Patient Information Service

A guide to the neonatal unit

Parent handbook

Women and children’s business unit

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Aims of this booklet

• To provide a useful, practical guide for parents whose baby requires admission to our neonatal unit

• To increase parental confidence when using services with which they are likely to feel unfamiliar

• To provide access to practical information

• To supply contacts who give further help, if required

• To explore common feelings of families at this time

• To help relieve some anxieties.

If you are worried or would just like a chat, please feel free to speak to any member of staff, day or night.

Direct telephone line to the neonatal unit 01702 385186.

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Welcome to Southend University Hospital NHS Foundation Trust neonatal unit

The Special Care Baby Unit (SCBU) or the Neonatal Intensive Care Unit (NICU) is a special unit for newborn babies who need continuous observation and care, and require closer monitoring than can be provided on the post-natal ward.

About the unit

Babies who have problems during or immediately after birth will be stabilised in the delivery suite or in the operating theatre and once stabilised will be transferred to the neonatal unit.

Our unit is divided into three areas according to the level of care required:

Intensive Care (NICU)

This is where very sick and premature babies are nursed. We use a lot of equipment which is vital for the monitoring and continuing support of your baby. The staff on the unit are trained to give this specialised care.

It is natural for you, the family, to find this frightening and overwhelming, but the staff looking after your baby will explain about the equipment and answer any questions you may have. Do not be afraid to ask the same questions over again, as the staff understand that parents may feel shocked and scared and therefore need to have information repeated several times.

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High Dependency Unit (HDU)

Babies admitted to this area need reduced support, but still require close observation and specialised care.

Special Care (SC) or nursery

Whilst your baby is in this area, preparations can be made for taking your baby home. In this room we continue to wean babies off monitoring equipment and establish whatever feeding method you have chosen. This can take time and patience is needed, as it is sometimes quite difficult to establish feeding.

Facilities

Parents’ lounge

The parents’ lounge allows you to have a cup of tea in peace and a chat or to watch television.

Parents’ rooms

We have two rooms available for parents. These are used for mothers who need to establish breastfeeding; parents who want to spend time with their baby prior to discharge home or for parents who have a critically unstable baby and do not want to leave the unit.

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The milk kitchen

This is where all the milk for your baby is stored. Mothers can be provided with an expressing kit whilst the baby is on the unit. The equipment needed for expressing milk can be sterilised and stored here.

Quiet room

This room is available for mothers who wish to breastfeed or express milk in private. It can also be used for counselling.

Religion

We respect all cultures and religious beliefs and where possible endeavour to meet any special requirements. Please do not hesitate to ask staff if you require a visit from a representative of your particular faith. The hospital has a chaplaincy and a prayer room which can be used when needed.

Staff training and education

Occasionally we have medical/nursing students participating in the management of babies. Your permission will be sought prior to any intervention. You do have the right to refuse.

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Staff you will meet

Neonatal nurses

These are qualified nurses who have also undertaken specialised training of sick newborn babies.

Qualified nurses

These are fully trained nurses who wish to specialise in neonates.

Nursery nurses

The nursery nurses are particularly skilled in parent craft and giving support to mothers.

Consultant neonatologist/paediatrician

Doctors specialising in the care of babies and children.

Staff uniforms

• Grey with red belt – matron

• Navy – lead nurse, sister/charge nurse

• Navy with white polka dots – clinical nurse specialist

• Light blue – neonatal nurse, qualified nurse

• Light green stripes – nursery nurse

• Blue blouse – ward clerk

• Lilac stripes – housekeeper

• Grey – student nurse

• Burgundy – domestic.

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Other staff you will meet

Health visitor

Your health visitor may visit you on the ward and then at home. The hospital liaison health visitor will update your own health visitor on your baby’s progress.

Social worker

The social worker is available to offer support regarding child care and can advise you on benefits and support services.

Hospital chaplain

The hospital chaplain can be of great comfort whether you are religious or not and can provide support.

Paediatric Community Nurse (PCN)

These are a group of nurses who will visit you if your baby still needs occasional monitoring/care at home.

Some of the other healthcare team members who may deal with various aspects of your baby’s care include the:

• Audiologist (hearing specialist)

• Radiologist (X-ray specialist)

• Pharmacist (medicines)

• Ophthalmologist (eye specialist)

• Physiotherapist

• Dietician

• Infant feeding specialist.

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A Bliss representative will be visiting the unit on a weekly basis. Bliss offers a wide range of Family Support services that provide confidential advice, information and support to the families of premature and sick babies. These services are free of charge and are available to help and support the whole family.

