Wednesday, 19 November 2014

1 in 10 babies need (EXTRA) SPECIAL CARE - A feature

1 in 10 babies need special care


This week, World Prematurity day has recognised the babies born too soon. Someone I know recently gave birth to twin girls - born 10 weeks early. The following texts reveal something about life for this new mum, who like millions of others, has been totally thrown in at the deep end. Then the following feature, hopes to reveal something about life as it is on a neonatal ward.


Sept 17th
Hello sweetie. Thought I would let you know I gave birth to Adeline and Poppy on the 1st sept - 10 weeks early. Both beautiful but very small and struggling in the Special Care Baby Unit at the moment. We hope to have them home in November when I can come and show them off! 
Nov 17th
It's very off and on. Severe reflux is leading to choking and apneas. In and out of hospital and having to keep each upright for one hour after feeds. Adeline needing stimulation to breath with each feed. Developing well despite all of it though. Both over 5lbs now. This feels like the toughest point yet... I'm looking forward to it getting better.
One in ten babies born in the UK will need extra special care.

Some of those babies are admitted to a NICU (Neonatal Intensive Care Unit), some to a HDU (High Dependency Unit) and others to a SCBU (Special Care Baby Unit).

Morag Campbell a Neonatologist at Guys and St Thomas’s hospital in South East London explains the difference between the level of care the three units offer.

‘A NICU treats very sick babies needing lots of attention. The HDU treats sick babies needing extra care and support, and the SCBU treats sick babies requiring additional help.’

Why are babies admitted to neonatal care?
‘There are many reasons why babies are admitted to neonatal care but the most common reason is premature birth,’ says Morag Campbell.

‘Full term babies may have been diagnosed before birth with either a kidney or heart condition. And post birth babies may have developed an infection or breathing or blood sugar problems.

‘The baby may have jaundice, in which the skin and whites of the eyes turn yellow as a result of the liver being underdeveloped.’

Entering a neonatal care unit?
Matron Jennifer Deeney from the Royal London Hospital in East London gives this advice to those entering neonatal care.

‘First of all, if you know during your pregnancy that your baby will need to go to a neonatal care unit, it is worth visiting beforehand. The environment itself is very overwhelming, and not what parents expect, so a pre-baby visit should help make it more familiar and less frightening.

‘When you enter a unit, prevent infection by using the hand-washing facilities available; before and after touching baby and as you leave the unit as well; this is key to keeping infection at bay.

‘If you are at all unwell, simply do not visit the unit for the protection of all babies.

‘Visiting policies vary from hospital to hospital, but a general rule of thumb is that parents can visit any time day or night. Siblings can visit too but they may be restricted at times. On our unit, in winter we restrict children under the age of 16 because it’s a notorious time for coughs and colds in children. Other family and friends have more set visiting times. There can only be two people at a cot at any time, and even that can be restricted. We simply cannot risk infection; babies get sick very quickly.’

Touching your baby in the neonatal care unit
Matron Jennifer Deeney explains, ‘Parents need to be aware that if their baby is in the NICU and is extremely ill or premature, it may be that they can only touch baby (and then in a particular way) as opposed to taking baby out of the incubator for a cuddle.

‘That said, parents are often surprised at how much they can touch their little one, for example, even if baby is ventilated, they may still be able to have a cuddle. And that is important. Research shows us that kangaroo care, (skin to skin contact) promotes wellbeing; heart rates stabilise and babies need less oxygen.’

Who are the staff on the neonatal unit?
The Senior Nurse and Sisters are in charge of the nursing staff which includes nurses of all grades, some of whom are in training. The medical staff consists of Consultants, Registrars and Senior House Officers. If a baby requires surgery, a Paediatric Consultant Surgeon will also be involved in the baby's care.

Other staff visiting may include Physiotherapists, Radiographers, Pharmacists, Dieticians and Social Workers. Social workers help parents in practical ways and can advise about benefits and maternity rights. And many units will have input from chaplaincy.

What questions should I ask the neonatal staff?
How long will my baby be in the unit?
What, specifically, is the problem?
What will be involved in my baby's treatment?
What medicines will my baby have to take?
What can I do to help my baby?
When will I be able to breast or bottlefeed my baby?
Will I be able to hold or touch my baby?
How often and for how long can I stay in the unit?
What sort of care will my baby need when we get home?

What are parents encouraged to do?
Senior Nurse Siew Kaoy from West Middlesex University Hospital in West London explains what parents are encouraged to do if their little one is admitted to a unit.

‘First of all as a parent you are encouraged to be there as often as possible. You are encouraged to ask questions and raise concerns.

‘Mothers are encouraged to try and give their newborns breast milk and for the first 48 hours are shown how to hand express. They are asked to express eight times daily and also at night. Units have facilities for expressing and storing.

‘Parents are encouraged to bond with baby: by cuddling but also holding hands, stroking baby’s head and talking to baby. If it is possible, skin to skin contact with baby is encouraged, for Dad too.

‘For very sick babies, the unit practises neuro-development care where mothers are encouraged to bring in a small item of clothing to be left in the incubator so that baby can detect her smell.

‘Lastly, parents are encouraged to be involved in nappy changing and positioning their baby in the incubator. And in time, when baby can maintain it’s temperature, then to bath baby.’

Bringing baby home
Most units like to send their babies home as early as possible for according to Neonatologist Morag Campbell, ‘Ultimately, babies will do better at home.’

Senior Nurse Siew Kaoy says, ‘Mums are encouraged to gain confidence by doing as much for their baby as possible before being discharged. Rooming in at least a night, or more if breast feeding.’

However, the day when you can bring your baby home is when it is gaining weight and maintaining a normal body temperature of 37degress.

Further support
BLISS, the special care baby charity, provides vital support and care to premature and sick babies and their families across the UK.

The BLISS Parent Support Helpline is 0500 618 140 or you can visit www.bliss.org.uk

This feature first appeared in Baby London Magazine

My daughter Esme received Special Care.