The second meeting of ambassadors was held last October in Madrid. More than xx doctors, nurses and parents from all over Spain came together to work on premature baby care. They each pooled their needs and perceptions in accordance with their specific points of view.
The meeting was set up around four working groups, organized by the topics under discussion: late premature babies, team relationships, the parents, and positioning and handling: the kangaroo method. After several hours work, the groups brought their lines of work together and made their conclusions public.
The conclusions reached by each working group are given below, as presented by the spokesperson of each group when the working time had come to an end.

BRIEF CONCLUSIONS OF THE WORKING GROUPS
Ambassadors Meeting – 16th October.

Group on Late Premature Babies

Group on Team Relationships

Parents’ group

Group on Positioning and Handling, Skin to Skin

Group on Late Premature Babies (volver)
Spokesperson: Frances Botet.

Conclusions on late premature babies:

• This is a population at risk. The babies vary greatly from one to another. Some have no pathology, while others do. Those born between week 34 and 37 (36+6) are considered late premature.

• They are babies at risk, but this does not justify separating them from their mother.

• The basic objective is to avoid maternal separation. To this end, the possibility of keeping the mother in order to remain in contact with the baby as long as possible should be considered.

• In the event they are admitted, they should be treated in the same way as non-late premature babies (minimum handling …).

• When 48 hours have elapsed, needs are evaluated; weight, maternal breastfeeding and jaundice. If all signs are favourable, the baby should go home:
  • Maternal breastfeeding: aspects to evaluate; set up a questionnaire/test to ensure evaluation every 8 hours (Ana Jimenez will draw up this questionnaire).
  • If after 48 hours, everything is okay, the babies will be discharged; this is considered an early discharge with monitoring by a paediatrician through primary home medical care or at the hospital. (As the case may be). Pilar Sainz will work on early discharges.

Group on Team Relationships (volver)
Spokesperson: Remedios García.

Conclusions:

• We considered who forms part of the team. It is formed by: a nucleus made up of the new baby, the parents, in close relation with the infirmary, the doctor, auxiliary staff and the relation with the Neonatology Unit, with its cleaning, radiology, maintenance, psychologists, etc.

• We reached the conclusion that the figure that should coordinate the care of the baby is the infirmary with the doctor completely aware at all times of everything that is happening therein.

• As for the Development Centred Care of each newly born baby, we feel it is fundamental to have a common project for the whole team, through:
  • Development Centred Care leaders. Select them for each shift so the development centred care comes to a fore.
  • These leaders will form a committee of experts.
  • The parents must be integrated into the team.

• As for the evaluation of the work, the following measures are suggested:
  • Establishment of quality controls for each baby (ensure their blanket is on …). Use the unit for these controls.
  • Production of a wide-ranging document describing: how to tackle the development centred care, clarification of situations that have occurred on other occasions, guidelines for the implementation of the development centred care in each group

Parents’ group (volver)
Spokesperson: María Sogel.

Conclusions:

• Points proposed for future development by unanimous agreement on: (1) the high risk of suffering development disorders in premature babies, (2) the essential role of the parents as carers of their children and (3) the consideration of the Neonatal Service as an essential instrument for treatment but equally important for the prevention of future diseases and disabilities:

• 1. Define the role of the parents in the Neonatal Area as a fundamental part of the team caring for their premature babies.
• 2. Define how parents can be integrated into the neonatal units:
  • recognizing them as part of the carer team and involving them as co-therapists,
  • creating an atmosphere (personal treatment, space and time) in which they feel comfortable and can carry out the tasks that correspond to them,
  • promoting the organizational changes and provision of the necessary resources,
  • providing them with the tools and mechanisms for learning how best to care for their babies,
  • providing them with psychological care so they can adequately confront the situations that may arise,
  • improving the communication of diagnoses and information in general held by professionals in the area.
• 3. Institutionalization of the Kangaroo Method in Spain:
  • a. as an essential contribution of the parents for their babies during the first stages of their development,
  • b. promoting its implantation in all the Spanish hospitals that have Maternity and Neonatal Areas,
  • c. creating a protocol for its correct employment to be respected by all the members of the care team including the parents.

• Creation of a Parents School integrated into Neonatology that provides the parents with the guidance, information and training required to adequately care for their babies after their discharge from hospital.

• Introduction of Early Intervention to the Areas of Neonatology defining it as integrated and complete care provided to the babies by a multi-disciplinary medical-therapeutic-social team through:
  • a. greater integration of the role of the neuro-paediatrician,
  • b. the incorporation of other professionals to these areas such as rehabilitation doctors, psychologists (for parents and for early stimulation of the babies), physiotherapists, occupational therapists, social workers, etc. as essential agents for early intervention.
  • (We must remember, according to the ‘White Paper on Early Intervention’ (2000), “The intervention directed at children with disorders in their development must begin as soon as the existence of a deviation in their development is detected”, and as a consequence, “the Neonatology service must be responsible for initiating the Early Intervention.”).

• Dissemination of good practices already up and running in certain Spanish hospitals, normally thanks to personal initiatives undertaken by the professionals working in the Neonatology Areas, and their generalization and implantation in all the country’s hospitals.

• Creation of a protocol for the passage of babies from Neonatology (upon discharge from hospital) to External Surgeries (at the hospital itself or in other Primary Care Centres), because the problems affecting premature babies do not suddenly disappear when they are discharged.

• Development of a Coordination Plan:
  • Between Neonatology Areas, Primary Care Centres, Base Centres and Centres for Development and Primary Care, required because the bodies involved in premature baby care belong to a range of departments in the Regional Governments.
  • Making health services responsible for taking the initiative as regards premature baby care during the first few years of their lives.

• Structuring the role of Parent Associations as collaborators of the professionals in the Neonatology Area and support for the new parents of the children admitted.

• From the parents’ perspective, definition of protocols for actions that minimize the pain caused to the premature babies by the tests and treatment they are subjected to during their stay in the Neonatology Areas.

Group on Positioning and Handling, Skin to Skin (volver)
Spokesperson: Nuria Herranz.

Conclusions:

• Objective to ascertain the theoretical bases for positioning and handling.
• Needs Exploring how to improve positioning devices (rolls, coverings, etc.).
• Seamless incorporation of the occupational therapist into the neonatology units (on a weekly basis, for example).
• Creation of standards or guidelines for the correct skin to skin to guarantee its appropriate implementation.
• Production of a video on positioning / handling so complete standards can be reached.
• Individualization of the positioning according to the gestation age of the baby
• Parental review of these standards.
• Review of the devices in daily use (compressors, splints, etc.).
• Obtainment of an evaluative strategy on positioning. Raising awareness so regular checks are made of the positioning of the baby.
• Creation of a commitment within the people in the group and its extension to others.