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Neonatal Leaflets

Each of the Neonatal Unit leaflets are detailed below, select the heading of the one you would like to view and the content will expand with an option for you to download the PDF version.

Leaflets can be made available in difference formats on request, to view in a different language select the language change in the bottom left of the screen.

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If you would like to make any suggestions or comments about the content of this leaflet, then please contact the Patient Experience Team on 0151 702 4353 or by email at Pals@lwh.nhs.uk.

  • Welcome to Transitional Care

    The leaflet is detailed below, or you can download the 'Welcome to Transitional Care' leaflet in PDF.

    Introduction

    Transitional Care (TC) means ‘In between care’ bridging the gap between the Neonatal Unit and the routine care that all babies receive on the maternity ward.

    Transitional Care is an area for mothers who are well following delivery to care for their low birth weight baby with additional support and encouragement from the TC team. The team is able to provide care which exceeds normal routine care.

    Admission

    Your baby may be transferred into TC after spending some time on the Neonatal unit or maybe admitted with you from delivery suite or the maternity ward to establish feeds, monitor temperature and/ or gain weight. Your baby will stay with you and be cared for by you with support from the TC team and a midwife will provide your maternity care.

    Babies on TC will often stay in hospital longer than normal as they would otherwise be nursed on the Neonatal unit. Most babies on TC will remain an inpatient between 5-10 days however due to individual circumstances this stay maybe longer.

    Staffing

    The Transitional Care team is led by a Team Leader, Registered Neonatal Nurses, and Senior Clinical Support Workers. They will support you as you care for your baby in preparation for home. An Advanced Neonatal Nurse Practitioner provides medical cover for Transitional care. Babies are reviewed daily and examined once a week but can be reviewed at any time if needed.

    Things You Will Need For Your Baby In TC:

    • Nappies
    • Cotton wool
    • Your baby’s own clothes if you wish

    We do have a stock of premature baby clothes which are washed on the premises which you can use if you prefer.

    If at any time the TC staff looking after your baby is out of the room and you require TC assistance, please use the phone on the desk and call Nursery 6 extension 4500 on the neonatal unit and ask for the TC staff to return

    Infection Control

    Hands must be washed on arrival in the room and gel before and after touching baby. We do not use powder or sterile water as babies are getting closer to home.

    We advise that you do not change your baby on the bed and request that all visitors 2 per bed (unless exceptional circumstances) use the chairs provided and not sit on the beds. Brothers and sisters may visit during visiting hours.

    Getting Ready For Home

    Before going home your baby will need to be:

    • Feeding well
    • Gaining weight
    • Staying warm in the cot

    Baby will have a hearing test usually on the day of discharge; this is part of the national screening program.

    You will also need to register your baby’s birth and register baby with your GP. Please inform nursing staff if you have changed your address and/or GP’s details.

    The TC team will advise, support and discuss the following topics;

    • Breast feeding
    • Bottle feeding (making feeds, sterilization)
    • Safety at home
    • Giving any necessary medication
    • Basic resuscitation
    • Safe sleeping

    Community Care

    Your baby may be followed up at home by our Neonatal Community Team who will monitor your baby’s weight, feeds and progress. Alternatively, care maybe provided by a community midwife. You will be told which team will visit you prior to discharge.

    If you live out of the area then care will be transferred to your local hospital where community staff or your Health Visitor will monitor your baby’s well-being.

    If a six week follow up appointment is required after your baby is discharged from hospital it will either be given to you at the time or sent out by post.

    At follow up clinic you will be seen either by a Consultant or Advanced Practitioner who will review your baby’s progress and answer any questions you may have.

     

  • The New-born Examination

    The leaflet is detailed below, or you can download 'The New-born Examination' leaflet in PDF. 

    If no problem is found, can I be sure that my baby is all right?

    Unfortunately, the new-born examination only allows us to pick up problems that are obvious at birth. Just because a baby seems normal when they are first seen, it does not mean that there can’t be anything wrong with the baby. There are some conditions that may show themselves only after a baby goes home. For example, some babies may not have had a heart murmur at birth, but develop a heart problem which only shows itself at a later date.

    There are also some babies that do not appear to have a problem with their hips at birth, but develop problems over the next few months. Health visitors and/or GPs regularly see babies in the first year of life and this will help to pick up any problems that develop.

    Will my baby need any medicines whilst in hospital?

    Vitamin K
    Doctors recommend that all new-born babies should be given vitamin K at birth to prevent a rare (but serious) condition, which causes severe bleeding. This is called “Haemorrhagic Disease of the New-born”. Vitamin K is usually given by mouth shortly after birth. Babies who are breastfed will need to have a further two doses at 7 days and 28 days of age.

    Immunisation
    Parents of babies who are at risk of developing Tuberculosis or Hepatitis B are offered immunisation for their baby at birth. For Hepatitis B, two more injections will be needed to complete a full course, at about 1 month and again at 12 months of age.

    When will a midwife or doctor see my baby again?

    All babies are seen after they go home firstly by a community midwife and then by a health visitor. They will check that your baby is feeding well and putting on weight. At about one week of age, a heel prick blood test is done on all new-born babies.
    This test will help to make sure that the baby has not got one of two important conditions, Hypothyroidism and Phenylketonuria.

    Your baby will also be examined at by your GP at 6-8 weeks of age.

    Reducing the risk of cot death

    Sadly, some babies die each year for no apparent reason from what is called ‘cot death’ or ‘sudden infant death syndrome’ (SIDS). Although we do not know exactly why this is, we do know that placing a baby to sleep on his or her back reduces the risk of it happening. Exposing your baby to cigarette smoke and/or overheating a baby increases the chances of cot death.

    The safest place for your baby to sleep is in a cot in your room for the first six months. There is increased risk of SIDS if baby shares parent’s bed especially if they smoke, have taken medication, consumed alcohol or are very tired, particularly if the baby is less than 11 weeks old.

    Your doctor or midwife will be able to give you more advice about reducing the risk of cot death in your baby.

    After I take my baby home, how will I know if my baby is ill?

    It is important for parents to be aware of the sort of things that may be a sign of illness in their baby. This is a list of things to look for.

    A baby that:

    • is not feeding well or keeps vomiting
    • is not putting on weight
    • is unusually hot or cold
    • is jaundiced (yellow) after 2 weeks of age
    • is unusually quiet or miserable
    • is ‘just not right’

    Contact your doctor at once if:

    • your baby turns blue or very pale
    • your baby has difficulty with breathing or has pauses between breaths of over 20 seconds
    • your baby is difficult to wake or is unusually sleepy

    Sometimes it is difficult to tell if a baby is ill. If you are worried about your baby, contact your health visitor or visit your GP.

    For further information contact your midwife or Paediatrician.

    Introduction

    A doctor and/or a midwife examine all new-born babies after birth.

    This examination allows us to look at your baby, and is also a good time to ask any questions you might have about your baby.

    This leaflet tells you about what we will be looking for when your baby is examined. It also provides some useful information about what happens in the first few days and weeks after birth.

    When will my baby be examined?

    New-born babies are usually examined sometime during the first day after birth.

    Who will examine my baby?

    A midwife will check your baby over soon after he or she is born. A children’s doctor (called a Paediatrician) or a midwife will do the new-born examination of your baby when you are both on the postnatal ward or MLU (Midwife Led Unit).

    What will the doctor or midwife look for?

    They will look at your entire baby, but in particular will examine his or her skin, head, heart, hips, eyes and genitalia.

    Anyone in your family has had problems with dislocated hips as a child.

    What do I need to tell the person examining my baby?

    The person examining your baby will need to know if:

    • There were any problems found during your antenatal ultrasound scans
    • Your baby had been lying in a breech position
    • Anybody from your family has had treatment for TB. Anybody in your family or household has come to UK from an area of the world where TB is common

    They will be happy to check your baby over and make sure that he or she is all right.

    What if I am worried about my baby?

    Tell the midwife or doctor who comes to examine your baby. Explain the concerns that you have.
    Exactly what is done will depend on what has been found.

    What happens if a problem is found?

    About 1 baby in 10 will have a problem found during the new-born examination. Usually this is a minor problem, which may not need treatment. Some babies will either need further tests or need to be seen again in outpatient clinic after they have been discharged from hospital.

    Common problems

    Bruises and birthmarks
    It is very common for new-born babies to have some bruising (and swelling) on the head after birth. This is just the result of the pushing and squeezing that is part of being born and will soon disappear. Babies often have other marks or spots on their skin. Most of these will also go away eventually, although this may take weeks or months. They are sometimes known as ‘stork marks’ or ‘strawberry marks’.

    Jaundice
    Jaundice is the name for the yellow colour of skin and eyes that develops in many new-born babies. It is usually completely normal and disappears within a few days. The midwife or doctor may decide to check the level of jaundice in your baby by doing a heel prick blood test. If a baby has severe jaundice, he or she may need light treatment called phototherapy.

    Heart murmurs
    A murmur is the noise made by blood as it passes through the chambers, valves and blood vessels of the heart. Murmurs may be normal (‘innocent’ murmurs) and are often heard in new-born babies. In others it may be the first sign that there is a problem with the heart. If your baby has a heart murmur, the doctor may decide to recheck the heart before your baby goes home. He or she may also need to arrange for some tests to be done to make sure that the heart is normal.

    Hips
    Checking your baby’s hips is an important part of the new-born examination. Some babies are born with hips that are not properly formed in their joints. This condition is more common in babies who have been lying in a breech position or where someone else in the family has had a similar problem. If the doctor finds any problem with your baby’s hips, or if there is any reason why your baby may be at risk of hip problems, he or she will arrange for a scan of the hips. An appointment will also be made for them to be seen by a specialist to check the hips again after discharge from the hospital.

    Genitalia
    During the new-born examination the doctor or midwife will check your baby’s genitalia. This is especially important in boys to make sure the testicles are in the right place. In some boys the testicles are not in the scrotum (undescended testes). These boys will need to be seen by a specialist who will decide if a small operation is needed to bring the testicles down.

    Cataracts
    A cataract is rare but important problem in new-born babies. It happens when the lens of the eye is cloudy and may affect a baby’s vision. A doctor will examine your baby’s eyes with a special torch to check for cataracts.

  • Retinopathy of Prematurity

    The leaflet is detailed below, or you can download the 'Retinopathy of Prematurity' leaflet in PDF. 

    What is Retinopathy of Prematurity?

    Retinopathy of Prematurity (ROP) is caused by an abnormal growth of blood vessels in the retina at the back of a premature baby’s eye. About 30-60 % of babies less than 1500 grams develop retinopathy, of which only 5% are severe. The severe form is rare, but if it is not treated, it may progress to blindness.

    How does it happen?

    The retina lines the inner wall of the eye.

    Babies who are born prematurely have blood vessel in the retina that is not fully formed. These blood vessels can grow abnormally into the vitreous (jelly) of the eye instead of along the wall of the retina and can cause problems with bleeding and/or scarring of the retina leading to retinal detachment and blindness.

    Why do some babies get Retinopathy of Prematurity?

    We don’t fully understand why some babies develop ROP and others escape without any problems. The main risk factors are prematurity and the need for extra oxygen. It is the smallest and sickest babies who may have needed extra oxygen for a long time that are most likely to develop ROP.

    How is it detected?

    All babies at 32 weeks or less than 1.5 kg are checked by a specialist eye doctor (an Ophthalmologist) between 4-6 weeks of age. This involves putting some eye drops into a baby’s eyes which makes it easier for the doctor to look into the back of the eye. The doctor uses a special torch called an ‘indirect ophthalmoscope’ to look at the baby’s eyes. Premature babies are usually checked every 2 weeks until the doctor is happy that they have not developed any eye problems.

    What does it mean if my baby has Retinopathy of Prematurity?

    Many premature babies develop a mild form of ROP (called stage 1 or stage 2) which will need to be checked regularly. Treatment is not needed for these stages and it resolves without any problems.

    Some babies have a more severe form of the condition called stage 3 ROP. These babies will need more frequent eye checks and sometimes need treatment to stop the growth of abnormal blood vessels.

    Ophthalmologist will decide whether a baby has severe ROP and which babies require treatment.

    It is very important for babies to attend regular checkups by the Ophthalmologist. ROP can get worse quite quickly in some babies and if an appointment is missed, the chance to prevent blindness may be lost.

    How is Retinopathy of Prematurity treated?

    Severe ROP is treated using an injection of a drug or a ‘laser’, which is a special type of light. Using this laser treatment on the eye reduces the chances of any more abnormal blood vessels developing in the rest of the eye. 

    What will happen if a baby with severe Retinopathy of Prematurity is not treated?

    Severe ROP can lead to blindness if it is not recognised and treated properly. This is why it is so important for all premature babies born before 32 weeks to be checked regularly.

    Are there any long term effects of Retinopathy of Prematurity?

    Premature babies (especially those with ROP) need to wear glasses in early childhood more often than babies who were not born prematurely. Some babies with ROP can develop a squint.

    Babies with severe forms of ROP may suffer some loss of vision, even with treatment.

    What is likely to happen if your baby needs treatment?

    Your baby will be sedated and the breathing supported with a ventilator during the procedure. The procedure itself usually takes one to two hours. Following the procedure your baby is likely to remain on the ventilator for 12 to 18 hours.

    How long is your baby likely to stay in hospital if admitted for the treatment?

    If your baby was admitted to LWH from another hospital for laser treatment, he or she is likely to stay for a maximum of 3 days in LWH.

    Where can I find out more about Retinopathy of Prematurity?

    The nurses and doctors looking after your baby will be able to tell you more about Retinopathy of Prematurity. There is also information on the Internet at this site:

    http://www.ropard.org/

  • Septic Screen

    The leaflet is detailed below, or you can download the 'Septic Screen' leaflet in PDF. 

    Septic Screen (looking for possible infection)

    A Doctor or Nurse Practitioner has assessed your baby and decided that a Septic Screen is required to identify any possible infection which may mean your baby will be prescribed antibiotics. There are many different reasons why your baby may become unwell or is unwell and these investigations will help us to exclude potential reasons. An important condition that we are trying to exclude is meningitis.