You and your baby

What baby will look like? Babies who are born prematurely may not look as you might have expected. Most premature babies look small and thin, which can make their skin look wrinkled. However, they are perfectly formed with eyelashes and fingernails and they can be very active. You will soon realise that they have individual characteristics of their own.

How you may feel

If your baby has to be admitted to our unit, you will no doubt be feeling very alienated from the happy image you had expected. You may feel: – frightened, guilty, shocked, numb, angry, confused, scared, and worried about the future. These feelings are very common and perfectly normal.

The midwives will do their best to help you, but being on a ward with healthy, crying babies and happy parents can be very hard to cope with when your baby is being cared for in another ward.

The experience of having a sick baby is unique to you. No doubt you will experience a wide range of emotions from high hopes to the deepest despair.

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You may have lots of questions you want to ask, but feel apprehensive about the answers.

You may be worried that something you did during pregnancy and labour may have affected your baby, or that something in the care you received has led to these problems.

These are all normal emotions and part of the grieving for the healthy, term baby you had expected. It is part of the process of coming to terms with the news of your baby’s condition. It takes quite a while to become attuned to the needs of your baby and to organise your life according to the baby’s needs.

It is important that you voice your fears and feelings and don’t bottle things up. Often parts of conversations are overheard and you may have picked up something that is not part of your baby’s care and you may be unnecessarily worried.

All staff have experience in dealing with worried parents, and are more than willing to listen to you. Do not hesitate to ask or phone the unit, there is always someone here to talk to you.

Please recognise that every baby is different with individual problems and needs.

The staff realise that fathers have fears too. It is normal to be frightened and worried about the future. We aim to support the whole family and do not want fathers to feel left out. Participating in all aspects of care, even the dreaded nappy change, will help you to get to know your baby.

It is equally important to acknowledge that you will be feeling tired and irritable. Try to make time for you and your partner to enjoy a meal, a film or an evening at home.

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I came into this world too soon,

from the comfort of my mothers womb.

With haste they brought me to Special Care,

to be tended by the Doctors and Nurses there.

There did not seem much hope or plan,

for such a tiny little man.

They knew for life I had to fight,

so watched upon me day and night.

Then to me they gave their share,

of such tender loving care.

Now their reward before much longer,

is to send me home, bigger and stronger.

With love from baby Shane. 28 week gestation.

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What can I do for my baby?

You may be feeling very apprehensive and frightened about touching and handling your baby. Staff will help you until you feel confident. We are very aware that this is your baby and we are here to support you as a family.

If you want to cuddle your baby at any time, do ask. If your baby is too unwell the staff will say so, but even babies on a ventilator can have cuddles. Cuddling helps to develop the emotional bond between baby and parents.

If you are unable to cuddle your baby at first, you can still provide loving contact by talking, singing, stroking and caressing. This is how you and your baby will get to know each other.

You will be encouraged to help with changing, feeding and bathing. You will feel uncertain at first, but don’t worry; a nurse will always be there to support you.

Some parents find it easier than others to look after their baby while on the unit. It is alright to feel awkward and clumsy. The important thing is that your baby is getting to know you.

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‘Skin to skin’ (also known as kangaroo care)

‘Skin to skin’ means placing a baby wearing only a nappy, in an upright position on a parent’s bare chest – tummy to tummy. The baby’s head should be turned so that its ear is below the parent’s heart.

Advantages of skin to skin:

• Facilitates parent: infant bonding

• Decrease in episodes of apnoea, bradycardia and stabilises the heart rate

• Reduction in oxygen requirements

• Promotes spontaneous respiration

• Maintains body temperature more efficiently

• Improves weight gain and reduces hospital stay

• Improves sleep (relieves colicky pain and crying)

• Optimises breastfeeding – increases milk production in mothers

• Reduces stress and anxiety.

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Containment holding (still holding)

This is a way of providing stability and predictability to babies and enables parents to gain confidence in the early days when the baby is medically unstable.

It is a slow process of resting hands on the baby with the effect of heaviness in touch. This helps to relax and soothe a baby who is very fretful and recovering.

The inherent touching instinct of parents is light finger tip stroking but this is not generally well tolerated by fragile infants.

What do I need to bring in for my baby?

If your baby is in the unit it would be very helpful if you could bring in some of the items listed:

• nappies

• cotton wool

• cotton buds

• nappy sacks

If you wish, you can also bring in some of your baby’s own clothes to dress him/her in.

