The Neonatal Unit Leaflets

The leaflet is detailed below, or you can download the 'Neonatal Unit - 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 ‘Reception/ The Hub Reception” and the Ward Clerk will check your details and allow you access.  Please be aware that they are not on duty overnight so if there is no response, please press for one of the other rooms and someone will help you.

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.

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, the digital code for these will be given to you on arrival and you can keep this locker for the extent of your stay.
• Remove all watches, bracelets and rings (except plain wedding rings) and roll up your sleeves.
• Then please ensure you wash and gel your hands thoroughly at the hand washing troughs on the main corridor before you proceed into the unit.
• Before entering the any of the clinical rooms apply the alcohol hand gel again which is located by the 
• After entering the room, please 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 room reapply the alcohol gel again using the gel located outside each door.
• Each time you return to the room 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 three areas; a designated Neonatal Consultant oversees the care and treatment of babies in each of these areas:

• Neonatal Intensive / High Dependency
• Low Dependency (LD)
• Transitional Care (TC)

Neonatal Intensive/ High Dependency

This critical care area provides support for babies who have breathing problems, are recovering from surgery or require other specialist treatments.

There is a range of specialist equipment to help care for your baby in these rooms.  For more information about the equipment used on a neonatal unit please visit the Bliss website or see the 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 Low Dependency (LD).

We also have rooms for consultations and meetings with parents if not able to meet at the cotside.

Ward Rounds in the Intensive / High Dependency Rooms

Each day there is a ward round led by a Consultant. You are welcome to stay in the room but we ask that you wear headphones until your baby’s condition is being discussed to avoid breaches of confidentiality.

Ward Rounds in the Low Dependency Rooms

In the Low Dependency rooms there is a Consultant ward round Monday – Friday.   You are welcome to stay in the room but we ask that you wear headphones until your baby’s condition is being discussed to avoid breaches of confidentiality. A weekly discharge planning meeting is held on Wednesdays to discuss plans for discharge home.

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

Nursing Hand-Over Times

Nurses’ hand-over times are 07:15 hours and 19:15 hours. 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 Ward.

The Transitional Care Team is led by a Team Leader, Registered Neonatal Nurses/ Midwives, and 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 will provide support and advice for premature babies and babies whose birth weight was less than 2.3 kg once discharged home from either, Transitional Care, the Neonatal Unit or Maternity. The team will monitor your baby’s progress before discharging you to the Health Visitor.  The team will also carry out any necessary blood tests a baby may need, and help parents access specialist teams and community services if required.

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.

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 this large number of Nursing staff and Clinical Support Workers in the unit who specialise in looking after sick or premature babies. The staff 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.

Physiotherapist

A Neonatal Physiotherapist‘s role is to support the development of babies who may be at risk of having movement or developmental difficulties. They will assess your baby and give advice to you and the nursing staff on developmentally supportive care, including, handling and positioning that is specific for your baby.  For some babies they will also be involved in neuro-developmental follow up post discharge to ensure the baby is developing their gross motor skills appropriate to their age.

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.

Care

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/ curtains 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.

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.

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.

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 the critical care areas and two visitors with one parent in the Low Dependency areas) 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. have a cold, flu, stomach upset. If you are unsure if your visitor 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 about the Unit

Toilets

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

Unit Cleaning

Each day the domestic staff 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 8 – 4500

            Room 7 – 4501        Room 9 --1705

           Transitional Care - 1409

Between 08:00 – 16:00 hours 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.  The very preterm nappies will be provided as these are not easily available to buy.

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/ High Dependency area however a comfort cloth can be used. In the 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. These 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 expressing it will help your milk to flow

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.

It is helpful if parents bring in sterilised bottles and teats prior to discharge home so the baby can get used to them and the staff can advise if any concerns are raised with their use. 

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.

Baby Diary

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.

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”.    The nursing staff will discuss this with you at the appropriate time when the test is due.

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 condition improves, 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.

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 Bliss helpline offers 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:

Peer support from other parents can be accessed by joining the closed Facebook site “Neomates- Liverpool” 

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

The Matron is available Monday - Friday

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.

There is also the 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 parent accommodation on the second floor – directly above the neonatal unit and this is offered when your baby is requiring intensive care subject to availability.   Cereal / toast / tea  and coffee are provided along with a small range of tinned / dried items for you to use.

Siblings cannot stay in these facilities.

If your stay is thought to be more long term there is also some offsite accommodation, these have kitchen facilities and a sitting room and can be arranged via the Shift Leader but please note that there is only one flat with facilities for siblings to stay.  This is means that the provision is reviewed every 2 weeks so that other families can use this accommodation and you may be asked to move to another flat without facilities for siblings.

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.

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 and a small range of tinned/ dried foods are provided.  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.

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 the trust website and a QR code can be found on the notice board. 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 on the unit,  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 the Main Reception  on the ground floor 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 the is a small seating 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 hours Afternoon visiting 14:30 – 15:30 hours Evening visiting 18:30 – 20:00 hours

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.