    What is involved in a Septic Screen?

    Cannula and Blood tests

    We will insert a cannula into one of your baby’s veins (usually the back of the hand) to collect some blood including a blood culture which we will send to the laboratory for a range of blood tests. This cannula will then be left in and secured in order for us to give your baby antibiotics or fluids if required. Once the cannula is no longer needed it will be removed.

    Lumbar Puncture

    A lumbar puncture is performed under strict aseptic conditions and involves putting a very small needle into the lower back to remove some fluid that surrounds the spinal cord and brain. To perform the test and obtain the fluid your baby is held in a curled position by a member of the nursing staff. This fluid is cerebral spinal fluid (CSF) and will be sent for analysis to look for signs of meningitis.

    The Results

    Some of the blood tests will be available in 3-4 hours; however the blood culture results will not be back for 36 hours. Blood culture samples show us if there are any bacteria in the blood by leaving them in conditions that allow the bacteria to grow. This process takes at least 36 hours so the results will not be available for this period of time.

    What happens next?

    During the 36 hour period whilst we are waiting for the results, your baby will be started on antibiotics which will be given through the cannula. Your baby will be monitored closely by staff on the neonatal unit or the post-natal ward. If your baby is with you on the post-natal ward you will need to return to the neonatal unit for the antibiotics to be given. The staff will tell you when the next dose of antibiotics is due each time.

    Your baby will be reviewed at 24 hours and again at 36 hours by the neonatal team and the results checked. If the results are negative, the team will stop the antibiotics, remove the cannula and you will be able to go home when you are both ready.

    However, if the results are positive, or if there is a concern about your baby, then your baby will continue to have antibiotics for at least 5 days. During this time your baby will be reviewed daily by the neonatal team and will also have some of the blood tests repeated. If your baby has to have a full course of antibiotics (5 days) then your baby will need to stay in hospital until 24 hours after the last dose of antibiotics and then will be able to go home.

  • Managing your Babies Pain

    The leaflet is detailed below, or you can download the 'Managing your Babies Pain' leaflet in PDF. 

    While your baby is with us on the Neonatal Unit it is sometimes necessary for the staff to carry out procedures and tests; some of these may cause pain or discomfort to your baby. Even just being separated from you in the incubator can cause your baby to feel some stress.

    This leaflet contains information on:

    • How you can work with staff to recognise when your baby is in pain or feeling uncomfortable
    • Some of the things the nurses and doctors might do to reduce their pain
    • Some ways that you can comfort your baby.

    In newborn babies it is hard to tell the difference between whether they are feeling stressed or in pain so we have to make sure we try and deal with both.

    How do we tell if babies are in pain or feeling stressed?

    Babies show some of the signs of pain and distress that older people do, however, because they can’t talk to us babies need to be looked at more closely.

    At least once every shift the nurses will do a score, called N-PASS (Neonatal Pain, Agitation and Sedation Score), which measures the level of discomfort your baby is in.

    They are looking at a number of different things:

    FACE – does your baby look unhappy, grimacing, wrinkled nose and forehead or are they relaxed with smooth features

    BEHAVIOUR – is your baby agitated and wriggly with sudden jerky movements or are they occasionally agitated but mostly still

    TONE – is your baby tensing its arms and legs, are the fingers clenched or relaxed

    CONSOLABILITY – is your baby irritable, often crying and very hard to settle or are they easily consoled with containment or dummy.

    What can I do to make my baby more comfortable?

    Strategies for pain relief

    1. Containment

    Premature babies enjoy a ‘still containment hold’ more than stroking or patting. To do this, let your hands just rest on your baby in the incubator placing one hand on your baby’s head and the other one onto your baby’s middle or bottom. This “still containment hold” helps to make your baby feel secure and relaxed.

    Your baby can lie on a thin sheet or muslin square which should be wrapped around them during handling and procedures to help them feel protected.

    1. Environment

    The unit is very bright and noisy and we try and reduce the light and noise your baby is exposed to. In intensive care they should always have an incubator cover on and sometimes the staff’s turns down the lights for a few hours in the day as well as at night. If your baby is by the window the blinds should be down if the sun is shining in. We encourage the staff to talk quietly and we ask visitors to do the same (we only allow two visitors to each baby at any time and ask you not to swap them over in one day).

    Although a lot of noise and loud sounds can be disturbing for your baby, the sound of your voice is familiar and comforting so talking or perhaps quietly reading while doing skin to skin or containment can be very restful for your baby.

    1. Non-nutritive sucking

    When your baby is admitted to the Neonatal Unit the staff will ask your permission to use a dummy and/or give your baby sucrose for uncomfortable procedures. Sucking on a dummy with or without sucrose during procedures is an effective way of helping reduce pain and stress in your baby.

    1. Skin to skin

    If your baby is well enough then laying them directly onto your chest is a good way to calm and relax him/her. It also encourages bonding between you and your baby. Once your baby is stable the nurses should encourage you to have skin to skin at least once a day.

    1. Positioning

    Sometimes just simply repositioning your baby using positioning aids such as a rolled blanket will help them to settle; moving your baby’s hands to their mouth is important to allow them to comfort themselves.

    1. Sucrose

    Sucrose is used to relieve pain in babies undergoing painful procedures. Research has shown that sucrose is a very effective analgesia in babies over

    31 week’s gestation, or when they reach 32 weeks corrected age if born before this time.

    Sucrose is a sugar and water solution. Although it is a foodstuff, not a medicine, it is prescribed so we can record the doses your baby has received. Sucrose works by stimulating babies own natural chemicals to ease pain.

    Examples of the type of procedures it could be used for are:

    • Having a drip inserted
    • Lumbar punctures
    • Having blood taken by needle or heel prick.

    How will it be used?

    Your baby will be given a small amount of Sucrose 24% given on a pacifier (dummy) or directly into the mouth just prior to or during a painful procedure.

    Strategies for pain relief

    Are there any concerns about safety? Sucrose used like this will not affect baby’s teeth. There are some thoughts that sucrose may affect baby’s taste for sweet foods in the future however there is little research evidence for its use under 32 weeks gestation.

    Staff will ask your permission:

    • To use a pacifier (dummy) for painful procedures
    • Or/and to give your baby sucrose.

    What will happen then?

    Whatever your decision it will be documented and will guide us for future procedures throughout your baby’s stay in hospital. If you have any questions please ask the nurse caring for your baby, an Advanced Neonatal Nurse Practitioner or ask to speak to a Doctor.

    Medicines we sometimes use for pain relief

    1. Morphine

    If your baby is ventilated they may receive morphine through an intravenous infusion. We can increase or decrease the dose depending on how much discomfort you and the nurses feel your baby is in; not all babies on the ventilator need morphine and we try to stop it as soon as we feel your baby no longer needs it.

    1. Paracetamol

    If your baby needs pain relieving medicine but is not ventilated we will give them Paracetamol through their drip; they also will have Paracetamol if they have had surgery. We sometimes give oral Paracetamol as a liquid medicine if they have had a difficult forceps delivery.

    Other General Points

    Sometimes the staff may feel that your baby has had a lot of distress and disturbance. They may suggest that it would be best to allow your baby to rest and sleep for a while so that he can regain his strength. If this does happen please understand that the staff believes that this personal quiet time is best for your baby.

    For some procedures there should be two people present, one to perform the procedure and the other one to offer comfort and console your baby. If you feel you would like to cuddle or hold your baby during the procedure please ask the nurse who is looking after your baby.

    Please remember, if you find that your baby likes to be comforted in a particular way, please let the staff know. You know your baby better than us.

  • A Guide for Parents to Support Their Premature Babies Development

    The leaflet is detailed below, or you can download the 'A Guide for Parents to Support Their Premature Babies Development' leaflet in PDF. 

    23-25 weeks

    • My skin is fragile and red looking, moisture is easily lost.
    • I can’t be dressed yet, so I lie in a warm humidified incubator, but I can hear and feel your touch.

    BRAIN – My brain cells are present but the nerve connections between them are not made yet and the surface of my brain is smooth.

    HEARING – I can react to different sounds but am disturbed by loud noises. I love to hear your familiar voices.

    VISION – My eyes are fully formed but my eyelids are fused, though light still shines through them. Covering the incubator will protect me from noise and light, but remember to keep a small flap open so you can still see me.

    HANDLING AND TOUCH – My muscles are weak, though I could move freely in the womb now I am fighting against gravity, my movements are jerky and I quickly become tired. I can feel you touching me, around my mouth is particularly sensitive. I am most comfortable if I am curled up and snuggled in a nest. Too much handling can cause me stress but by holding my hand or foot very still, I am comforted.

    FEEDING – I can suck and swallow but as I am weak I have to have my feeds through tubes.

    26-27 weeks

    I have downy hair called lanugo on my body. My skin is fragile, I look very pink and see through, and moisture is easily lost from my body so I still need to be kept warm in humid air in the incubator.

    BRAIN – My brain is smooth and the blood vessels in my brain are delicate. Brain cells are in place ready to make connections.

    HEARING – My hearing is developing now but I need protection from noise and need to have periods of quiet time. I react to different sounds and I am disturbed by loud noises.

    VISION – My eyes are still hazy but you will notice eye movements in response to sounds.

    HANDLING AND TOUCH – I prefer to be curled on my side as I was in the womb. If you touch my palm I’ll try and grasp your finger. My sleep patterns are irregular, I like containment holding rather than stroking as it makes me feel secure. If I am stable I could have skin to skin with you (also known as Kangaroo care) which we would both enjoy.

    SMELL AND TASTE – My taste buds are developing and I can experience some flavours.

    FEEDING – I haven’t mastered the art of sucking, swallowing and breathing yet so I still have to be fed by tubes. 

    28-33 weeks

    I will be covered in a white creamy substance (called vernix) if I am born now. I am a little fatter and you can notice my finger nails. I may not need humidity now so I can be dressed, though I may be in an incubator.

    BRAIN – My brain and nervous system is rapidly developing and folds are forming. When I am in light sleep I have rapid eye movements, which will help me to develop the cortex (surface) of my brain. By 32 weeks I can respond to pain, light and sound and I am also showing clear signs of deep sleep, which will help me to grow.

    HEARING – My hearing is well developed and I like listening to your voices. I am still sensitive to sound. I like to have quiet time during the day to rest and grow.

    VISION – I like to peep at you but my eyes are sensitive to light, I am able to open and close my eyes but I can’t focus yet. At 32 weeks I will make efforts to fix on your face briefly.

    HANDLING AND TOUCH – I need plenty of sleep but I also like to be held with my legs supported, otherwise my legs will relax to either side like a ‘frog’. My feet are very sensitive to touch. I like to be placed on my side so I can touch my face, which comforts me and feel my hands, which will help with my development. I also like to be cuddled and have skin to skin with my Mum or Dad (also known as Kangaroo care).

    SMELL AND TASTE – My taste buds are still developing but if I have something sour like vitamins, I will pucker my lips. Mum, if you hold a soft cloth next to your skin and then place it close to me, when you are not there, I will be able to smell you and feel comforted.

    FEEDING AND BEHAVIOUR – Around this time I develop reflexive responses such as rooting and grasping and by 32 weeks I can start to co-ordinate my sucking, breathing and swallowing. My suck is too weak yet to take a full feed, but I can nuzzle at the breast and non-nutritive sucking on a dummy will help to develop my sucking ability.

    34-36 weeks

    I am getting much fatter now. I may have a lot or a little hair on my head. I have defined fingernails, eyelashes and eyebrows and my toenails have now reached the toe tips. I may still be in an incubator but I may be in a cot and getting ready for home.

    BRAIN – My brain is rapidly growing. I can now start to block out noise and light, this is called habituation and shows I am maturing. My sleep and alertness is now well defined.

    HEARING – I can recognise some familiar sounds and if I get upset I maybe calmed down by soft speech. If there is a loud noise I will jump, I still enjoy quiet times.

    VISION – I can see the shape of your faces now though it may be an effort to focus my gaze. By 36 weeks my pupils can react to light so I like to experience day and night. Black and white visual patterns are too stimulating for me yet, so should be avoided.

    HANDLING AND TOUCH – My muscle tone has improved and I can turn my head from side to side with smoother more controlled movements. I would love to spend time interacting with you when I am awake. Beware if I am over stimulated, I can get hyper alert or can appear glazed and become sleepy. If I am given a few moments break, l will recover and may be able to continue. I would enjoy a bath occasionally now.

    SMELL AND TASTE – I may wake up and root for my feeds now and enjoy some breast or bottle feeds. Avoid exposing me to strong perfumes or cigarette smoke as this is unpleasant and over stimulating for me.

    FEEDING AND BEHAVIOUR – My suck, swallow and breathing co-ordination is continuing to mature.

    37+ weeks

    I will be going home soon. I am fully grown now, I am fatter and the hair on my body has gone. My skin is pale pink and soft. I can tell you when I am hungry or tired.

    BRAIN – My brain now has a folded surface and will continue to grow and develop, especially for first 1 or 2 years.

    HEARING – I can recognise your lovely voices and all the tunes you played before I was born. I can still be easily overwhelmed by loud noises.

    VISION – My vision is not fully developed, but will develop rapidly in the first year. I can’t focus very well yet but I like light and dark contrast and curvy lines and faces, I like bright colours like red too. I do like to experience light as well as dark now.

    HANDLING AND TOUCH – I need to be close to you now as my nervous system continues to develop. I like the familiar secure feeling of being cuddled and I like to be stroked. I have regular sleep patterns and will wake up for feeds.

    SMELL AND TASTE – I can tell the difference between sweet and sour, preferring sweet. My head will turn towards the smell of milk.

    FEEDING AND BEHAVIOUR – I have strong rooting and sucking patterns and breathing, sucking and swallowing patterns are now smoother.

    PLAY – I will be able to play with you soon. By 42 weeks I will start to imitate facial expressions and respond to smiles and by 47 weeks I will respond to an object such as a rattle or other suitable toy.

