even bigger turnout!

South Africa has seen a steep increase in litigation, where billions of Rand needs to payed out to claimants. In the public sector these payments come from the resources budget, creating a vicious circle and a serious problem. Mediation could be a possible solution to address these matters.

Mediation is an alternative dispute resolution with many benefits. Among others it saves tremendous cost compared to litigation. Furthermore, settlement can be reached much quicker whereas litigation takes years which results in those involved being subjected to tremendous levels of stress and uncertainty. By following the Mediation route parents of children with Cerebral Palsy can get treatment for their children much earlier. Moreover, Mediation is focused on restoring trust and relationships between the parties involved.

Win-Win!

You may wonder why I bring up Mediation, but in our NICU environment medical errors or unforeseen complications may occur. During those times one probably are worried about future litigation. It is those cases that can be settled quickly though Mediation. Sometimes parents just want to understand what happened. They do not necessarily want a big settlement. Mediators facilitate the communication between the two parties in dispute and create a confidential and non-prejudice environment where both parties can come up with amicable solutions for their dispute. A win-win situation.

However, at this moment some matters had been Mediated successfully, but it is still a new concept and implementation of it will take some time.

Below are a few links to some articles:

Mediation could ease SA’s medico-legal woes but it’s no quick fix

Mediation – an alternative to litigation in medical malpractice http://www.samj.org.za/index.php/samj/article/view/8851/6360

Understanding the medico-legal landscape in South Africa

The Tygerberg Hospital Neonatal Nurses Seminar hosted by Stellenbosch University, supported by NNASA and the Tygerberg Hospital Children’s Trust. 26 November 2019.

Focused delegates.

In the Cape, we are privileged to have cost-free annual seminars, meticulously planned by the respected, energetic and committed Arina Jenkins, the recipient of the Neonatal Nursing Excellence award at the NNASA Conference last year. Arina works in the NICU in the Tygerberg Children’s Hospital. For the last four years, she has arranged wonderful annual seminars which have each been attended by up to 300 neonatal nurses, doctors and allied health professionals from Public and Private Hospitals, clinics, colleges and universities as far afield as Worcester!  The focus of the seminars is to reduce neonatal deaths, reduce neonatal mortality and to better equip the nurses attending, to be advocates for neonates. This approach was chosen because Millennium Development Goal 4 (to reduce child mortality) was not successfully achieved regarding the reduction of neonatal mortality by the end of 2015. Information regarding the Sustainable Development Goal 3 (to ensure healthy lives and promote wellbeing for all at all ages) was shared as the foundation for the seminar.

Great turnout.

This year the theme was ‘Ending preventable neonatal deaths’, focusing on infection which has been identified as the third major cause of neonatal deaths worldwide. Presenters included doctors and nurses with a very special final presentation by Arina, introducing mothers and their NICU graduates to the delegates.

The first presentation of the morning set the scene for the seminar, with information about the Sustainable Development Goal 3, focusing on the impact of neonatal sepsis and what action is needed to make an impact on this critical area in NICU care. The morning continued with presentations on the management of neonatal sepsis, necrotising enterocolitis, antibiotic resistance and the necessary actions required to prevent antibiotic resistance in the NICU, which gave the delegates much food for thought. Nurses’ presentations included infection surveillance and the prevention of outbreaks, and an inspiring group presentation by the nurses from a neonatal ward, who implemented steps to make a significant and continuing impact on the prevention of Central Line-associated Bloodstream Infections in the neonatal wards at Tygerberg Hospital.

After lunch we were educated about a new dressing that is a prevents bacteria from multiplying in a wound. Then we met a number of NICU graduates whose mothers touched our hearts, assuring us that our work is well worth it!

There was wonderful representation and support from our colleagues who supply the NICUs with equipment and support. Delegates were given a goodie bag, there were lucky draw prizes and generous food supplied for tea and lunch! We left after 15h00 feeling well stimulated, educated and challenged to continue with the satisfying and rewarding work that we do.

World Prematurity Day 2019: Parents at the helm, babies #BornTooSoon at the heart

From healthy Newborn Network: Mary KinneyAmialya Durairaj

World Prematurity Day, which takes place on 17 November, is a key day in the global health calendar that reaches millions of people each year through the media and events all over the world to ensure that the preterm birth prevention and care remain a global health priority. The theme for this year’s World Prematurity Day was Born too Soon: the right care, at the right time, in the right place. HNN celebrated it along with partners and, while we are still tallying results, it is clear that activities took place in more countries than ever before.

A glimpse at history

World Prematurity Day started with parents. The first international awareness day for preterm birth on 17 November was launched by European parent organizations in 2008. It has since evolved into a worldwide annual observance by development agencies, governments, professional associations, hospitals and parents.

Parents have always played a central role in the care of preterm babies. With developments in science, health care systems and social norms, their role evolved.

For most of history, families, especially women, were primarily responsible for all newborn care in the home environment. With a wave of advancements designed to improve survival in higher income countries in the late 19th and early 20th century, parents were excluded from the caregiving for hospitalized babies, partly due to concerns about infection. The result of this separation between newborns and parents had adverse consequences, including reduced bonding, neglect and abuse, as well as other physical and emotional issues for both parents and their children.