Family Integrated Care (FiCare)

This is a model of care planning and delivery encouraging parental involvement as partners in their baby’s care. 

A parent passport has been introduced which will enable parents to document skills that they have completed. This will allow for good communication and consistency across nursing staff and units within the neonatal network.

 

 

 

 

 

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

Introduction

A Doctor, Advanced Neonatal Nurse Practitioner (ANNP) and/or a Midwife examine all new-born babies after birth.

This examination allows us to look at your baby and it 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), an Advanced Neonatal Nurse Practitioner (ANNP) 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.

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

The person examining your baby will need to know if:

• Anyone in your family has had problems with dislocated hips as a child
• Anyone in your family has been born with heart conditions or any visual impairments
• If you were fit and well during pregnancy, and if you have been taking any medications
• If you have ever suffered from any medical conditions which have involved your Thyroid gland
• 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.

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.

 

 

 

 

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.

2. 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.

3. 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 expressed breast milk (EBM) or sucrose during procedures is an effective way of helping reduce pain and stress in your baby.

4. 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.

5. 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.

6. 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.

2. 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 believe 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!

 

 

 

 

 

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.

 

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.

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.

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.

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

 

This guide should be used in an emergency if your baby appears not to be breathing.

Check whether your baby responds to gentle stimulation.

 

If no response, shout for help and ask for someone to dial 999. If you are alone, take your baby to the phone and dial 999 yourself.

Position your baby on his/her back on a flat, hard surface and start Basic Life Support using the ABC of Resuscitation

 

A - Airway

Keep the Airway Open

Look for any obvious foreign material in your baby’s mouth. If you can see anything, turn your baby over and give five firm taps on the back with the heel of your hand.

To open the airway, gently tilt back your baby’s head and lift the chin. Do not tilt the head too far back.

B – Breathing 

If your baby is not breathing, start mouth to mouth breathing

Is your baby is breathing on their own? Check by looking, listening and feeling for no more than 10 seconds:

LOOK at the chest and abdomen for movement

LISTEN over the mouth for breath sounds

FEEL with your cheek, over your baby’s mouth for air

If there are no signs of breathing in 10 seconds, start mouth to mouth breathing:

Keep the airway open as described above.

Cover your baby’s mouth and nose with your mouth ensuring there is a good seal.

Gently blow into the lungs until the chest rises and falls. Take a fresh breath each time before giving these breaths. Do this 5 times.

Reassess the breathing. If your baby is breathing, turn them onto their side and wait for help. If your baby is still not breathing, continue as follows.

C – Circulation

Start heart massage if your baby does not have a heartbeat

Check for a pulse (heartbeat) by feeling the inner part of the upper arm at the elbow for 10 seconds. If you can’t feel a pulse or the pulse is very slow (less than 60 beats per minutes), start heart massage (cardiac compressions). 

 

With the tips of two fingers on the lower half of the breastbone, apply gentle but firm pressure to push it down by about 1 inch. Repeat this quickly 30 times, and then give 2 mouth to mouth breaths.

Continue alternating between giving 30 cardiac compressions and 2 mouth to mouth breaths.

Check for signs of breathing and circulation until the ambulance arrives, or your baby starts breathing for itself.

 

 

 

 

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.

 

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

The Low Dependency room 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, and advice and help the transition from the Neonatal Unit to home.

Staffing

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.

Each 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 14.00 hrs

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).

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 in Low Dependency

•  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 the low dependency areas.

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
• 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 the low dependency areas. This information helps us continually improve the service we offer.

 

 

 

 

 

The leaflet is detailed below, or you can download the 'Patent 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 arteriosus 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 duct 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 duct 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 duct 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 some of the organs in 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 oxygen support.

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 PDA which might be causing as problem 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 likely to be causing problems.

What Will Happen If My Baby Has A PDA?

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

How Is PDA Treated?

If the doctors decide that the duct is causing a problem and needs treatment, they might use medicines such as ibuprofen or paracetamol to try and close it. These medicines are initially given for around 3 days after which the baby may need a repeat heart scan. If the duct is still open and causing a problem, repeating the treatment might be considered.

Finally, if medical treatment is not effective and the doctors still think the duct 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?

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 early. Paracetamol is routinely used to provide pain relief in newborn babies and is not considered to have any important side effects. 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 side effects. However, because they can be significant, and because of the uncertainties regarding treatment, the decision to treat is not taken lightly.

How Can I Find Out More About PDA?

Your baby’s nurses and doctors can give you more information. Please ask them if you would like to know more about PDA or the various treatment options.

 

 

 

 

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:

• NHS choices website - nhs.uk/conditions/Jaundice-newborn
• NICE website - nice.org.uk/guidance/CG98

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

Why is my baby being referred?

All babies have their hips examined as part of the newborn 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 newborn 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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

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 into 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

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 vocalise 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.

The leaflet is detailed below, or you can download the 'Welcome to Transitional Care' 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 Low Dependency room 8 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, sterilisation)
• 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 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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The leaflet is detailed below, or you can download the 'Intraventricular Hemorrhage' leaflet in PDF.