  • Heart Murmurs

    The leaflet is detailed below, or you can download the 'Heart Murmurs' leaflet in PDF. 

    What is a Heart Murmur?

    All babies have their heart examined as part of the new-born examination. This is done so that babies who have a problem can be diagnosed and treated as early as possible. Your baby has been found to have a heart murmur. Most babies with a murmur do not have a heart problem, but we need to look into things a bit more. The purpose of this leaflet is to give you some information about heart murmurs in new-born babies.

    It is a noise made by blood as it passes through the heart. It can be heard using a stethoscope. In some babies it may not be there all the time – it may come and go. Some murmurs are normal (called ‘innocent murmurs’) and are often heard in new-born babies. Others may be the first sign that there is a problem with the heart.

    What Does It Mean For My Baby?

    Once a murmur has been heard it is important to look for other signs to check that the heart is otherwise normal. If the Paediatrician or midwife examining your baby is happy that he or she has no other problems, they will arrange to listen to the heart again before you take your baby home. Often the murmur will have gone by then and nothing more will need to be done.

    If your baby is unwell, or if the murmur is still there when you are ready to take your baby home, he/she may need to have further tests which may include a heart scan. Depending on the results of these tests your baby will be discharged home without any further follow-up, given an appointment to be seen in our clinic in about 6 weeks or referred to a heart specialist. If a heart problem is diagnosed we will give you more information at that time about what it means for your baby.

    What Are The Things I Should Look Out For When I Take My Baby Home?

    • You should seek advice from a Midwife, Health Visitor or GP if your baby:
    • Looks blue or pale
    • Has difficulty with his or her breathing
    • Is finding it difficult to feed, or is breathless or sweaty during feeds.
  • Basic Infant Resuscitation

    The leaflet is detailed below, or you can download the 'Basic Infant Resuscitation' leaflet in PDF. 

    Basic Infant Resuscitation Guide

    ABC of Resuscitation

    ABC of Resuscitation - Breathing

    ABC of Resuscitation - Circulation

  • Vitamin K

    The leaflet is detailed below, or you can download the 'Vitamin K' leaflet in PDF. 

    Why Do Babies Need Vitamin K?

    After your baby is born, a midwife will ask for your permission to give vitamin K to your baby.

    Vitamin K is essential to prevent a serious bleeding condition called ‘Vitamin K Deficient Bleeding’ (VKDB). This condition causes excessive bleeding. About half of the babies affected bleed into their brain and these babies either die or survive with disability.

    In babies who don’t get vitamin K at birth, about 4 to 10 babies in 100,000 get VKDB. Babies at increased risk include babies with liver disease and babies of mothers receiving drugs such as Warfarin, Rifampicin or anticonvulsants, but most babies affected don’t have any of these risk factors. If we didn’t give vitamin K, we would expect to see one baby from Liverpool Women’s Hospital every year or two with VKDB.

    When Is Vitamin K Given?

    In this hospital we recommend that all babies are given vitamin K shortly after birth.

    How Is Vitamin K Given?

    Vitamin K can either be given by mouth or as an injection. If your baby is sick, premature or not feeding properly, we will give the vitamin K as an injection. If you have liver disease, or if you are on certain medications (such as Warfarin, Rifampicin or any anticonvulsant), we will also give it as an injection. Otherwise, you can choose which type of treatment your baby has.

    Which Is The Best Way To Give Vitamin K?

    The injection will be uncomfortable for your baby, but only as much as any other injection, like the childhood vaccinations we recommend. The injection provides complete protection against VKDB.

    If vitamin K is given by mouth, several doses are needed. The first dose is given on the day of birth and a second dose is given when the baby is 7 days old. For breast fed babies, a further dose is given when the baby is 28 days old. Bottle-fed babies don’t need this third dose, because vitamin K is already added in small amounts to formula milks. Although giving vitamin K by mouth gives a lot of protection against VKDB, it does not give complete protection and there is still a risk of dangerous bleeding in some babies.

    What Do We Recommend?

    We recommend that all babies born at Liverpool Women’s NHS Foundation Trust should receive vitamin K on the first day of life as an injection. We believe this is the safest and most effective way to protect your baby. We think that the extra protection that an injection gives is worth the discomfort of an injection.

    If you have any questions about vitamin K, please ask to speak to the Midwife or Paediatrician looking after you and your baby or telephone the Neonatal Unit on 0151 702 4093.

  • Welcome to Low Dependency Nursery 6

    The leaflet is detailed below, or you can download the 'Welcome to Low Dependency Nursery 6' leaflet in PDF. 

    Staffing

    The Low Dependency room or Nursery 6 is an area for parents and their babies to prepare for home.

    Our aim as a multidisciplinary team is to provide and assist our Parents/ Carers with parenting skills, support, advice and help to transition from the Neonatal Unit to home.

    The Low Dependency Team or Yellow team is led by a Team Leader, Neonatal Nurses and trained Clinical Support Workers. They will support you as you care for your baby in preparation for home.

    The HDU Registrar and Advanced Neonatal Nurse Practitioners provide Medical cover for the low dependency nursery. Babies are examined once a week, but can be reviewed at any time if needed to be.

    On Tuesday morning there is a consultant ward round around 09.30-10.00. Your baby’s individual needs and possible timescale for discharge home will be discussed at this round or at the multidisciplinary discharge meeting on Wednesdays at 11.30.

    Infection Control

    The hand hygiene guidelines are the same as for the rest of the unit i.e. Use hand gel going in and out of the room. Wash hands on arrival in the room and gel before and after touching baby (leaflet available outside nursery).

    We do not use powder on the umbilicus or sterile water as babies are getting ready to go home and these are not now necessary.

    Can you ensure that after your baby’s care is completed, the only thing left on the cot shelf is the hand gel.

    We also ask that you only bring water in a closed container in the room to drink, no food please.

    Things You Will Need For Your Baby on Nursery 6

    • Nappies
    • Cotton wool
    • Your own baby’s clothes if you wish (2-3 changes per 24 hours).
    • A drawstring washable bag for baby’s own dirty clothes, (as you will need to take your own baby’s clothes home to wash). We do have a stock of premature baby clothes, which are washed on the premises which you can use if you prefer.

    Bathing

    From about 32 weeks if baby is stable you will be able to bath your baby. It is recommended to bath no more than two or three times a week, and to use plain water if less than a month old. For an older baby you can provide your own shampoo and baby bath.

    Developmental Care

    Developmental Care items such as gel pillows and rolled blankets are gradually withdrawn from use before your baby goes home and the “Back to Sleep” guidance is followed.

    The cot will be put in the horizontal position. 

    Toys should be minimal and washed by parents weekly. We have a small range of toys to loan for older babies; please ask the nurse looking after your baby.

    Kangaroo care/skin to skin is also encouraged in Nursery 6.

    Monitoring

    Initially your baby may have a monitor for heart rate and blood oxygen levels, so nursing staff can observe without disturbing them. This will be changed to an apnoea mattress once baby reaches 34 weeks and all observations are satisfactory. The apnoea mattress will be discontinued prior to discharge.

    Getting Ready For Home

    Before going home your baby will need to be:

    • Feeding well
    • Gaining weight and weigh over 2kg
    • Staying warm in a cot

    If your baby is bottle feeding you may bring in your own sterilised bottles and teats, in preparation for home. We ask you to sterilise them at home as we are unable to provide this on the unit.

    Baby will have a hearing test usually on the day of discharge; this is part of the national screening programme.

    You will also need to register your baby’s birth and register baby with your GP. Please inform nursing staff if you have changed your address and/or GP’s details.

    Parent Education

    Parent/Carer education teaching sessions are provided. We will arrange a date and time with you to attend these sessions. These are taught by our Clinical Support Workers or nursing staff who will discuss the following topics:

    • Breast feeding
    • Bottle feeding (making feeds, sterilisation)
    • Safety at home
    • Giving any necessary medication
    • Basic resuscitation
    • Safe sleeping

    When the decision has been made for baby to go home, you are welcome to stay for a night prior to discharge (subject to availability of rooms). Please ask the staff member looking after your baby.

    Community Care

    Your baby may be followed up at home by our Neonatal Community Team who will monitor your baby’s weight, feeds and progress. Alternatively, care maybe provided by a Community Midwife. You will be told which team will visit you prior to discharge.

    If you live out of the area then care will be transferred to your local hospital where community staff or your Health Visitor will monitor your baby’s well-being.

    If a six week follow up appointment is required after your baby is discharged from hospital it will be sent out by post. At follow up clinic you will be seen either by a Consultant or Advanced Neonatal Nurse Practitioner who will review your baby’s progress and answer any questions you may have.

    If you have any questions or concerns, please discuss them with the nursing staff looking after your baby.

    We welcome your feedback on the care you have received throughout your baby’s stay on the unit, and ask if you could complete one of the discharge questionnaires. These can be obtained from any member of staff in Nursery 6. This information helps us continually improve the service we offer.

    Low Dependency Team Leader:

    0151 708 9988 ext. 4193

  • Patient Ductus Arteriosus

    The leaflet is detailed below, or you can download the 'Patient Ductus Arteriosus' leaflet in PDF. 

    What Is Patent Ductus Arteriosus (PDA)?

    The ductus arteriosus is a short blood vessel that connects the two main arteries in the body – the aorta, which carries blood from the heart to the body, and the pulmonary artery, which carries blood to the lungs. Normally the ductus is open when the baby is in the womb and it usually closes in the first few days after birth. PDA (or ‘duct’) refers to the situation in which the ductus remains open (patent) after birth.

    Which Babies Are Prone To Develop PDA?

    The ductus can remain patent in any baby, but this is much more common in premature babies than in full term babies.

    Why Is PDA Important?

    If the ductus stays open, it can put extra strain on the heart and the lungs. The heart has to work harder to cope, not only with its normal job of pumping blood around the body, but also with pumping blood through the ductus into the lungs. The lungs and their blood supply, in turn, can become overloaded because of the extra blood being pumped through them. Finally, the extra blood pumped to the lungs results in low blood flow to the organs in the lower part of the body, particularly the bowel and kidneys, which may interfere with their function.

    How Do I Know If My Baby Has A PDA?

    If your baby was born prematurely, the doctors will check him or her regularly for signs of a PDA. The most common sign is a heart murmur (an extra heart sound). Your baby may also be struggling to wean off the ventilator, CPAP or high flow nasal cannula oxygen support.

    What Will Happen If My Baby Has A PDA?

    These signs are not specific, and there may be a PDA without the signs being present. Therefore, if the doctors are concerned that your baby has a ‘significant’ PDA they will arrange for a scan of his or her heart (an echocardiogram or ECHO). This will show whether the duct is open and whether or not it is significant.

    There is a lot of uncertainty about how to manage PDA. This includes uncertainty in deciding whether the ductus is actually causing your baby any problems and uncertainty in how best to treat a significant ductus. The doctors will consider the balance between possible risks of treatment and possible benefits from closing the ductus, and will discuss the pros and cons of treatment options with you.

    How Is PDA Treated?

    Reducing the baby’s fluids may reduce the strain on the heart and lungs. Using diuretics, (medicines that increase the amount of fluid that the baby passes), may also be used for this purpose.

    If these measures do not help, the next line of treatment is to use a medicine called Ibuprofen to try to close the ductus. It is given for several days and acts by blocking some of the chemicals that keep the ductus open. After treatment, the baby may have a repeat ECHO, and if the ductus is still open and significant, repeating the treatment may be considered.

    Finally, if medical treatment is not effective and the doctors still think the ductus is causing significant problems, surgical closure of the ductus will be considered. The decision to offer surgery will be made in consultation with the heart specialists at Alder Hey Children’s Hospital which is where the surgery would be done.

    Are There Any Risks Associated With Treatment?

    Restricting the baby’s fluids is not ideal in the long term as this may also restrict the amount of calories and other nutrition necessary for growth. Diuretics can be associated with problems in fluid and salt levels in the body. Ibuprofen can reduce the blood supply to organs such as the kidneys and bowel, affecting the way they function. These effects are usually mild and settle down after treatment is finished but sometimes they may cause the treatment to be stopped. Surgical closure of the ductus is a major procedure for a small sick baby, and while it is almost always effective in closing the duct, it may also be associated with significant risks.

    Most babies who need treatment for a PDA do not experience these adverse effects. However, because they can be significant, and because of the uncertainties regarding treatment, the decision and recommendation to treat is not made lightly. A doctor will discuss the issues fully with you before treatment.

    How Can I Find Out More About PDA?

    Your baby’s nurses and doctors can give you more information. If the decision is made to recommend surgical closure of the ductus, the heart specialists will discuss this further with you.

  • Jaundice in New-born Babies

    The leaflet is detailed below, or you can download the 'Jaundice in New-born Babies' leaflet in PDF. 

    Jaundice is common in new-born babies and is when their skin and whites of their eyes (sclera) look yellow. For most babies this is usually harmless and resolves with no treatment but some babies may develop high levels of jaundice which can be harmful if not treated.

    What Causes Jaundice?

    Jaundice can occur in some babies as a normal thing (we call this physiological jaundice) or it can happen because of an underlying problem (we call this pathological jaundice).

    Physiological Jaundice

    All people, including babies, are continually breaking down old blood cells. When these are broken down a yellow substance called bilirubin is made. The build-up of bilirubin in the skin is called jaundice.

    The liver normally helps removal bilirubin from the body so jaundice does not occur in most people. In new-born babies the liver is not quite as good at removing the bilirubin as the liver in later life so jaundice is common in the first few days of life. In the vast majority of babies, this jaundice is only mild, is completely harmless and goes away without any treatment.

    Pathological Jaundice

    If jaundice increases very quickly or reaches high levels, this can be harmful to the baby. It can affect the baby’s brain. This ‘pathological’ jaundice always has some underlying cause that is making the jaundice worse than ‘physiological’ jaundice. Common causes are abnormally rapid breakdown of red blood cells, liver disorders or infections.

