| Family-Centered Care Core Components: |
| (a) The facility will: 1. allow all parents to have reasonable access to their infants at all times; 2. have access to the services, personnel, and equipment needed to provide the appropriate level of care for all infants; 3. support the physiologic, developmental, and psychosocial needs of infants and their families; 4. have a process to screen every family for social determinants, depression, and cultural needs; and 5. refer patients and families to appropriate resources as needed. |
| Family-Centered Care Additional Best Practices: |
| (b) Implement the utilization of primary nursing. (c) Involve family in daily and multidisciplinary patient care rounds. (d) Implement and support a family advisory council. (e) Establish a process to evaluate potential health disparities of the patient population served. (f) Implement a coordinated process to assess and address the emotional needs of families. (g) Engage in shared decision-making by involving family in discharge planning, including transport discussions. (h) Provider and staff training on shared decision-making and how to engage in difficult and inclusive conversations. (i) Explicit efforts to support lactation and the needs of breastfeedinga individuals. |
| Lactation and Neonatal Nutrition |
| (j) The facility will: 1. have personnel with the knowledge and skills to support lactation available at all times; 2. have pumping equipment and secure human milk storage facilities available; 3. have policies and procedures in place to support: i. the initiation and maintenance of lactation; ii. early initiation of milk expression; iii. safety, preparation, storage, and use of human milk and formula; and iv. long-term pumping and transition to breastfeeding; and v. the utilization of donor human milk, if available. 4. provide annual education to all direct care providers on the importance of, and support of lactation (ie, pumping, mixing, safe storage, misappropriation, and proper identification); and i. all direct care providers have didactic education, skills verification, and competency on the proper mixing of human milk and formula; 5. establish a program for breastfeeding and lactation support, including data collection. |
| Neonatal Resuscitation |
| (i) The facility must have written policies and procedures specific to the resuscitation and stabilization of newborns based on current standards of professional practice.7 1. At least 1 person with the skills to perform a complete neonatal resuscitation including endotracheal intubation, establishment of vascular access, and administration of medications must be immediately available on-site 24/7.7 2. A full range of neonatal resuscitative equipment, supplies, and medications must be immediately available at all times.7 3. If the facility provides obstetrical delivery services: i. Each birth will be attended by at least 1 AAP Neonatal Resuscitation Program (NRP) trained provider whose only responsibility is the management of the newborn and initiating resuscitation.7 ii. In the event of identified antepartum and intrapartum risk factors, at least 2 NRP trained providers should be present at birth and be responsible solely for the management and resuscitation of the newborn.7 Additional qualified providers should be available depending on the anticipated risk, number of newborns, and the obstetrical setting.7 iii. If advanced resuscitation measures are anticipated, a fully qualified neonatal resuscitation team should be present at the time of birth.7 |
| Radiology |
| (j) When obtaining imaging in neonatal and obstetrical patients, radiology services will incorporate the “as low as reasonably achievable” principle.8 |
| Policies and Procedures |
| (k) The facility will have written: 1. neonatal, medical, and ancillary care guidelines, policies, and procedures that are established on evidence-based literature, and best-practice standards, that are monitored and tracked for adherence, reviewed at least every 3 years, and revised as needed; 2. a policy that mandates the escalation of concern and the urgent presence of a privileged care provider at the bedside, including a method to track adherence; 3. policies and procedures that define the criteria for neonatal team presence at a delivery and identify a method to track adherence, if applicable; 4. policies and procedures for the triage, stabilization, and transfer of obstetrical patients to the appropriate level of care, if applicable; 5. policies and procedures for consultation by telehealth and telephone, if applicable; 6. policies and procedures for intrafacility and interfacility neonatal transport; 7. policies and procedures for transfer to a higher level of neonatal care or for services not available at the facility, if applicable; 8. policies and procedures for car seat safety observation before discharge; and 9. policies and procedures for disaster response, including evacuation of obstetrical and neonatal patients to the appropriate level(s) of care. |
| Staff Privileges |
| (l) The facility will have: 1. specified requirements for all privileged care providers participating in the care of neonatal patients, and have a credentialing process for delineation of privileges; 2. a process to verify that all ancillary care services, clinical staff, and support staff have relevant neonatal training and expertise; and 3. a mechanism in place for medical, nursing, and ancillary care leadership to review and approve these credentials and track adherence. |
| Family-Centered Care Core Components: |