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Feeding your baby

At first your baby may be fed intravenously with a special solution and then fed via a naso-gastric tube (Ng tube.) Pre-term babies do not develop their sucking reflex until 34-36 weeks and are unable to coordinate sucking, swallowing and breathing. When the baby is ready to be fed, the staff will discuss the options with you.

Teaching a baby to bottle or breastfeed isn’t always easy, so we gradually introduce or offer feeds as the baby demands. Every baby is an individual and their feeding regime is tailored to suit their needs. They may have Ng feeds and bottle/breastfeeds at intervals from one hour to four hours.

Parents can be offered to room in with their baby before taking them home, so that they may become adjusted to each others routine.

Breastfeeding

Although your baby may be sick or premature, it is still possible for your baby to have breast milk. The unit staff will show you how to express your milk and store it until your baby can be fed. The milk can be stored in a fridge or a freezer and used when required.

A teaspoon of milk can be a few hours feed for a very tiny baby and the small amounts of colostrum you express at first are very nourishing and will help protect your baby against infection. Information about expressing and storing your milk is available in our parent leaflets and also from staff.

When you go home it is possible to hire an electric breast pump through a local agent. The contact number is in the parents’

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lounge. Breastfeeding mothers are encouraged to visit and be with their babies more frequently, which will help with feeding and also milk production. Mothers may also be offered to room in to establish breastfeeding.

Advantages of breastfeeding

• Improves mother: baby bonding

• Babies tolerate (digest and absorb) breast milk better than formula

• It boosts baby’s immunity with the help of the immunoglobulin which is present in breast milk

• Available at the right temperature

• Less costly

• Prevents obesity and diabetes in babies as they grow older

• Helps in the involution (contraction) of the mothers uterus

• Helps to prevent breast cancer in the mother

• Protects from gut infections.

Bottle feeding

As soon as your baby starts to show signs of sucking, we will slowly introduce bottle feeds. If you let us know when you are visiting, we can coordinate the bottle feeds to fit in with your visiting times.

Parents are advised to bring their own bottles so that their baby gets used to their own bottles before they go home.

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General information

As the baby’s parent you are always welcome, day or night. Siblings are allowed to visit, but no other children because of the risk of infection.

For security purposes all visitors, including grandparents, must be accompanied by either you or your partner. We also ask that you restrict visitors to two around the cot/incubator at any time. (This should include at least one parent.) Any siblings visiting the babies are the responsibility of the parents.

Visiting times for parents is 24 hourly. Visiting times for family and friends is between 7.00am and 9.00pm.

All parents can request a parking permit, although concessions are offered depending on the duration of stay in the unit. Please see a member of staff for details.

Quiet hours

There are two ‘Quiet hours’ on the neonatal unit.

Times are subject to change, please speak to the nurse in charge for further information.

During this time no non-essential procedures will be carried out on your baby by medical/nursing staff.

We also encourage parents not to handle their baby (unless feeding) for this short time. This is to allow your baby to have undisturbed rest to encourage his/her growth and development.

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Common conditions of newborn babies

Respiratory Distress Syndrome (RDS) This may occur in premature infants and is due to the lack of surfactant which helps the air sacs in the lungs to remain open.

Chronic lung disease This is a condition which usually occurs in babies who are ventilated for a long time and require long term oxygen therapy.

Transient Tachypnoea of the Newborn (TTN) For some newborns, the breaths during the first few hours of life are more rapid and laboured than normal. This is due to a lung condition known as TTN where the lung fluid has not been completely removed out of the lungs after the baby takes its first breath. This usually resolves after a few days.

Jaundice Jaundice normally develops in all newborn babies, due to the high level of bilirubin in the blood, which gives the infants skin and eyes a yellowish tinge. Depending on the level of bilirubin, treatment may or may not be needed. If the bilirubin level (SBR) rises above the acceptable level, treatment is required. This is called phototherapy.

Patent Ductous Arteriosus (PDA) Patent Ductous Arteriosus is normally present in the unborn baby which helps in the circulation. PDA may be seen in newborns, but does not usually require any treatment. Some babies (usually preterm babies) may need to be treated for PDA with medications such as Indomethacin or Ibuprofen.

Hypoglycaemia Hypoglycaemia is a condition where the blood sugar level can drop down below the acceptable level.

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Equipment used

Incubator An incubator is a specialised piece of equipment supplying the baby with a stable, warm environment, so that the baby uses minimum energy for maintaining body temperature and most of the energy is used for the growth of the baby.