    What Should You Do If Your Baby Is Jaundiced?

    If you think your baby’s skin or the whites of their eyes appear yellow it is important to inform your midwife or doctor the same day so they can be assessed.

    You should seek urgent attention if your baby:

    • Is jaundiced on the first day of life or is excessively sleepy or not interested in feeding
    • Has pale chalky stools or dark urine.

    Any of these situations may mean that your baby may need some tests and possible treatment.

    How Do We Test For Jaundice?

    Your midwife/doctor may check the levels of bilirubin in your baby’s blood using a blood sample taken from baby’s heel or by using a handheld device which is placed on the baby’s head or chest.

    The result of your baby’s bilirubin level will be plotted on a graph. There are a number of graphs. The graph that is used for your baby depends on how many weeks pregnant you were when your baby was born. This gives three options: 

    • Your baby has low levels of jaundice and doesn’t need any more tests.
    • Your baby has a raised level of jaundice that doesn’t need treatment but needs repeat measurement within 6 to 12 hours to ensure it hasn’t risen.
    • Your baby needs to start treatment.

    How Do We Treat Jaundice?

    Treatment for the majority of babies is phototherapy.

    Phototherapy involves placing the baby under a special light (not sunlight) which helps the body to breakdown the bilirubin. Some babies need just a single light but if the levels of jaundice are higher sometimes a second or third light is used as well.

    For the light to work the baby needs to be naked with just a nappy. The baby will be nursed in an incubator to keep them warm whilst they are being treated and their temperature will be measured regularly to make sure they are not becoming too hot or cold.

    The baby will need to wear an eye shield to protect their eyes from the bright light. The baby’s eyes will need to be checked regularly to look for any signs of eye irritation or infection.

    Some babies may show signs of dehydration when they are jaundiced and receiving phototherapy. We will check for signs of this by monitoring the baby’s weight and checking how many wet nappies they are making. If there are signs of dehydration, extra feeds may be necessary to replace the fluid. Babies who are becoming dehydrated do not need water or other fluid’s, they should just be given extra milk feeds.

    Phototherapy is, however, a safe, well tolerated treatment.

    The baby does not have to be under the light continuously. We encourage you to take baby out for breaks for cuddles, to be changed and to feed. If you wish to breastfeed this is also encouraged and does not have to stop because of the phototherapy.

    If the jaundice levels are very high a baby can require treatment using a blood transfusion called an exchange transfusion. This is very rare. If it becomes necessary for your baby a doctor will discuss this fully with you.

    Monitoring Jaundice

    Your baby will need to have repeat blood tests after 6 hours to monitor the levels of bilirubin and to assess if the phototherapy is working.

    This is plotted on the chart and once the levels are low enough to stop treatment the lights can be stopped.

    Occasionally the levels of jaundice can rise again when the lights are stopped so all babies have a repeat blood test 12 – 24 hours after treatment is stopped to ensure that there has been no ‘rebound jaundice’.

    Prolonged Jaundice

    Most babies, jaundice gets better within a few days. If your baby is still jaundiced after two weeks (or three weeks if your baby was premature) then make sure you tell your midwife or doctor as they may need further tests. 

    Further Questions and Information

    If you have any questions or concerns please speak to any of the midwives, nurses or doctors who will help to answer your queries at the time. If you want more information, please see:

  • Your Babies Hips

    The leaflet is detailed below, or you can download the 'Your Babies Hips' leaflet in PDF. 

    Why Is My Baby Being Referred?

    All babies have their hips examined as part of the new-born examination. This is done so that babies who have a suspected problem with their hips can be referred as early as possible to a specialist (called an Orthopaedic Surgeon).

    The purpose of this leaflet is to give you some information about why your baby has been referred to the Baby Hip Clinic at Alder Hey Hospital.

    When the Paediatrician or midwife examined your baby they found that he/she may have a problem with his/her hips which needs to be checked out by a specialist. This will be done at Baby Hip Clinic at Alder Hey Hospital.

    Some babies are born with hips that are found to be abnormal in some way during examination. This is sometimes called a ‘clicky hip’. Other babies are at risk of hip problems because they were born breech or because someone in their family has had hip problems during childhood. It is very important that we know about such babies because any problems they may have need to be properly diagnosed and treated in the first few weeks after birth. However, only a small number of babies who are referred will actually be found to have a problem.

    How Will You Arrange For My Baby To Be Seen In Baby Hip Clinic?

    We will make a referral to the Orthopaedic team at Alder Hey Hospital and you will receive a letter from them soon. You will then be asked to ring Alder Hey Hospital to make an appointment for your baby to be seen at Baby Hip Clinic. Please remember to ring as soon as possible after receiving the letter so that there is no delay in your baby getting an appointment to be seen.

    What Will Happen When My Baby Is Seen In Baby Hip Clinic?

    Your baby will be examined again by a specialist who will also arrange an ultrasound scan of your baby’s hips. The ultrasound scan is similar to the scans which are done during pregnancy – it is quick and painless and does not upset the baby. You will be told about the results of the examination and scan during your visit to Alder Hey Hospital.

    Where Can I Find More Information?

    This leaflet gives some basic information about hip problems in new-born babies. Your midwife or Paediatrician will be able to answer any general questions you may have about your baby’s hips and the reasons for referral to the baby Hip Clinic.

    If you have any questions after you and your baby have been discharged from Liverpool Women’s Hospital, please ring us on 0151 702 4093. Your Midwife or Health Visitor may also be able to give you further information after discharge.

  • Information for Parents

    The leaflet is detailed below, or you can download the 'Information for Parents' leaflet in PDF. 

    The staff on the Neonatal Unit at Liverpool Women’s NHS Foundation Trust would like to extend a warm welcome to you and your baby.

    We recognise that this is a difficult time for you and we know that however small or sick your baby is, you, the parent(s) are the most important people in your baby’s life.

    We will do everything we can to support, inform and guide you throughout your time here.

    Location of Unit

    The Neonatal Unit is situated on the first floor of the hospital opposite to Delivery Suite and next to the Maternity Base.

    The Neonatal Unit provides expert care for new-born babies who are unwell.

    It offers specialised care for:

    • Babies born prematurely
    • Babies with health problems diagnosed before birth (antenatally) or after birth (postnatally)
    • Full-term babies who have become unexpectedly unwell

    Access to the Neonatal Unit and Security

    To gain access to the unit you have to press the corresponding button for the room where your baby is being cared for, on the intercom system outside the main door to the Neonatal Unit. Staff will check your details and who you have come to see, before letting you in. If you are unsure press ‘staff base’ and when on duty the Ward Clerk will check your details and allow you access. Please be aware that they are not on duty outside normal office hours.

    For the safety and security of your baby, please do not let any other person come in the door behind you or open the door for another person.

    There is also a lower button for visitors with restricted mobility. Staff will come and manually release the doors if required so please allow a few extra minutes.

    Infection Control

    We aim to provide a safe and clean environment. The following applies to parents and visitors

    Remove all outdoor coats and handbags / bags and leave in the lockers provided before entering the nursery.

    Please do not leave any valuables unattended in these areas, as the Trust cannot be held responsible for any loss. Lockers are provided for parents at the main entrance, these require a pound coin or token to lock. Please empty the lockers and return the key after every visit so other parents can have access to the facilities.

    Remove all watches, bracelets and rings (except plain wedding rings) and roll up your sleeves.

    Before entering the nursery apply the alcohol hand gel which is located by the nursery doors.

    After entering the nursery wash and dry your hands and reapply the alcohol gel.

    Remember to always gel your hands before and after touching your baby.

    When leaving the nursery reapply the alcohol gel again using the gel located outside each nursery.

    Each time you return to the nursery you must repeat this process.

    It is the neonatal unit’s practice that only parents and grandparents should touch the baby while in intensive care to reduce the risk of transferring any infection.

    Staff and parents are regularly monitored for effective hand hygiene. Please contact a member of staff if you have any concerns.

    The Neonatal Unit is divided into four areas; a designated Neonatal Consultant oversees the care and treatment of babies in each of these areas:

    • Neonatal Intensive Care Unit (NICU)
    • High Dependency Unit (HDU)
    • Low Dependency (LD)
    • Transitional Care (TC)

    Neonatal Intensive Care Unit (NICU)

    The NICU provides support for babies who have breathing problems or requires other specialist treatment.

    There is a range of specialist equipment to help care for your baby in the NICU’s rooms and nurseries. For more information about the equipment used on a neonatal unit please see the accompanying Bliss Parent Information booklet. If you have not received this in your admission pack, please speak to a member of your neonatal care team.

    Once your baby is getting better and needs a little less nursing support, they will be transferred to either the High Dependency Unit (HDU) or Low Dependency (LD).

    The HDU provides support for babies who require less intensive care than babies in the NICU, but who are still not stable enough for the care provided in the LD. This may be because they still need some breathing support; special intravenous feeding (directly into a vein) or they are recovering from surgery.

    Ward Rounds In the Intensive and High Dependency Areas

    Each day there is a ward round led by a Consultant. You are welcome to attend but we ask that you wait outside the room until your baby’s condition is being discussed to avoid breaches of confidentiality. If you are breast feeding or having your baby out for skin to skin we can offer you earphones while the ward round is going on so that you are not disturbed.

    There is a weekly meeting for the Low Dependency area led by a Consultant to discuss plans for the discharge home.

    The nurse looking after your baby will let you know what time these rounds take place.

    For more information about the equipment used on a neonatal unit please see the accompanying Bliss Parent Information booklet

    Nursing Hand-Over Times

    Nurses’ hand-over times are 07.15 hours, 13.15 hours and 19.15 hours. At these times parents are asked not to be present or to wait outside the room to avoid breaches of confidentiality. The handover takes approximately 15 minutes. 

    Transitional Care

    Transitional care is an area for mothers who are well following delivery to care for their low birth weight baby with the additional support and encouragement from the Transitional Care Team who provide care that exceeds normal routine care. It is located in Room 6 on the Maternity Base.

    The Transitional Care Team is led by a Team Leader, Registered Neonatal Nurses/ Midwives, and Senior Clinical Support Workers. They support and educate parents in caring for their baby in preparation for home. In addition the team also supports midwifery staff in problem solving in the maternity ward to prevent unnecessary separation of mother and baby.

    An Advanced Neonatal Nurse Practitioner provides the medical cover for these babies who are reviewed daily and examined once a week but can be reviewed at any time if needed.

    Neonatal Outreach Team

    Alongside the Transitional Care Team, the Outreach Team will work closely with you to make sure that you feel confident to care for your baby when you go home.

    This is a team of Neonatal Nurses/ Midwives who provide support, advice and monitor the babies weight, feeds and progress once discharged from either Transitional Care, Neonatal Unit and Maternity if a baby is less than 2kg. The team will also carry out any necessary blood tests a baby may need, and help parent’s access specialist teams and community services if required.

    Staff

    The Neonatal Unit is staffed by a highly skilled team who are dedicated to giving your baby the best possible care.

    Doctors

    There is a team of Consultant Neonatologists. These doctors are responsible for the care of new-born babies who need extra support shortly after birth. They also supervise a team of paediatric middle-grade and junior doctors, and provide 24-hour emergency and specialist care. They will carry out most of your baby’s routine medical care. If your baby needs an opinion from another Specialist, the doctors from that team may see your baby in the Neonatal Unit, or in their clinic once your baby has gone home.

    If you have any questions about your baby’s progress, you can ask the doctors on a daily basis. You can also request a meeting with a Neonatal Consultant who will be happy to discuss your baby’s care with you.

    Advanced Neonatal Nurse Practitioners

    A team of Advanced Neonatal Nurse Practitioners (ANNPs) work alongside the medical staff. They are very experienced Neonatal Nurses who have undertaken additional specialist training to enable them to examine, diagnose, request investigations and perform any of the procedures performed by medical staff.

    They are led by a Neonatal Nurse Consultant who provides support to the ANNP and junior medical team, and on occasion takes ward rounds in place of the Neonatal Consultants in the high dependency and low dependency areas.

    Nurses

    The Neonatal Unit has a Head of Neonatal Nursing and a Matron who is in charge of a large number of Nursing staff and Clinical Support Workers in the unit who specialise in looking after sick or premature babies. They will update you each time you visit on your baby’s progress. There is also a Shift Leader available 24 hours a day on the unit who has overall responsibility for the care delivered during that period.

    Radiographers

    Radiographers are health professionals who take X-rays of your baby. This is to identify and monitor diseases, bone and soft tissue abnormalities and is also necessary to check the position of your baby’s Intravenous lines and tubes.

    Ophthalmologists

    Ophthalmologists are doctors who specialise in eye care. They visit the unit once a week. All babies born under 33 week’s gestation or 1.5kg are referred to the Ophthalmologist as part of a national screening programme.

    Pharmacists

    Pharmacists visit the ward on weekdays (Mondays to Fridays) to review your baby’s medication. You can ask them for more information about your baby’s medicine should you wish.

    Liaison Health Visitor

    The Liaison Health Visitor is responsible for informing your Health Visitor about your baby’s admission, progress and discharge plans. All families with a new baby will have contact with a Health Visitor close to their home that will be there to provide support and advice on child and family health matters.

    Counselling/Support for Parents

    We understand that having a sick or premature baby can be extremely stressful for parents and so we can offer you support through our family support counsellor.

    Spiritual Team

    Our spiritual team supports people of all faiths and beliefs, as well as those who do not have a particular religious belief. A member of the hospital chaplaincy team also visits the unit several times a week, if you would like to have a Baptism or naming ceremony arranged please ask the staff who can contact them on your behalf at any time.

    Research

    There is an experienced research team who are committed to advancing medical care through improved knowledge and understanding. A member of the research team may come to discuss with you about becoming involved in a research study.

    Students

    Medical students spend some time on the neonatal unit as part of their basic training and qualified doctors have placements here as part of their ongoing professional development. Student nurses and midwives also have placements here as part of their training. They are allocated to a nurse and will care for your baby under the nurse’s supervision and with their assistance.