| (a) The facility will: 1. allow all parents to have reasonable access to their infants at all times; 2. have access to the services, personnel, and equipment needed to provide the appropriate level of care for all infants; 3. support the physiologic, developmental, and psychosocial needs of infants and their families; 4. have a process to screen every family for social determinants, depression, and cultural needs; and 5. refer patients and families to appropriate resources as needed. |
| Family-Centered Care Additional Best Practices: |
| (b) Implement the utilization of primary nursing. (c) Involve family in daily and multidisciplinary patient care rounds. (d) Implement and support a family advisory council. (e) Establish a process to evaluate potential health disparities of the patient population served. (f) Implement a coordinated process to assess and address the emotional needs of families. (g) Engage in shared decision-making by involving family in discharge planning, including transport discussions. (h) Provider and staff training on shared decision-making and how to engage in difficult and inclusive conversations. (i) Explicit efforts to support lactation and the needs of breastfeedinga individuals. |
| Lactation and Neonatal Nutrition |
| (j) The facility will: 1. have personnel with the knowledge and skills to support lactation available at all times; 2. have pumping equipment and secure human milk storage facilities available; 3. have policies and procedures in place to support: i. the initiation and maintenance of lactation; ii. early initiation of milk expression; iii. safety, preparation, storage, and use of human milk and formula; and iv. long-term pumping and transition to breastfeeding; and v. the utilization of donor human milk, if available. 4. provide annual education to all direct care providers on the importance of, and support of lactation (ie, pumping, mixing, safe storage, misappropriation, and proper identification); and i. all direct care providers have didactic education, skills verification, and competency on the proper mixing of human milk and formula; 5. establish a program for breastfeeding and lactation support, including data collection. |
| Neonatal Resuscitation |
| (i) The facility must have written policies and procedures specific to the resuscitation and stabilization of newborns based on current standards of professional practice.7 1. At least 1 person with the skills to perform a complete neonatal resuscitation including endotracheal intubation, establishment of vascular access, and administration of medications must be immediately available on-site 24/7.7 2. A full range of neonatal resuscitative equipment, supplies, and medications must be immediately available at all times.7 3. If the facility provides obstetrical delivery services: i. Each birth will be attended by at least 1 AAP Neonatal Resuscitation Program (NRP) trained provider whose only responsibility is the management of the newborn and initiating resuscitation.7 ii. In the event of identified antepartum and intrapartum risk factors, at least 2 NRP trained providers should be present at birth and be responsible solely for the management and resuscitation of the newborn.7 Additional qualified providers should be available depending on the anticipated risk, number of newborns, and the obstetrical setting.7 iii. If advanced resuscitation measures are anticipated, a fully qualified neonatal resuscitation team should be present at the time of birth.7 |
| Radiology |
| (j) When obtaining imaging in neonatal and obstetrical patients, radiology services will incorporate the “as low as reasonably achievable” principle.8 |
| Policies and Procedures |
| (k) The facility will have written: 1. neonatal, medical, and ancillary care guidelines, policies, and procedures that are established on evidence-based literature, and best-practice standards, that are monitored and tracked for adherence, reviewed at least every 3 years, and revised as needed; 2. a policy that mandates the escalation of concern and the urgent presence of a privileged care provider at the bedside, including a method to track adherence; 3. policies and procedures that define the criteria for neonatal team presence at a delivery and identify a method to track adherence, if applicable; 4. policies and procedures for the triage, stabilization, and transfer of obstetrical patients to the appropriate level of care, if applicable; 5. policies and procedures for consultation by telehealth and telephone, if applicable; 6. policies and procedures for intrafacility and interfacility neonatal transport; 7. policies and procedures for transfer to a higher level of neonatal care or for services not available at the facility, if applicable; 8. policies and procedures for car seat safety observation before discharge; and 9. policies and procedures for disaster response, including evacuation of obstetrical and neonatal patients to the appropriate level(s) of care. |
| Staff Privileges |
| (l) The facility will have: 1. specified requirements for all privileged care providers participating in the care of neonatal patients, and have a credentialing process for delineation of privileges; 2. a process to verify that all ancillary care services, clinical staff, and support staff have relevant neonatal training and expertise; and 3. a mechanism in place for medical, nursing, and ancillary care leadership to review and approve these credentials and track adherence. |
The word chestfeeding may be used by nonbinary, transgender, and other parents to identify how they feed their infants. It may refer to human milk or human milk substitute feeding, from a person who lactates or not. Because of this broad and variable definition, chestfeeding and breastfeeding are not always synonymous, and the words are not interchangeable. Published literature findings on breastfeeding may not hold the same outcomes for chestfeeding. Throughout this document, the words breastfeeding and human milk will be used.