The right to be together

By the mid-20th century, the unintended consequences of this separation were beginning to be recognized by advocacy communities. New groups emerged led by parents in the U.S., Britain and Australia, and successfully lobbied for family-friendly hospital-wide changes, such as the families’ right to stay with their children. Parents also had a fundamental role in raising awareness among nurses and physicians that even very preterm newborns feel pain and discomfort.

Parents have a vital role to play in small and sick newborn care. As they consistently care for their own newborn, they can become “patient experts” with a deep knowledge of health issues. They often observe newborn responses, interact with the health-care team and meet with other parents and support groups.

Some parents will even study their newborn’s condition, engage in health research, and become active with public health and policy advocacy and lobbying. As a result, parents of small and sick newborns are a great asset as advisors to inpatient newborn care units seeking to improve quality, safety and family-centered care.

By working with local and regional parent support organizations, health-care providers and facility managers can provide or supplement resources to promote partnerships between parents and health-care teams, and influence policies and practices for affected families.

In all instances, it is critical to keep babies #BornTooSoon at the heart of all interventions, ensuring that their rights and their families’ rights are upheld and protected.

Learn about the role of parents, newborn care, rights and much more:

So many of our hospitals around the country now celebrate WPD. Here is a taste of some of those celebrations. We encourage you all to get active next year-Its a great time to celebrate your successes and raise awareness of the needs of our precious babies.

Sadly this will be my last message as President. After 13 years it has come time for me to step down as President of NNASA. I will be leaving you in the capable hands of Carin Maree and the rest of the board. Don’t despair-I will remain on the board to assist and support them during this transition. Thank you to all who have contributed to and supported NNASA thus far. Together we are greater than the sum of our parts! I look forward to all that NNASA and our members will achieve in the years to come.

NNASA was founded at the end of 2006 by a passionate group of KZN neonatal nurses who had a vision to unite and support neonatal nurses in South Africa and beyond. Since that time we have grown to include members in most provinces, the public and private sector, universities and in the trade. We have strengthened bonds with other associations eg SOMSA and USANA and are represented on many national/ international organisations eg  COINN, FUNDISA, SACSoWACH and Forum for Professional Nursing Associations et al. We have hosted 8 National conferences and 1 International conference. We have a few members beyond our boarders and as of this last month have been joined by the newly formed Kenyan Neonatal Nurses Association and have interest from a nurse in Ghana. Our passion is spreading!

Founding Board

I thought it would be a good time to reflect on our three core values: Care, Passion and Excellence.

Care:

“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, and honest accomplishment, or the smallest act of caring, all of which have the potential to turn a life around!” Leo Buscalgia

On those days when our work seems overwhelming and it is tempting to just go through the motions, to seek greener pastures or to finally give up-remember the incredible privilege we have been given: to mold a life! The potential of that precious prem’s future is in our hands. At no other time in their life does nursing play such a crucial role in saving and shaping their life as in their first month.

Take time to swaddle, give sucrose, provide skin to skin care, engage with families, provide breast milk,  touch, take photos and do all those little things. It is in those moments that it all becomes worthwhile.

Passion:

At our conference last year, inspired by President Ramaphosa’s ‘Tuma Mina’ call, we lit sparklers and each recommitted ourselves to giving of our best in caring for our precious babies.

“Passion begins when a fire is lit inside us but it always seeks outward expression. Our passions energise us to take action. If we are passionate about something, we will give it our all! If a goal or endeavor is important enough to us, we can transform even a daunting challenge into a deeply engaging process by charging our effort with inner passion.”  2012-Celebrations of life.

Excellence:

“We are what we repeatedly do-therefore excellence is not an act but a habit.” Aristotle

 “Excellence is not a skill. It is an attitude” Ralph Martson.

“Start where you are. Use what you have. Do what you can. Success is a journey, not a destination. The doing is often more important than the outcome. From what we get, we can make a living; what we give, however, makes a life.” Arthur Ashe.

Pursuit of money and position will only grant momentary happiness but when you impact a life for good its ripples impact you and the receiver for life. Assess what is motivating and driving the decisions and actions you make. In desiring to give of your best in service to others you are seeking a treasure that money cannot buy.

Nelson Mandela said:  “Our children are the rock on which our future will be built, our greatest assets as a nation. They will be the leaders of our country, the creators of our national wealth and those who care for and protect our people.”

I therefore charge you to guard our future well-serve your babies and their families with care, passion and excellence. Unite with other nurses and the people of our beautiful rainbow nation in seeking “whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—anything that is excellent or praiseworthy” Philippians 4:8

As we are only holding our conferences biannually it is very difficult to try and hold a face to face AGM. We have therefore decided, this year, to hold it electronically. You can download the “minutes” from our meeting by clicking below.

Should anyone have any questions, concerns or matters they would like to raise with the board please email us on info@nnasa.org.za

NNASA will be hosting its 9th National Neonatal Nurses Conference from 3-4 June 2020 at the Wanderer’s club in Johannesburg-Yes we are finally coming to Gauteng again! On the Gautrain bus route and with plentiful accommodation options in the area there is no excuse not to come.

The conference theme is Purposeful Passion and you don’t want to miss this one as we are doing things a little differently this year …. Following our usual 2 full conference days we are hosting an all day trade exhibition. This will be open to all health professionals working with neonates. Picture workshops, presentations, food stalls and lots of networking!

So start planning today! Send your abstracts to info@nnasa.org.za. We look forward to seeing you there.