    Transfer of Care

    The Neonatal Unit at Liverpool Women’s NHS Foundation Trust specialises in looking after babies who require intensive care. When your baby no longer needs intensive care, we will arrange for your baby to be transferred back to your local hospital. This will happen even if you have planned to have your baby at Liverpool Women’s Hospital but have a nearer hospital, or if you have been referred here for your baby’s specialist care before birth.

    Transferring your baby back to your local hospital is beneficial for many reasons: It makes it easier for you and your family to visit your baby, it allows the doctors at your local hospital to get to know you and your baby and it allows for your baby’s follow-up clinic appointments to be organised.

    We understand that the idea of your baby being transferred to another hospital can be stressful. Please be assured that we only arrange the transfer when we are sure that it is the right time for your baby.

    Transferring babies back to their local hospital helps us to provide specialised intensive care to those babies who need it most, like your baby did when they were first born. It is possible for you to visit your local unit before the transfer. If you would like to do this, please speak to the staff caring for your baby.

    Caring For Your Baby

    Staff will involve you in the care of your baby as soon as possible. You may feel a little apprehensive about touching your baby at first, but staff will help you to gain your confidence.

    It is very important that you have contact with your baby. At first it may only be a touch, but as soon as baby’s condition allows you will be able to have a cuddle and perhaps have skin to skin contact which is sometimes called Kangaroo care. This is especially beneficial for Mum and/or Dad as well as baby.

    The staff will guide you on what is appropriate for your baby at different stages of their development.

    You May Feel A Little Apprehensive About Touching Your Baby at First, but Staff Will Help You to Gain Your Confidence Breastfeeding

    The staff actively support a mother’s choice to breastfeed her baby whenever possible. Breast milk is the best option for your baby, particularly when they are born prematurely or are unwell.

    Breast milk is much easier for babies to digest than formula milk and helps protect your baby from infections. Very small babies only need very small amounts of milk, so any milk you produce can be given to your baby.

    There is a room in the unit where mothers can express their milk in private. There are also screens in the rooms so that you can express beside your baby. Bonding squares are provided to all mothers on admission to the unit. Each mother is given two squares, one is kept with their baby and one is kept on the mother’s body. They help the mother and baby to bond by smell and help mothers who are expressing in the stimulation of oxytocin, the “let down reflex”.

    Skin to skin contact will help mothers who are expressing increase her oxytocin levels for breast milk production and is great step towards breastfeeding. Skin to skin contact enhances feelings of affection between mother and baby and promotes bonding.

    Visiting

    We operate an open visiting policy for parents and baby’s own brothers and sisters. No other children are allowed.

    The Parents’ sitting room is only for mothers and fathers, (or mothers and their support person) and the baby’s siblings. Visitors are not permitted to wait there.

    There is a play area within the sitting room with toys for brothers and sisters of babies on the unit. Because of the small space and the potential for hot drinks being accessible, children must be supervised at all times.

    There should be no more than two visitors at the cot/incubator at one time, and one of them must be a parent. Visiting hours are displayed in the unit. You are welcome to have someone with you – a maximum of two visitors per session may come to the unit and see your baby (one at a time with a parent present) in order to minimise the risk of infection to your baby. Please respect these precautions. If this causes extreme difficulties please speak to the Shift Leader.

    Visitors should not visit if they are unwell e.g. has a cold, flu, stomach upset. If you are unsure if you should visit, please phone and check with the nurse looking after your baby. They must not visit the unit wearing a uniform from another healthcare setting as this increases the infection risk to the baby.

    Information on the Unit Toilets

    Toilets including a disabled toilet are situated the main corridor of the unit Baby changing facilities can be found in the disabled toilet.

    Unit Cleaning

    Each day the domestic staffs needs to have access to the clinical area to maintain the high standards of cleanliness required for this Neonatal Intensive Care Unit. We ask that the parents discuss the times of their morning visits with the nursing staff so that the cleaning does not interfere with their plans to care for their baby.

    Parking Facilities

    Contained in the admission pack is a leaflet concerning car parking. Authorisation can be given to parents to park in designated areas without charge. Please make sure you get this form signed by the Shift Leader as this will instruct staff on the main hospital reception to issue you with a card after each visit to allow you to leave the car park without charge.

    Phoning

    Parents can telephone any time day or night and we will not give out information to anyone else.

    The hospital phone number is: 0151 708 9988 if you know the room number where your baby is being cared for, chose Option 5 and the extension of the that room (listed below) if not, then choose Option 0, then ask the switch board operator to put your call through to the neonatal reception.

    Room 1 – 1201                                       

    Room 2 – 4652

    Room 3 – 4505                                       

    Room 4 – 4506

    Room 5 – 4507                                       

    Room 6 – 4500

    Room 7 – 4501                          

    Transitional Care - 1409

    Between 08.00 – 16.00 hrs only you can ring on a direct line number to the reception desk on 0151 702 4193 but this is not staffed after this time. Please ensure we have your phone number in case we need to contact you. (NB: We may have difficulty contacting you on a mobile phone, so an alternative land line number must be given where possible).

    Other Things to Know

    The nurse allocated to help you care for your baby is responsible for all the care delivered on that shift so we ask that parents do not cancel alarms, adjust oxygen levels, Intravenous or oral feeding tubes. Un-authorised changes can cause harm to your baby sometimes with very serious consequences.

    Individuals who put baby’s health at risk by un-authorised adjustment of treatment will be excluded from the unit.

    Red Trolleys

    Please do not disturb the staff, except in an emergency, when you see them working at a red trolley as they are calculating, preparing or administrating complex medication therapies for babies and need to concentrate so they do not make a mistake.

    Nappies and Cotton Wool

    Parents must provide their own disposable nappies and cotton wool for their baby during their stay on the Neonatal Unit. Most large supermarkets and chemists stock premature nappies and you can also buy them on the internet.

    Quiet Time

    Although the nurseries can be very busy we aim to keep the Neonatal Unit environment as quiet as possible and we would ask that you and your visitors help us achieve this.

    Drinks in the Nurseries

    Hot drinks are not permitted in the nurseries. Water in a sealable bottle/ container is allowed.

    Baby Clothing

    We have a stock of baby clothes, which are washed on the premises.

    You can bring your own clothes for your baby, but they must be labelled with your baby’s name and the family must take them home to wash.

    It is recommended that the clothes are washed at no lower temperature than 60º Centigrade and that they are tumble-dried.

    Toys

    Toys are not allowed in incubators/ cots whilst the baby is in the Intensive Care area however a comfort cloth can be used. In the High Dependency/ Low Dependency areas, two small washable toys can be left in the incubator/ cot if the baby does not have any Intravenous lines in place, which should be taken home and washed weekly.

    Comfort Cloths

    If you hold a cloth close to your body, you can transfer your unique smell to your baby who will be comforted when the cloth is placed next to him/her. You also will be comforted if you take a cloth home with your baby’s smell on it and if you are breastfeeding it will help your milk to flow when you are expressing.

    These cloths must also be washed frequently at 60º Centigrade.

    Strong smells including strong perfumes will be too stimulating for your baby, so please try to avoid them.

    Use of Dummies

    The staff will ask for permission to use a dummy while the baby is not receiving any milk feeds as this helps develop the sucking process and will help the baby reach full milk feeds more quickly.

    Dummies can also be used as a method of pain relief during short procedures such as taking blood from a heel prick.

    Dummies must be washed with hot soapy water, rinsed, dried and stored in a small container between uses. Dummies provided in hospital MUST NOT be taken home and used after discharge.

    Parents Message Sheet

    This message sheet is for you to write on. You can tell us what you would like us to know about who’s who in your baby’s family, how you are intending to feed, when you will be coming to visit and to leave any messages. The sheet should be handed to the nurse caring for your baby to be displayed at your baby’s bedside. This is your property and you can keep it if you wish.

    The Little Lamb Diary

    Parents and staff have helped to develop this diary.

    It is intended as a place for you to write about treasured moments or reflections and keep a photograph of your baby. Please ask if you would like one.

    Baby Link

    This is an online diary that contains photos and short messages. Should parents wish to use this facility, they will be able to access the diary using a user name and password of their choice, the nurse caring for your baby will be able to organise this for you. Parents will then be able to review photographs and diary entries about their baby wherever they wish.

    This will be subject to availability of staff time to make entries.

    Tests

    There are a variety of routine tests that premature babies will have on the unit; further information is available, just ask a member of staff.

    Blood Spot Screening

    On admission to the unit your baby will have a sample of blood taken for blood spot screening. A further sample will be taken along with any routine blood due between day 5 and day 8 of life. This is a national test to check for blood disorders such as phenylketonuria (PKU), hypothyroidism,

    Sickle cell anaemia and cystic fibrosis as early recognition and treatment is essential for babies with these disorders.

    If your baby is born less than 32 weeks gestation they will need a repeat sample taken on day 28 of life or at discharge. If you do not wish you baby to have these tests please tell the nurse or doctor looking after your baby.

    You should have received a leaflet about the blood spot test in your antenatal information pack. If you have any further questions ask the nurse or doctor to explain it to you.

    Hearing Screening

    All infants will have their hearing checked prior to discharge as part of a national screening programme.

    You should have received a leaflet about the blood spot test in your antenatal information pack

    ‘Planning For Leaving Hospital’.

    As your baby becomes more stable and is able to control their temperature, they will move from an incubator to a cot. The machines monitoring heart rate and oxygen levels will no longer be needed and will be replaced by monitors which check your baby’s breathing. These will be removed before the baby is discharged.

    As your baby matures, or becomes well, we will want to try and encourage them to take feeds by mouth. The change from tube feeds (liquid nutrients passed down a tube from the nose into the stomach) or intravenous feeds (nutrients passed into a vein) might start slowly by introducing one feed per shift, by your chosen method (breast or bottle). Then the frequency and the amount of milk are increased.

    As your baby gradually progresses from one to three-hourly feeds, your presence becomes even more important. Your baby needs to learn the technique of feeding, by breast or bottle, and so do you. By being present at feed times you will get used to your baby’s feeding style and your confidence will grow.

    Visiting during the day also helps to develop your baby’s sense of a day/ night cycle. When you are at the unit during the day, we encourage you to care for your baby whenever possible.

    Hearing you and seeing you is good stimulation, and aids your baby’s development.

    There are fewer chances to interact with your baby at night-time. Babies are only handled for feeding, changing, or if they are unusually unsettled.

    Follow-Up Care

    Some babies who are admitted to the Neonatal Unit for a short time do not need any follow-up care after they are discharged. Others however will have a follow-up appointment with one of the Consultants at about four to six weeks after leaving the unit. This will take place at Liverpool Women’s Hospital. Babies who are born very premature, or are very unwell, will have follow-up appointments at the Liverpool Women’s Hospital and the Alder Hey Children’s Hospital. The appointments will continue for at least two years so that staff can closely monitor the development of your baby.

    Information and Support for Parents

    There are many organisations which offer information and support for parents. You should have received the Parent Information Guide produced by Bliss – if you have not, please ask us for a copy. It includes contact details and website addresses of organisations and support groups, which can help you while your baby is in the unit, and when your baby goes home.

    The unit also have a number of volunteers trained by Bliss to offer support to parents. They are called Bliss Champions or Bliss Buddies. Champions visit the unit weekly and offer face-to- face, bedside support. Buddies are matched through the Bliss helpline and offer support by telephone, text or email. Champions and Buddies are often parents that have also had a baby on a neonatal unit and may have had similar experiences to you. Please see the posters around the unit for more information. You will find that all the staff are very supportive but if you would like to talk to someone else, the following people may be able to help:

    There is a Shift Leader available 24 hours a day on the unit.

    Matron: 0151 702 4091

    If you wish to speak to a Consultant or Doctor please tell the nurse caring for your baby.

    An interpreter service is also available and the staff caring for your baby can organise this.

    Patient Advice and Liaison (PALS) Manager, extension 4353.

     

    Accommodation

    Within the unit are two parents’ bedrooms, these are for short-term use only and are in great demand. Siblings cannot stay in these facilities. If you are staying, we ask that you vacate the room for a short time at 11.00 hours each day, to have your bed put up and the room cleaned. For safety reasons please do not try to put the bed into the upright position yourself.

    The rooms are used to assist parents in preparation for home. If you wish to stay, ask your nurse who will book the room for you if it is available.

    In the event of a baby being very sick you may have to move at short notice so that other parents can be close to their baby.

    There is also some offsite accommodation available for parents who do not live in the Liverpool area. This can be arranged via the Shift Leader but please note that there is only one flat with facilities for siblings to stay.

    Parents must cater for themselves and keep the accommodation clean and tidy as they are only cleaned by the unit staff on departure in preparation for other parents to use.

    Parents who fail to keep the accommodation to an acceptable standard or whose behaviour is inappropriate whilst staying here will be asked to leave immediately. No alternative accommodation will be arranged by the Neonatal Unit.

    As the accommodation is shared with other parents, visitors are not permitted on these premises. Smoking is only permitted within designated smoking shelters on the hospital site and is not permitted at all in the offsite accommodation.

    Food For Parents

    If you are staying in one of the two onsite parent’s bedrooms, breakfast items are provided and you can order from the hospital menu for other meals. Alternatively you can bring your own food and use the parents’ kitchen which has a toaster, microwave and refrigerator. Please clean the area after use. If you are visiting during the day you can bring your lunch and store it in the fridge. Please put the date on as all food not labelled and /or more than 24 hours old will be discarded for health and safety reasons.

    There is also a hot drink machine in the parent’s sitting room. This is provided without charge for parents and maintained by the supplier however if there are any problems with the machine please inform the Ward Clerk or Shift Leader.

    If you arrive out of hours and are resident in the parent rooms and have missed a meal, snacks can be obtained for you, please ask the Shift Leader if required.

    Food is also available in the restaurant, cafe and from the shop in the foyer – please check the opening times displayed outside these venues.

    Family Information

    Information can be found on notice boards in the waiting area and on a table in the main corridor. If you cannot find anything you feel you need, please ask the nurse caring for your baby.