Monitor This is a machine which monitors the heart rate, respiratory (breathing) rate and the amount (saturation) of oxygen running through the body.

Ventilator This is a machine which helps the baby with his/her breathing.

Continuous Positive Airway Pressure (CPAP) This is used for babies who can breathe by themselves but require a little assistance. The CPAP machine delivers the pressures that the lungs require to help them inflate via a mask or two soft prongs which fit into or on the nose.

Phototherapy This is the treatment given for jaundice in newborns. Here the baby will be exposed to phototherapy light. The light rays help to break down the bilirubin in the blood to a water soluble form and will be excreted through the urine and faeces.

Apnoea monitor This is a small square shaped pad that will be kept under the mattress or may be attached to the baby by a sticky pad, which senses the breathing of the baby. It gives an alarm if the baby stops breathing or when baby is taken off the mattress.

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Infusion pumps These are used to give fluids, blood, blood products or medication to the baby at a set rate.

Commonly used terms

Meconium The first soiled nappy by a newborn is called meconium. It is green thick and sticky and has no odour.

EBM This is the abbreviation used for expressed breast milk. Fresh EBM can be stored in the fridge for 48 hours and in the freezer for three months. Once defrosted it should be used within 24 hours. Fresh EBM can be kept at room temperature for four hours. Warmed up EBM should be used immediately.

Aspirate This is a small amount of fluid from the stomach which is examined to check the position of a feeding tube.

Bradycardia Bradycardia is the slowing of the heart rate (less than 100 beats/minute). This is commonly seen in preterm babies. This usually corrects itself as the baby gets older.

Tachycardia If the heart beat of the newborn is more than 180 beats per minute it is called as tachycardia.

Tachypnoea A respiratory rate above 80 per minute is termed tachypnea.

Apnoea A term used when a baby stops breathing for more than twenty seconds. (Often seen in pre-term babies.)

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Nil By Mouth (NBM) If the baby cannot be fed, either by breast, bottle or tube it is known as ‘nil by mouth’.

Saturations (Sats) This is the saturation or concentration of oxygen running through the body.

Haemoglobin This is a protein which is present in the red blood cells. It picks up oxygen in the lungs and delivers it to the tissues.

Routine tests

Blood gas This test is performed to evaluate the amount of oxygen and carbon dioxide in the blood. This gives an indication of how the lungs are functioning.

Serum bilirubin This is the test done to measure the amount of bilirubin present in the blood to diagnose jaundice. Blood is usually collected from a heel prick.

Blood Glucose Monitoring (BM) This measures the amount of glucose (sugar) in the blood. This is done by taking a drop of blood by a heel prick.

X-ray Babies may need X-rays to be taken to check for any problems in the chest or in the abdomen. When an X-ray is taken, babies are exposed to a minimum amount of radiation. No baby will be unnecessarily exposed to X-rays.

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Head scan A head scan is an ultrasound examination of the brain. This is carried out routinely on babies born less than 32 weeks. It will be performed in older babies (above 32 weeks) if there is a specific reason. This does not cause any harm to the babies.

Eye test Eye examinations are routinely needed for babies born at less than 32 weeks.

Audiology screening This is carried out on all babies to rule out any hearing problems.

Blood spot test (previously known as the Guthrie test) This is performed on all babies to rule out congenital hypothyroidism, sickle cell disease, cystic fibrosis and phenylketoneuria.

Common used lines

Nasogastric Tube (NGT) A Nasogastric tube is a small tube which is passed through the nose into the stomach for the purpose of feeding some babies and also to aspirate the stomach content.

Intravenous cannula/fluid (IVI) Fluids or medication are given to the baby, through a catheter inserted into the vein.

Umbilical Artery Catheter (UAC) A UAC is a small flexible tube that is put into the artery of the umbilical cord stump that sticks out of the baby’s belly button. It is used to take blood samples, (to avoid frequent heel pricking) and to check blood pressure.

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Umbilical Vein Catheter (UVC) This is the Insertion of a small tube into the umbilical vein for fluid and medication administration.

Peripherally Inserted Central Catheter (PICC) PICC also known as a ‘Longline’ is a fine long flexible tube inserted through a vein into a bigger vein and is used to give your baby medicines and feeding solutions.

When will my baby be discharged?

Every baby is individual and the day of discharge depends upon the gestation, weight and clinical condition of the baby. Babies may be discharged home even if they are being tube fed (not having all bottles) with the PCN team.

Discharge

Preparation for discharge starts right from the time the baby is admitted to the unit. There is a predicted date of discharge for pre-term babies at 35 weeks and a second predicted date if baby needs further care on the neonatal unit.

