Description of the Initiative
In 2009, the WHO/UNICEF updated the BFHI standards (i.e. the “Global Criteria). In their document, these organizations encouraged the adaptation of the Ten Steps to Successful Breastfeeding for neonatal intensive care, mentioning that it should include criteria or standards for care, discharge planning, post-discharge assessment, and special support for mothers.
In the same year the Nordic and Quebec working group was formed by professionals from Sweden, Norway, Denmark, Finland, and Quebec, Canada to address the expansion of the BFHI to neonatal care. This group developed a unified expansion of the BFHI to Neonatal Wards (Neo-BFHI), based on review of the evidence, expert opinion, and experiences in the Nordic countries and other countries around the world.
To remain consistent with the WHO/UNICEF 2009 update of the BFHI standards, the expansion to neonatal wards closely follows the original Ten Steps to Successful Breastfeeding. Furthermore, to ensure that recommended practices focus on respect to mothers, a family-centered approach and continuity of care, the working group formulated three Guiding Principles meant to be basic tenets in all of the Ten Steps. In agreement with the BFHI, the adaptation also includes respect of the International Code of Marketing of Breast Milk Substitutes.
It must be noted that in the spirit of this adaptation, neonatal intensive care/special care wards typically cover all levels of neonatal care, including preterm, low birth weight, and sick infants, and also healthier infants who require episodic or short-term monitoring or medical interventions.
The Neo-BFHI package with the expanded version of the Baby-friendly Hospital Initiative (BFHI) includes:
Neo-BFHI: The Baby-friendly Hospital Initiative for Neonatal Wards. Three Guiding Principles and Ten Steps to protect, promote and support breastfeeding. Core document with recommended standards and criteria (Based on BFHI Revised, Updated and Expanded for Integrated Care, Section 1).
Neo-BFHI: The Baby-friendly Hospital Initiative for Neonatal Wards. Self-Appraisal Tool to assess standards and criteria (Based on BFHI Revised, Updated and Expanded for Integrated Care, Section 4)
Neo-BFHI: The Baby-friendly Hospital Initiative for Neonatal Wards. Educational material for decision-makers and staff.
Neo-BFHI: The Baby-friendly Hospital Initiative for Neonatal Wards. External Assessment Tool (Based on BFHI Revised, Updated and Expanded for Integrated Care, Section 5. This document is confidential and is only sent to BFHI country coordinators).
Note: To download the package we would ask you to fill out a registration requiring limited information in order to monitor interest for the program. We thank you in advance and if you experience any problem please contact a member of our group.
Download the Neo-BFHI Package
Power Point Presentations on the Neo-BFHI
Haiek LN, Hansen MN, Hannula L, Ezeonodo A. How to use the Neo-BFHI Package: Tools for self-appraisal, monitoring, the external assessment process, and education material.
Haiek LN. Global pilot testing of the Neo-BFHI Package.
The Adaptation Process
To make sure that the Neo-BFHI would emerge as a truly international program:
- The First International Neo-BFHI Conference and Workshop was organized in Uppsala, Sweden in 2011 with participants from 24 nations who gave their suggestions.
- Many BFHI Country Coordinators and international experts from 20 countries have given their invaluable feedback during the development of the Neo-BFHI Core document and after performing pilot tests between 2013 and 2015 of the confidential Neo-BFHI External Assessment Tool.
- The Second International Neo-BFHI Conference was held in Uppsala, Sweden, May 19-20, 2015 with participants from 32 nations.
References for the Neo-BFHI recommendations: Nyqvist KH, Maastrup R, Hansen MN, Haggkvist AP, Hannula L, Ezeonodo A, Kylberg E, Frandsen AL, Haiek LN. Neo-BFHI: The Baby-friendly Hospital Initiative for Neonatal Wards. Core document with recommended standards and criteria. Nordic and Quebec Working Group; 2015.
Peer-Reviewed Articles (2012 & 2013)
Nyqvist KH, Häggkvist AP, Hansen MN, Kylberg E, Frandsen AL, Maastrup R, Ezeonodo A, Hannula L, Koskinen K, Haiek LN. Expansion of the ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations for three guiding principles. Journal of Human Lactation 2012;28(3):289-96
Nyqvist KH, Häggkvist AP, Hansen MN, Kylberg E, Frandsen AL, Maastrup R, Ezeonodo A, Hannula L, Haiek LN. Expansion of the Baby-Friendly Hospital Initiative ten steps to successful breastfeeding into neonatal intensive care: Expert group recommendations. Journal of Human Lactation 2013; 29(3):300-9.
Nordic and Quebec Working Group Members
Kerstin Hedberg Nyqvist, RN, PhD
Elisabeth Kylberg, Nutritionist, PhD, IBCLC
Mette Ness Hansen, RN, Midwife, MPH, IBCLC
Anna-Pia Häggkvist, RN, MSc, IBCLC
Regnhild Maastrup, RN, PhD, IBCLC (Email: email@example.com)
Annemi Lyng Frandsen, RN, IBCLC, MSA
Leena Hannula, RN, Midwife, PhD
Aino Ezeonodo, RN, CEN, CPN, CNICN, MHC
Laura N. Haiek, MD, MSc (Email: firstname.lastname@example.org)