    Picture Board

    Parents love to look at the photos in the gallery and see how premature babies have grown. If you wish your baby to be in the gallery don’t forget to send your story/photo in to the Matron on the neonatal unit.

    Registering Your Baby’s Birth

    You can register your baby in the hospital by appointment in the Register Office on the 1st floor or at the Liverpool Register Office in the Cotton Exchange, Old Hall Street, Liverpool 3. Tel: 0151 233 3004. A baby’s birth must be registered by law within 42 days (6 weeks).

    If you are still an inpatient you can request an appointment in the hospital ex 4479.

    Fire Alarm and Generator Testing

    The fire alarm is tested once a week. If the alarm goes off please stay by your baby however if you are in the sitting room or the bedrooms please return to the room where your baby is being cared for and await further instructions from nurse in charge of the room.

    Generator testing also takes place monthly; this sometimes causes the baby’s alarms to go off but there is no danger to baby and the staff will be aware of this happening.

    Taxis are available outside main hospital entrance

    If visitors require access to baby feeding facilities these are available in the main foyer – please ask at Reception for the key.

    Travel

    • Mersey Travel Travelline telephone: 0871 200 2233
    • National Rail enquiries: 0845 748 4950
    • More Travel information can be found at the main hospital reception.
    • Hospital Telephone number: 0151 708 9988

    Address: Neonatal Intensive Care Unit, Liverpool Women’s NHS Foundation Trust, Crown Street,

    Liverpool L8 7SS. Visitors who do not have access to the unit can wait on the main hospital corridor and should not try to enter the unit for safety and security reasons.

    Visitor Waiting Areas

    To the left as you enter the unit by the rocking horse, there is an area for visitors to wait if they are asked to leave the clinical area for any reason, they should not wait in the main corridor as this is constantly in use by staff and needs to be clear in case of an emergency.

    The parent’s sitting room is NOT an area for visitors to use.

    Visiting On the Transitional Care Area

    This is restricted to two visitors per bed. Partner support 09:00 – 21:00 hrs Afternoon visiting 14.30 – 15.30 hrs Evening visiting 18.30 – 20.00 hrs

    If your baby is not having large amounts of milk to start with, it is perfectly safe for it to be frozen and stored until the time when the baby needs it. There are freezers available to store the milk. You will need to clearly label each container of expressed milk with your baby’s name, date of birth, hospital number and the date and time it was expressed.

    The nurse looking after your baby will give you advice and support on expressing milk and breastfeeding. Support is also available through the Neonatal Breast Feeding Team.

    The unit offers high quality electric breast pumps available on a loan basis, free of charge but must be returned before your baby is discharged. This service enables mothers to express their milk when they have gone home and bring it to the neonatal unit for their baby - a very practical way in which mothers can contribute to their baby’s development and growth in the crucially important early days and weeks of life.

    Two parents room are available on the Neonatal Unit where mothers can ‘room in’ with their baby to establish breastfeeding when getting ready for home.

    Donor Breast Milk Bank

    We also understand that this can be a stressful environment and establishing a good milk supply can be difficult. This is where the donor breast milk bank proves invaluable. Donor mothers (who have more milk than their babies need) can give milk to the milk bank, where it is pasteurized, stored and supplied to neonatal units.

    The medical team will discuss with you whether your baby would benefit from donor breast milk and will always ask for your consent (permission) before giving donor milk to your baby.

    The Trust’s Infant Feeding Team also has a helpline and an infant feeding clinic for support when you go home. The clinic is held on Thursday morning 09.00 –13.00 pm in the antenatal clinic. Mothers who need support can phone the Infant Feeding Helpline 0151 702 4293 for a discussion with an Infant Feeding Advisor and book an appointment if that is required. This clinic is for mother’s booked at the Liverpool Women’s Hospital and for babies up to 6 weeks of age.

    Developmental Care for Your Baby

    Developmental care promotes each baby’s comfort and sleep in a way that reduces the stresses of the Neonatal Unit environment. This includes the use of positioning and handling techniques, reducing the discomfort of the Neonatal Unit environment (noise and light levels) so ensuring that your baby is as comfortable as possible.

    We also have a room for consultations and meetings with parents.

    Infant Feeding Helpline:

    0151 702 4293

  • Caring for your Babies Cannula

    The leaflet is detailed below, or you can download the 'Caring for your Babies Cannula' leaflet in PDF.

    What is a cannula?

    A cannula is a plastic tube inserted into your baby’s limb (hand/foot/arm/leg). The cannula allows us to give medication (in this case it will be antibiotics).

    If your baby is discharged from the Neonatal Unit to a post-natal ward but still requires antibiotics, the cannula will stay in until the antibiotic course has finished.

    If the cannula accidently falls out it is important to inform a Nurse or Midwife immediately as there may be some bleeding and the cannula will need to be replaced.

    How can you help care for your baby’s cannula?

    • Leave the limb with the cannula in out of your baby’s vest or baby-grow (the Nurse/Midwife caring for your baby can show you how to do this).
    • Take extra care when holding your baby so that you don’t press on or pull at the cannula.
    • If you are letting someone else hold your baby make sure that they also take extra care when holding them so that they don’t press on or pull at the cannula.
    • If you think the dressing looks loose let a Nurse/Midwife know so it can be fixed/replaced.
    • If the cannula accidently comes out it is important to come to the Neonatal Unit 30-60 minutes earlier than the planned antibiotic dose as your baby will need a new cannula.
    • A mitten or a sock can be put over the cannula to keep it secure.

    Questions you may have:

    Can I bath my baby?

    It is important that the cannula stays dry so we advise you not to bath your baby. However staff can support you if a bath is necessary.

    Does the cannula hurt my baby?

    After the cannula has been inserted and is not in use it should not cause any pain. Sometimes babies may become agitated when medication is given through the cannula as it can feel cold, however this should quickly settle.

    Can I hold my baby as normal?

    Yes you can hold your baby but we advise you to be careful of the cannula to prevent it falling out.

  • What Happens if there is a Chance my Newborn Baby will have an Infection

    The leaflet is detailed below, or you can download the 'What Happens If There Is A Chance My Newborn Baby Will Have An Infection?' leaflet in PDF.

    Most babies are born fit and healthy. However, some babies can develop an infection shortly after they are born or during birth. In a small number of babies, their infections can be serious, or even life-threatening. When a baby develops infection in their first 72 hours of life, this is called early onset neonatal infection.

    This leaflet describes how we can quickly diagnose these infections and what can be done to prevent and treat them.

    Before Your Baby Is Born – What Happens If My Baby Is Known To Be At Risk Of Early Onset Neonatal Infection?

    Even before your baby is born, healthcare professionals will be frequently assessing whether your baby is at risk of an early onset infection.

    Below we list the main risk factors which increase the chance that your baby may have an early onset infection and detail what the healthcare professionals do about this. Group B Streptococcus (also known as GBS or Strep B or group B Strep) is the most common cause of early onset infection in babies – it is a common type of bacteria found in approximately 25% of women. It usually causes no problems, but GBS can put your baby at increased risk of early onset infection.

    What Are The Risk Factors For An Early Onset Infection In Your Baby?

    The risk factors for early onset infection in your baby include:

    • You have previously had a baby who had a GBS infection
    • GBS has been found on a vaginal or rectal swab, or from a urine sample, taken from you during the current pregnancy
    • Your waters (membranes) breaking before labour starts
    • Your baby is born before 37 completed weeks of pregnancy (preterm) following labour that was not started artificially
    • Your baby is born before 37 completed weeks of pregnancy (preterm) and your waters broke more than 18 hours before your baby was born
    • You have a fever with a temperature of more than 38°C or you have a confirmed or suspected infection of the waters (Chorioamnionitis)

    If one of these is relevant to you, the healthcare professionals looking after you can decide whether it is in your and your baby’s best interests to give you antibiotics (usually penicillin) aimed at preventing early onset neonatal infection in your baby. Your baby will then be closely assessed when they are born.

    If you had GBS in a previous pregnancy and the baby did not have an infection, this will not affect the birth in this pregnancy.

    Antibiotics In Labour

    Once labour has started in women with risk factors (such as above) antibiotics have been shown to be very effective at preventing early onset infection in babies. Your health professionals may offer you these, or advise you to have them.

    The antibiotics (usually penicillin) should be started as soon as possible in labour once the decision has been made to give them. They are given by a drip directly in to your blood (intravenously) and stopped once the baby has been born. Having these antibiotics should not affect your mobility during labour.

    Antibiotics & Allergic Reactions

    Serious allergic reactions to antibiotics are rare but, if you have ever had an allergic reaction to penicillin, it is very important that you tell your midwife and doctor. Other antibiotics can be used for those who are allergic to penicillin. Allergic reactions to antibiotics are extremely rare in babies. So, even if you are allergic to penicillin, your baby can receive penicillin. Please discuss with your health professional if you are concerned.

    After your baby is born - What happens if my baby is known to be at risk of early onset neonatal infection?

    Any healthcare professional who comes into contact with you and your baby in the first few days after birth (even if none of the above risk factors are present) will assess for any signs and symptoms of infection.

    If any of the above risk factors are relevant to you, your baby will be monitored for any signs and symptoms of infection when they are born for at least 12 hours after birth. This will be done by regularly monitoring your baby’s temperature, breathing, pulse rate and looking for the signs and symptoms of infection listed below. If your baby remains well during this period of monitoring and there are no other issues, your baby can be discharged home.

    Your baby might need antibiotics if:

    • Two or more of the above risk factors are present or
    • Your baby has any of the signs and symptoms of infection mentioned below or
    • You receive antibiotics for a bacterial infection such as blood poisoning (septicaemia) 24 hours before the birth, or at any time during labour, or within 24 hours after the birth of your baby or
    • You had twins or triplets and an infection is suspected or confirmed in one of the babies.

    Some of the common signs and symptoms of infection include:

    • Breathing problems such as irregular or rapid breathing or difficulty in breathing
    • Altered behaviour such as excessive crying
    • Floppiness
    • Refusing to feed, vomiting
    • Altered responsiveness or being unresponsive
    • Abnormal temperature (below 36°C or above 38°C)
    • Abnormal heart rate
    • Jaundice within 24 hours of birth
    • Pauses in breathing (apnoeas)

    If you or the healthcare professionals notice one of these signs or symptoms in your baby, your baby might need further monitoring or tests (such as a blood test) and antibiotics.

    If your baby does need antibiotics or tests, healthcare professionals will explain what will happen and why. Please have a look at another leaflet: My baby may have an infection – what does that mean?

    Who Can I Talk To About This?

    Please ask the healthcare professionals looking after you and your baby any questions you may have. In the hospital you can also talk to the Patient Advisory and Liaison Service (PALS). Outside the hospital you can talk to charities that help parents. These include:

    Group B Strep Support

    For information for families affected by group B Strep and their health professionals.

    PO Box 203,

    Haywards Heath RH16 1GF

    Tel: 01444 416176 Email: info@gbss.org.uk www.gbss.org.uk

    Bliss

    An organization that supports families that have had a sick or premature baby.

    9, Holyrood Street, London SE1 2EL

    Tel: 020 7378 1122

    Freephone helpline: 0500 618140 Email: Hello@bliss.org.uk www.bliss.org.uk

  • Going home. What next Developmental advice for families of premature babies in the first six months

    The leaflet is detailed below, or you can download the 'Going home. What next Developmental advice for families of premature babies in the first six months' leaflet in PDF.

    Developmental Advice for Families of Premature Babies in the First Six Months

    This booklet is a guide for parents of premature babies on the best ways of helping babies develop at home in the first six months.

    Having a premature baby can be a stressful and frightening time for parents, especially in the early days or weeks while their baby may be in hospital.

    Once a baby becomes well and strong enough to leave hospital, there is the excitement and challenge of caring for baby at home.

    We trust that this booklet helps provide parents with confidence and knowledge for the next stage of the journey as they settle into their new life at home with their baby.

    The neonatal unit is situated on the first floor of the hospital opposite to delivery suite and next to the maternity base.

    How Is My Baby Different?

    Premature babies are babies born before 37 weeks gestation. They have not had as much time in the womb to develop as full-term babies. Instead of being curled up in the calm, protected womb they experience the lights, noises, and sensations of the hospital nursery environment. When it’s time to go home, premature babies may look and behave differently to full-term babies especially if they are born before 32 weeks. They may:

    • Be smaller
    • Be floppy and have less curled up limbs
    • Be more jittery or jerky with their movements
    • Tire more easily
    • Dislike touch and movement
    • Be more unsettled and difficult to settle to sleep
    • Be slow or messy to feed, suffer from reflux or need tube feeds at home until their sucking grows stronger
    • Need to have oxygen at home due to ongoing breathing difficulties.

    What Can I Do To Help My Baby?

    It is important to keep a positive attitude. We know parents can make an enormous difference to their baby’s long term development. We hope that with this guide and with the support from people like your health visitor you will be able to do the best for your baby. It is important to pick up any problems and get assistance for these as early as possible. Early help will improve your baby’s long-term development.

    Developmental Milestones

    How Old Is My Baby?

    Your baby is lucky as they have two 'birthdays':

    • The actual day they were born, and
    • The due date, the date they were meant to have been born.

    When you look at your baby’s development it is important to take their prematurity into account. Often you will hear the term ‘corrected age’. Your baby’s corrected age is the age they would be today if they had been born on their due date. This is the age we use when looking at how well your baby is growing and developing. So remembering your baby’s due date is helpful when working out the corrected age. We use the corrected age until your baby is around two to three years of age. Remember: the following developmental milestones are a guide only; if your baby has not reached these milestones or you have concerns feel free to seek help and discuss it with your doctor or health visitor.

    What should my baby be doing?

    Milestones are the stages or skills that your baby reaches as they grow and develop. Sometimes your baby may not be reaching the milestones below; especially if they have ongoing medical issues such as needing oxygen, or being tube fed. Even babies born at full term will reach their milestones at different ages.