Criteria for discharge

All babies should be maintaining feeds either by breast or bottle, and should be gaining weight – (refer to the Going Home Board in the nursery).

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Rooming in

Parents are given the opportunity to room in with their baby in the parents’ room for a night or two. During this time all the care of the baby will be carried out by the parents themselves. Babies will be weighed and if they are putting on enough weight, and feeding well, they will be discharged home.

Follow up

If a follow up appointment is needed for your baby, a letter will be given to you when the baby is discharged or will be posted to your address.

TTA (take home medicines)

Babies who are taking prescribed medications will be given them to take home. If further medications are needed then these should be obtained from your GP, after they have seen the baby.

Information to GP and health visitor

On discharge a letter giving information about your baby’s care while he/she was on the neonatal unit will be sent to your GP.

A purple form which will be given to you (or will be kept in the back of your red book) should be handed over to your health visitor when she makes the first visit. We will inform your health visitor when your baby goes home. All babies must be registered with the GP before discharge from the unit.

PARENTS PLEASE REMEMBER TO BRING YOUR BABY’S CAR SEAT AND WINTER CLOTHES (IF NEEDED) TO TAKE YOUR BABY HOME IN.

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Practical tips

• Write down any questions as you think of them, to help you remember

• Talk to the nurses/doctors about your fears and worries

• Keep a daily record in a diary or notebook about your baby and your feelings. Get a first year book

• Take lots of photographs

• Get into a routine as soon as possible

• Accept help when offered

• Take time out to recharge your batteries

• Plan the visits of family and friends

• Get sleep and rest and do not forget to eat properly

• Wear cool clothing. The unit is very warm to suit the babies.

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Weight conversion chart

(100 grams = 3.5 ounces) (454 grams = 16 ounces = 1lb)

grams pounds & ounces grams pounds & ounces

500 1 02 1.90 4 03550 1 03 1.95 4 05600 1 05 2.00 4 06650 1 07 2.05 4 08700 1 09 2.10 4 10750 1 10 2.15 4 12800 1 12 2.20 4 13850 1 14 2.25 4 15900 1 16 2.30 5 01950 2 01 2.35 5 031.00 2 03 2.40 5 041.05 2 05 2.45 5 061.10 2 07 2.50 5 081.15 2 08 2.55 5 101.20 2 10 2.60 5 121.25 2 12 2.65 5 131.30 2 14 2.70 5 151.35 2 16 2.75 6 011.40 3 01 2.80 6 031.45 3 03 2.85 6 041.50 3 05 2.90 6 061.55 3 07 2.95 6 081.60 3 08 3.00 6 101.65 3 10 3.05 6 111.70 3 12 3.10 6 131.75 3 14 3.15 6 151.80 3 15 3.20 7 011.85 4 01 3.25 7 02

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grams pounds & ounces grams pounds & ounces

3.30 7 04 4.70 10 053.35 7 06 4.75 10 073.40 7 08 4.80 10 093.45 7 09 4.85 10 113.50 7 11 4.90 10 123.55 7 13 4.95 10 143.60 7 15 5.00 11 003.65 8 00 5.05 11 023.70 8 02 5.10 11 043.75 8 04 5.15 11 053.80 8 06 5.20 11 073.85 8 08 5.25 11 093.90 8 09 5.30 11 113.95 8 11 5.35 11 124.00 8 13 5.40 11 144.05 8 15 5.45 11 164.10 9 00 5.50 12 024.15 9 02 5.55 12 034.20 9 04 5.60 12 054.25 9 06 5.65 12 074.30 9 07 5.70 12 094.35 9 09 5.75 12 104.40 9 11 5.80 12 124.45 9 13 5.85 12 144.50 9 14 5.90 12 164.55 10 00 5.95 13 014.60 10 02 6.00 13 034.65 10 04 6.05 13 05

Weight conversion chart

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Patient Information Service

www.southend.nhs.uk

For a translated, large print or audio tape versionof this document please contact:

Patient Advice & Liaison Service (PALS)

Southend University Hospital NHS Foundation TrustPrittlewell ChaseWestcliff-on-SeaEssex, SS0 0RY

Telephone: 01702 385333Fax: 01702 508530Email: pals@southend.nhs.uk

Written by the neonatal unit staffReviewed and revised March 2016Leaflet due for revision March 2018

Form No. SOU329 Version 3

If this leaflet does not answer all of your questions, or if you have any other concerns please contact the neonatal unit on: 01702 385186.

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