    At Around 1 To 2 Months Corrected Age Your Baby May:

    • Start to communicate with you by smiling, ‘talking’ and looking at your face very closely
    • Start to hold their head up for longer when you hold them upright
    • Prefer to look one way but should be able to turn their head equally to the right and left
    • Begin looking at things, especially your face.

    At Around 3 To 4 Months Corrected Age Your Baby May:

    • Start to laugh and follow objects and people with their eyes
    • Show excitement when something is about to happen
    • Enjoy babbling and making noises and ‘talking’ when you talk to them
    • Be able to push up with their arms, while lying on their tummy on the floor
    • Have a steady head and turn to look in all directions
    • Bring their hands together and not favour one hand more than the other
    • Grasp a rattle placed in their hand
    • Take their hands and toys to their mouth
    • Bring their feet together and tuck their legs up.

    At Around 6 Months Corrected Age Your Baby May:

    • Start to enjoy playing ‘peek-a-boo’
    • Sit for a few seconds leaning forward on their hands
    • Roll from their tummy to their back, and roll from their back to their tummy
    • Reach out easily for toys with either hand
    • Take weight through their legs with their heels down, and bounce up and down.

     

    When Should I Seek Help?

    Warning signs: consult your paediatrician or Gp or health visitor if you have one, if your child exhibits any of the signs listed below at the ages indicated.

    At 6 Months Corrected Age:

    • Difficulty lifting their hands and pushing up on their arms while lying on their stomach
    • Cannot stay lying on their side to play with toys
    • Not sitting, even with support
    • Not rolling or is rolling by arching their neck and back
    • Makes no effort to reach or “bat” at objects
    • Does not move their head toward a sound or search for objects with their eyes
    • Grasps an object weakly or holds only for a moment
    • Keeps their hands fisted and/or keeps their thumb inside their fist
    • Is not able to get their hands to their mouth or together
    • Continues to have trouble taking a bottle or first solids
    • Does not coo or babble.

    At 12 Months Corrected Age:

    • Is sitting but not able to sit without support
    • Is crawling or “bottom shuffling” by moving both legs forward at the same time
    • Is not easily able to pick up small objects, such as finger foods
    • Does not search for a hidden object
    • Does not vocalize consonant and vowel combinations (“ba”)
    • Does not look at books for short periods of time. (Keep in mind that if they are busy learning to crawl and walk, they may not have much interest in sitting down activities. Encourage them to spend some time doing “quiet” activities, such as looking at books)
    • Does not respond to simple familiar speech routines, such as pat-a-cake
    • Uses one side of their body much more often than the other.

    At 18 Months Corrected Age:

    • Does not walk, or constantly walks on their toes
    • Does not imitate sounds or produce any sound combinations that represent a word
    • Cannot build a tower with blocks
    • Is more interested in putting toys in their mouth during play, rather than more purposeful play using their hands.

    Communicating With Your Baby

    It takes time to get to know your baby’s signals and to recognise what your baby is trying to tell you. By responding to your baby’s messages, you will be better able to provide what they need. Spend time communicating with your baby while you do everyday things such as bathing, feeding or changing their nappies.

    What Is My Baby Trying To Tell Me?

    When your baby is:

    • Alert: they may be telling you they are ready to play by looking at you, smiling and being bright-eyed
    • Stressed and unable to cope with any more stimulation: they may look away, grimace, yawn or cry
    • Tired: they may have jerky movements, yawn, cry, rub their eyes, or pull at their hair or ears. If your baby is tired or stressed try calming them with a firm cuddle, massage, a gentle song, a soothing voice or a feed.

    How Can I Help My Baby Learn To Communicate?

    • When you communicate with your baby:
    • Try to make eye contact
    • Give big smiles and be reassuring and encouraging
    • Talk or sing about what you are doing and copy their sounds and face movements so they learn to ‘talk’ to you
    • Give them plenty of time to react and respond
    • Give them a break if they look tired or stressed
    • Try to avoid having too many distractions around.

    Closeness with Your Baby

    Why Are Cuddles Important?

    Most babies enjoy being held and cuddled. Skins to skin cuddles are particularly good for your baby’s development. When cuddling, help your baby to hold their head in the middle and tuck their hands and feet in towards the middle. You could cuddle your baby in your arms, have them lying on your lap, facing you or wrapped chest to chest. Cuddles will help your baby learn about their body, help them feel secure and may help them settle better. Some babies also enjoy being held close to mum or dad in a carrier, sling or snuggled in a wrap.

    Moving and Carrying Your Baby

    Your baby can be carried in a variety of positions to help strengthen their muscles and encourage development. Sometimes carry your baby on their tummy. This will help them develop control of their head and back muscles. Whenever you move your baby, help them to feel more secure and develop stronger muscles by:

    • Gently telling them before you start to move them what you are about to do
    • Holding them snugly to help stop any jerky movements
    • Using slow gentle movements and avoiding sudden rushed movements
    • Carrying them in a variety of positions during the daytime so they can learn to hold their head up when carried on their tummy or when held sitting up.

    Playing With Your Baby

    Why Is Play Important?

    Play is much more than just having fun. Through play your baby learns to:

    • See, hear, smell, touch and explore lots of different things
    • Communicate with you and with others
    • Discover the world
    • Make things happen such as a noise or movement.

    When Is The Best Time To Play?

    Early in your baby’s life they may seem to do nothing but eat and sleep! This stage doesn’t last for long.

    Take the opportunity to play when they start to stay awake for longer periods, or when they are more alert and looking around. But remember:

    • Premature babies can get tired quickly so you may need to keep these play sessions short
    • If they suffer from reflux they may not like lying flat or on their tummy on the floor
    • Sometimes just cuddling, looking at and talking to your baby is a lovely way to play
    • Your baby will tell you when they have had enough by looking away, arching, grimacing or crying
    • Try to make playing with your baby a part of everyday activities such as when changing nappies, dressing, bathing or while doing household jobs.

    Why Is Tummy Time Important?

    Spending time on their tummy in the early days is important to help your baby develop strength in their head, neck and arm muscles. Later this will help them to roll, crawl and sit. You can help by:

    • Starting tummy time with them lying over your shoulder or on your chest as they will enjoy the vibration of your voice and feel the warmth of your skin
    • Carrying them over your arm
    • As they get older placing them over your legs when you sit on the floor, or over a rolled up towel or horseshoe play ring
    • Giving them short periods on the floor and increasing the time as they get used to it
    • Keeping tummy time short if they are unhappy; you may start with just a few seconds
    • Encouraging and reassuring them with smiles, songs or massage
    • Keeping them ‘entertained’ by using toys and mirrors
    • Avoiding placing your baby on their tummy soon after a feed.

    How Can I Help My Baby Learn To Sit?

    Sitting is important for your baby as they can learn more about the world from this position and once sitting can progress to crawling, standing and walking. You can help by:

    • Giving your baby some time, while well supported, in a rocker chair with things to look at and reach for using supports e.g. rolls, to help hold their head in the middle and make it easier to bring their hands and feet together.
    • As they get stronger, sit them on your lap or on the floor. Initially your baby will need support around their upper chest and shoulders.as their balance improves you can hold them lower, around their waist
    • Later as they get stronger you can sit them on the floor between your legs
    • Showing them how to roll from their tummy onto their side and then onto their back if they seem to be stuck’ or becoming frustrated.

     

    Feeding Your Baby

    What Should I Expect With Feeding Patterns?

    • Feeds should last no more than 20 to 30 minutes as both you and your baby will become tired and frustrated if you persist for longer.as they grow and become stronger, feed times should become shorter
    • Feeding on demand usually works best for babies
    • After the first few months, most babies need to feed 3 to 4 hourly during the day
    • Most babies will need to be fed during the night, usually reducing to one night feed by around 6 months of age
    • Your baby should use a regular sucking pattern and not get out of breath.

    What Problems With Feeding Might I Expect?

    Feeding is hard work for any baby but especially for premature babies who may have ongoing lung problems, reflux and reduced muscle strength and endurance. Premature babies can have difficulty staying awake, or they may become distracted and fussy when feeding.

    How Can I Help My Baby Feed Well?

    Try to make feeding a calm, relaxed and enjoyable time for you and your baby. Don’t push them if they are upset, crying or too tired. Be aware of your own feelings as they will pick upon these.

    Help Your Baby Do Their Best By:

    • Looking out for their feeding signals such as wriggling, restlessness, or finger sucking so you can begin feeding before they become upset
    • Supporting yourself well in a comfortable chair in a quiet area so you can be as relaxed as possible
    • Feeding them in a quiet place with few distractions
    • Supporting your feet which will raise up your knees to help support them so your arms won’t get so tired
    • Supporting their head and ensure it is in line with their body and not twisted to one side
    • Positioning their chin tucked down little: as a guide fit 2 fingers between their chin and chest
    • Holding their arms and legs gently curled up, if they are floppy they may feed better if wrapped
    • Watching them closely and watching for signs of discomfort, or the need for a break
    • If they fall asleep during a feed, then stop and try to gently wake them by changing their nappy, using a damp cool flannel on their face, or tickling their feet before offering the rest of the feed
    • Allowing them 5 to 10 minutes to burp and rest during feeding
    • Feeding them in a more upright position if they have reflux
    • If they cough or splutter sit them up and give them time to recover.

    If They Are Breastfed, You Can Help By:

    • Starting each breastfeed on the breast last fed from
    • Allowing them to empty the first breast before offering the second
    • Allowing top-up feeds after abreast feed for the first days or weeks; as they grow bigger and stronger they won’t need these anymore.

    If They Are Bottle-Fed, You Can Help By:

    • Preparing the bottle before they get upset
    • Ensuring the milk is warm.

    How Will I Know When My Baby Has Had Enough To Drink?

    It can be worrying not knowing if they are drinking enough. They should have a wet nappy at each nappy change. Also have them weighed regularly to ensure they are feeding well and putting on weight.

    When Should I Seek Help With Feeding My Baby?

    • If they are not putting on weight
    • When feeding time is stressful for either you or your baby
    • If they regularly cough, splutter, choke, changes colour (becomes dusky or very pale), vomits or has difficulty breathing
    • If feeds are taking a long time (more than 30 minutes).

    Weaning

    A lot of parents worry about when to wean their premature baby. It can also be confusing to read guidelines for term and well babies. All babies reach a stage when breast or formula milk does not supply all the nutrients they need. Premature babies in particular need careful planning of the nutrients in their food, to make sure they continue to develop and grow. New tastes and textures help encourage babies to eat a range of foods, which helps make sure that their diet is balanced later in life. Solid foods help babies to practise lip, tongue and jaw movements. Eating together is also an important social activity. It is thought that babies can learn skills like eating from watching others. Weaning also provides a great opportunity for all members of your family to become involved in feeding your baby.

    The most important thing to lookout for before weaning is signs that your baby is ready. Every baby is an individual and will be ready at different stages, especially if they were born early. There are some important signs to look out for.

    See if your baby can…

    • Support themselves in a seated position. Premature babies might need extra support
    • Hold their head in a stable position
    • Show an interest in other people eating
    • Lean forward and open their mouth towards a spoon or food

    Put things to their mouth and make munching, up and down movements. Your baby might show one of these signs first, but it is recommended to wait until you see a few before starting weaning. Your baby needing more milk, or needing more feeds in the night is not necessarily a sign that they are ready to wean. This could be a growth spurt. You do not need to wait for your baby to have teeth or reach a certain weight before weaning. Some health professionals say that four months corrected age is the youngest age a premature baby should be weaned. There are different opinions about the best age range to wean a premature baby. Some health professionals say that premature babies often show these signs that they are ready for more solid foods somewhere between five to six months corrected age. Remember – your baby will show you when they are ready. Because all babies develop differently, your baby might show these signs at different stages to others, especially if they were born early. There is not very much research on weaning premature babies. It is important to remember that you know your baby best.

    How Do I Start Weaning?

    It can help to plan when you want to start weaning. Parents can find it easier if they choose a time when their baby isn’t too hungry or tired. Playing with food is an important part of learning about how to eat it giving your baby some food to touch and feel can be helpful.

    They will likely spit food out to start with, as they get used to new textures. It can be easier to start with one meal a day and see how your baby reacts. It is important that you and your baby are comfortable when trying new foods. The best feeding positions will let your baby:

    • Bring their hands together
    • Be supported to sit upright
    • Hold their head up easily

    Always make sure your baby is supported so that they can sit without sliding or slumping to one side. You should never leave your baby alone whilst they are eating. Once your baby is older, highchairs with trays can provide a helpful position for your baby to hold food in their hands and feed themselves. Remember that weaning is a process of introducing your baby to food gradually. You should continue with breast milk or formula milk feeds.

    Traditionally, the first foods that are used to wean are smooth, runny foods. This is because your baby will also be learning how to chew, having only taken milk by sucking until now. Many health professionals still suggest this as a first method, and others suggest that a baby’s first foods can be more solid. After the first few weeks, you can introduce wider range of foods and, if you have started with soft pureed food, you can introduce more soft lumps e.g. Bananas, porridge.

    Baby-Led Weaning and Premature Babies

    There are different choices you can always necessary for first foods to be completely smooth and fed on a spoon. Another popular option is to allow your baby to take and eat food when they are ready. This is known as baby-led weaning which allows the baby to join in family mealtimes and share the same foods, adapted to suit their abilities. They are able to explore food and decide how much or how little to eat, and how quickly. Milk feeds should continue as their main source of nourishment as your baby gets used to a mixed diet and learns to manage different textures. The aim of baby-led weaning is for your baby to feed themselves whenever possible.

    Gagging or Choking

    It is usual for babies to gag slightly as they get used to more lumpy foods.it is the body’s way of getting food back into the mouth to avoid choking. Encourage your baby to keep trying to chew the food. Eventually they will learn to chew and bite food rather than just suck. Parents sometimes worry about their baby choking. Never leave your baby alone when eating.

    If your baby ever struggles to breathe, call 999 immediately.

    Bathing Your Baby

    Bath time can be a fun time for your baby to move freely, grow stronger and learn about their body. A warm bath can be relaxing for your baby, especially if they have reflux or are very unsettled at times. To make bathing more enjoyable try:

    • Keeping your baby warm when they are in or out of the bath
    • Wrapping them in a muslin cloth if they do not like bathing or feel scared being undressed; then gently place them in the bath and slowly remove the wrap once they are relaxed
    • Keeping them covered with a flannel over their chest if they prefer as some babies are happier when covered
    • Gently swishing them from side to side while singing a simple song such as ‘row, row, row your boat
    • Having them push their feet off from the end of the bath.

    Settling Your Baby to Sleep

    How Long Should My Baby Sleep?

    Sleep is very important to help your baby’s brain develop. In the first few months after going home babies usually sleep about 16 to 20 hours in every 24-hour period, some even longer!

    How Can I Be Sure My Baby Settles And Sleeps Well?

    Premature babies may have difficulty learning to settle and sleep, especially at night. Your baby may take many weeks to develop a regular awake and sleep time. You can help by:

    • Encouraging play and stimulation during the day rather than at night
    • Having an evening routine such as a bath, followed by a feed, then a story or lullaby. Some babies prefer to feed on waking; others may play for a while then feed before settling down.
    • Providing a night light or playing a radio softly as babies who have spent a lot of time in hospital often
    • Become used to the noise and light and find them comforting
    • Wrapping your baby in a thin cloth, such as muslin, with their arms and legs ‘bent up’ and their hands together. This reminds them of time curled in the womb and helps them feel secure.

    For Safe Sleeping Always Follow These Guidelines:

    • Sleep your baby on their back, never on their tummy or side
    • Sleep your baby with their head and face uncovered
    • Do not use pillows, bumpers or soft toys in the cot
    • Do not expose your baby to cigarette smoke
    • Sleep your baby in their own cot next to your bed for the first 6-12 months.

    Colic and Wind

    Babies who have spent time in special care seem to suffer from winding problems more than full term babies. Baby massage is particularly good forgiving relief from colic and wind.as well as massage, the following could help, but you should also ask advice from a health professional:

    • Ensure your baby is sitting upright during feeds (if they are old enough) and is not gulping too much air
    • Try a medium-flow teat rather than a slow-flow or ‘new-born’ teat
    • Give your baby a warm bath
    • Hold them and rock them gently
    • Give them colic drops or gripe water. While colic is particularly common in the first few months, it rarely lasts very long and causes no long-term problems.

    Reflux

    Reflux, or gastro-oesophageal reflux, is a common problem in babies, especially premature babies. Reflux occurs when some of the partly digested milk or food in the stomach comes back up into the food pipe (oesophagus) and sometimes into the mouth. As the stomach contains acid that helps to digest food, the acidity can cause some discomfort and burning sensations within the food pipe. This can be painful for babies and they may become irritable during and after feeding times.

    Why Does Reflux Happen?

    When food is taken through the mouth, it travels down the food pipe and into the stomach. There is a small band of muscle above the stomach opening (called the lower oesophageal sphincter). This band opens when food is about to enter the stomach and then closes so that food remains in the stomach. However in premature babies their band of muscle is weak and doesn’t close properly, so food can go back into the food pipe and into the mouth. This is known as reflux, when partially digested milk or food enters back into the mouth. Symptoms of reflux can include:

    • Bringing milk back up with burping
    • Vomiting that often shows no clear pattern in terms of timing or amount
    • Fussiness, crying and restlessness
    • Refusing to feed and fighting the nipple/teat
    • Only taking small quantities of feed
    • Arching back during feeding
    • Choking or gagging
    • Changes to the baby’s skin colour.

    More Severe Complications Of Reflux Can Include:

    • Chest infections
    • Poor weight gain
    • Feeding/eating difficulties
    • Inability to lie flat after a feed without discomfort
    • Becoming anaemic.

    Treatment for Reflux

    Treatment depends on the severity of the reflux. Some babies on the neonatal unit can be managed by nursing them in different positions. Mild reflux tends to improve on its own and gets better when the baby begins to wean onto solids.

    Ways to Help Your Baby

    • Giving your baby skin to skin after a feed to allow the food to settle before laying them in a semi-inclined-cot.
    • Changing your baby’s nappy before feeding makes vomiting less likely
    • Feeding your baby with slightly smaller volumes of milk but increasing the frequency of feeds throughout the day
    • Burping your baby more frequently. Sometimes medications may be given to help. These may include feed thickeners, which are added to the baby’s milk to help reduce the effect of reflux. Thickeners work by making the feed more solid once it is in the stomach and this makes it harder to bring back up. Infant Gaviscon is an example of this. Other medications may help to lower the acid production in the stomach and to speed up food passage through the stomach. Reflux is often worse when a baby is lying flat on their back, so it can help if you keep your baby’s head gently raised during the day. The most important time is after a feed; at this time you should hold your baby upright for as long as you can.

    Constipation

    Preterm babies have more trouble with constipation than full-term babies for several reasons. Decreased muscle tone, preterm formulas and a history of bowel infections can all contribute to problems with stools in premature babies, even after they come out of the hospital. The number of stools your baby has each day doesn’t define constipation. Many perfectly healthy babies only have bowel movements every few days, especially if you breastfeed. Constipation refers to the quality, not that your baby doesn’t have a bowel movement every day. Straining, crying or grunting while having a bowel movement doesn’t necessarily mean that your baby is constipated, although it may. New babies aren’t familiar with the sensations of passing a bowel movement and often react with facial expressions and noises that make having a bowel movement sound difficult even when it’s not.

    What Can I Do About It?

    If you are concerned about your baby consult your Gp. Never give a premature baby over-the-counter medications to treat constipation without your doctor’s approval.

    There are several things you can do for your constipated baby:

    • Give your baby extra drinks of cooled, boiled water.
    • Babies over 6 months who have started on solids can have fruit juice as well as fibre: pureed or chopped apples, apricots, blueberries, grapes, pears, plums, prunes, raspberries and strawberries are all high in fibre.
    • Check bottles are being made correctly – too much baby milk powder will make the feed too concentrated.
    • Gently massage your baby’s tummy in a clockwise direction. Some baby oil on your hands may help. But if your baby seems tense or doesn’t like the sensation stop immediately.
    • Gently move your baby’s legs in a cycling motion. Sometimes this gentle “exercise” can help move the poo through their system.
    • Give your baby a warm bath and apply some cream or petroleum jelly around her bottom to soothe and prevent soreness.

    Illnesses

    With a premature baby, the immune system is weaker and premature babies have a higher chance of being re-admitted to hospital after going home. That means that for the first few months you need to be extra careful – especially during the colder months when cold and flu viruses are circulating.

    How to Protect Your Premature Baby

    Try not to put them in situations where they are likely to pick up infections. As your baby grows and becomes more robust, you can relax a little. Eventually they will deal with colds and other infections in the same way as any other child.

    Diarrhoea and Vomiting In Premature Babies

    Diarrhoea and vomiting are usually caused by a bug. Tummy bugs are common among young children, but they can be serious for babies because of the risk of dehydration.

    How to Treat a Tummy Bug

    The most important thing you can do is to keep your baby well hydrated through the illness. Breast or bottle feed frequently, or give cooled boiled water mixed with rehydration salts (available over the counter – talk to the pharmacist for advice). Even if you are breastfeeding, you can give your baby extra liquids by cup, spoon or bottle.

    When to Go To the Doctor with Your Premature Baby

    Contact your doctor immediately if your premature baby:

    • Has diarrhoea six or more times in 24 hours
    • Has fewer than four wet nappies in 24 hours
    • Has a dry mouth
    • Has a sunken face, eyes, or fontanelle (the soft spot at the top of the head)
    • Is very lethargic or irritable.

    Coping With a Baby with a Cold

    A cold is an extremely common viral infection. Symptoms include a runny or blocked nose, a cough and temperature. It’s very normal for babies to get colds, but it can be uncomfortable for them, and they may be tetchy or have difficulty sleeping, which can take its toll on the whole family. If your baby seems to be in discomfort or has a high fever, you may want to give them some baby paracetamol or ibuprofen. You can buy this over the counter from the pharmacist. 

    When a Cold Develops Into a More Serious Illness

    In premature babies, however, cold can develop into more severe complications, so if you are at all concerned about your baby see your GP. The common cold can develop into the following, more serious illnesses.

    Flu

    It’s easy to confuse flu with a severe cold, but if your baby has a temperature of more than 38°c and is shivery, they may have flu.

    Chest Infections

    If your baby has a high temperature, wheezing, shallow or rapid breathing, a rapid heartbeat or goes off their food, or if the muscles in their chest are sunken in, they may have a chest infection such as bronchiolitis.

    Ear Infections

    If your baby develops a high temperature three to five days after cold symptoms start, seems very ill and distressed, and keeps pulling at their ear, they could have an ear infection.

    When to go to the Doctor

    If you think your baby may have a chest or ear infection or seems dehydrated, or the fever isn’t coming down, go to your Gp as soon as possible, as they may need antibiotics to prevent further complications. Flu is not normally treated with medication, but if your baby is considered to be at high risk, they may be given an antiviral drug.

    Signs of Meningitis

    • Seek urgent medical advice if your baby:
    • Has a high temperature, with cold hands and feet
    • Has pale skin with a rash or blotches that don’t fade when you press the side of a glass against them
    • Breathes fast or grunts
    • Has an unusual cry or moaning
    • Is floppy, unresponsive and drowsy, with staring eyes
    • Has convulsions
    • Is refusing food and throwing up
    • Has a bulging or tensing fontanelle(the soft spot on their head)
    • Has a sore neck and dislike of bright lights (though these symptoms can be hard to spot in babies)
    • Is being fretful and doesn’t want to be touched.

    When to Call 999

    • If your baby is having trouble breathing
    • If your baby is unconscious or doesn’t seem aware of what’s going on
    • If your baby won’t wake up
    • If your baby has their first fit or convulsion, such as twitching or eyes rolling into the back of their head.

    Follow Up

    What Is The NICU Follow-Up Clinic?

    We provide specialised medical and developmental care for babies and children up to at least 2-4 years of age. Our team includes doctors and therapists with extensive experience caring for babies and children who have potential to develop complex medical or developmental needs. Part of your follow up will be held at Liverpool women’s hospital but most of it will be held at alder hey children’s hospital.

    Why Was My Baby Referred Here?

    Babies need specialised follow-up care for many different reasons.

    Some of these conditions include:

    • Prematurity (birth prior to 34-week gestation)
    • Low birthweight.(<1.5kg)
    • Feeding and growth issues
    • Brain bleeds, seizures or other neurological diagnoses
    • Infant drug exposure and/or withdrawal
    • Babies who required cooling treatment.

    What Specialised Developmental Care Is Provided?

    We provide formal standardised testing that starts at 6 months corrected age. Our team includes a physiotherapist, an occupational therapist and a speech and language therapist available to recommend home exercises specific to your child’s development. If your child is in need of specialized developmental services, we help arrange those services near your home.

    How Often Will My Child Be Seen?

    Appointments and frequency will vary depending upon your child’s individual needs, but we will see most children to assess motor, language and cognitive skills at the following routine visits:

    • 1 month
    • 3-month
    • 6-month
    • 12-month after hospital discharge
    • Then yearly until 4 years of age.

    Well Done

    Congratulations on taking home your NICU graduate. We at the Liverpool Women’s Hospital NHS Foundation Trust wish you all the best for the future. Enjoy your time together.

  • Steroids in Chronic Lung Disease (CLD)

    The leaflet is detailed below, or you can download the 'Steroids in Chronic Lung Disease (CLD)' leaflet in PDF. 

    What Is Chronic Lung Disease?

    Chronic Lung Disease (CLD) is a general term used to describe the long-term lung damage that occurs in some premature babies. It is also sometimes known as Bronchopulmonary Dysplasia (BPD). Damage occurs because immature, fragile lungs can easily become inflamed and scarred.

    Premature babies who develop CLD often need more help with their breathing than babies with healthy lungs. This may mean being on a ventilator and/or in oxygen for several weeks.

    How Can Steroids Help?

    Steroids are medicines which are sometimes used to prevent and treat lung problems in premature babies. For example, steroid injections are given to mothers who are likely to deliver prematurely to try and mature the baby’s lungs and prevent respiratory problems. Steroids can also be given after birth when a premature baby has developed CLD. They act by reducing the inflammation in the lung.

    What Are The Specific Benefits Of Steroid Therapy?

    Reducing inflammation helps to improve lung function in babies with CLD. Steroids have been shown to help babies to get off the ventilator (‘be extubated’) and to allow them to be treated with less oxygen. We hope that this will allow a baby’s lungs to heal more quickly than if they remained on a ventilator and in high levels of oxygen.

    Side Effects of Steroid Therapy

    All medicines have some side effects. Steroids are potentially powerful drugs but also have important side effects. Some of these side effects (such as poor growth, raised blood pressure and high blood sugar levels) are relatively minor and easily corrected once the steroid treatment is completed.

    However, the long-term side effects are more significant and generally cause more concern. In babies with CLD, early treatment before three days of age with steroids may be linked with problems with brain development later in childhood. This may show itself as weakness or stiffness of one or more limbs and/or as slower development compared to other children of the same age. Overall, this means that although babies treated early with steroids tend to have fewer problems with their lungs they may be at greater risk of later problems with brain development. There is no convincing evidence that later treatment with steroids (after three days) is linked with problems with brain development.

    Which Babies Are Given Steroids?

    Most babies with CLD do not need steroids, even if they remain on a ventilator for a long time. Steroids are only used to treat babies with severe, life-threatening lung problems after the first week of life. The decision to use steroids is made by the Consultant in charge of the Neonatal Unit. They will decide whether a baby is sick enough to be considered for treatment and will weigh up the risks and benefits of using steroids. Parents are always kept up to date about the management of their baby and will be fully involved in any decisions about using steroids.

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