What Is Intraventricular Haemorrhage?

Intraventricular haemorrhage (IVH) means bleeding (haemorrhage) into (intra) the normal fluid spaces (ventricles) within the brain.

Why Does It Occur?

All babies have tiny blood vessels close to the ventricles of the brain. These are fragile and can easily be damaged, causing bleeding. This bleeding can occur on one or both sides of the brain.

Which Babies Are At Risk Of Developing IVH?

IVH almost always occurs in premature babies. It tends to happen most commonly in the smallest and sickest babies, those born before 28 weeks of pregnancy or weighing below 1000 grams (2 lb. 4oz). This is because these babies have the most fragile blood vessels that can bleed very easily.

How Is IVH Diagnosed?

Babies often have few outward signs that can tell doctors and nurses looking after them that an IVH has occurred. Therefore we have to do a brain scan to diagnose whether or not a baby has developed an IVH.

All babies born less than 32 weeks’ gestational age or weighing less than 1500g at birth will undergo a routine scan within the first 48 hours of birth. This scan is called a Cranial Ultrasound Scan (or “head scan”) and uses sound waves to get a picture of the baby’s brain through the “soft spot” at the top of the skull. This is identical to the sort of scan most mothers have at about 20 weeks of their pregnancy and does not cause any pain or discomfort to the baby. Head scans are performed by one of the Doctors or Advanced Neonatal Nurse Practitioners (ANNPs) caring for your baby.

The head scan not only diagnoses whether an IVH is present, but also gives doctors useful information about the extent of any bleeding that has occurred. This scan will be repeated at regular intervals, depending on how your baby is and what is found.

Can IVHs Be Prevented?

A pregnant mother who may deliver her baby prematurely is sometimes given steroid injections. These medicines are used to make a baby’s lungs more mature but can also reduce the risk of the baby developing an IVH. Unfortunately there is not always enough time for steroids to be given to a mother before her baby is delivered.

What Are The Complications That May Develop After An IVH?

The fluid that is continuously produced inside the ventricles normally drains out of the brain and is then absorbed into the circulation. Sometimes the blood inside the ventricles clogs up the drainage system, causing a build-up of fluid. This may make the ventricles swell up. If this does not settle by itself, it can cause a build-up of pressure inside the skull. This is called hydrocephalus and will need to be treated to reduce the risk of any brain damage from occurring.

Even without this sort of swelling of the ventricles, babies who have had a severe haemorrhage (a large IVH) can develop problems later on in childhood. All babies born prematurely have regular check-ups in Outpatient Clinic. Babies who have had a large IVH will need to be checked particularly carefully for signs of any problems. These problems may show themselves as delayed development (where a child appears to be developing at a slower rate than other children of a similar age) or as problems with nerves and muscles (eg. weakness or stiffness of the limbs).

What Does An IVH Mean For My Baby?

The outlook for a baby with IVH will depend on the amount of bleeding that has occurred and whether any complications have arisen after the bleeding has occurred. A small amount of bleeding is very common in premature babies and very few babies born before 28 weeks have no bleeding at all. This form of IVH is not itself a problem and there will be no complications from it.

Other babies will have more bleeding and therefore a higher risk of developing complications. Regular ultrasound scans and measurements of a baby’s head size will allow the doctors to find out whether or not the bleeding has caused any complications.

Is There Any Treatment For IVH?

Unfortunately there is no specific treatment (either with medicines or surgery) that has been shown to help babies once they have developed an IVH. All babies will continue to get the same care and support that all premature babies receive on the neonatal unit. Some babies may need a blood transfusion to replace the blood lost due to the IVH and to prevent anaemia.

 

 

 

 

 

 

 

 

 

 

The leaflet is detailed below, or you can download the 'You and Your Premature Baby' leaflet in PDF.

This leaflet is written for parents who are at risk of having a very premature baby (delivering between 22 and 25 weeks of pregnancy). We will help you to make some important choices about your care before and during labour if this was to happen.

This leaflet contains important information to help you decide what would be best for you, your baby and your family. We are happy to go through this leaflet with you to explain things further and give you a chance to ask questions.

The obstetricians (doctor who look after pregnant women) and neonatologist (doctor who look after sick newborn babies) will discuss with you what it may mean for your baby if he or she delivers early. Babies born very prematurely may not survive or may have long-term problems.

These problems are set out in more detail below. The chances of survival depend on many factors including how many weeks into the pregnancy you are, birth weight, any abnormalities picked up on scan, how strong they are when they are born and whether there is any infection present. You will be offered a visit to the neonatal unit, which is where your baby is likely to receive specialist care, if delivered early.

This leaflet is written for parents who are at risk of having a very premature baby (delivering between 22 and 25 weeks of pregnancy).

We will help you to make some important choices about your care before and during labour if this was to happen.

For All Women at Risk of Extremely Premature Delivery We May Consider The Following

• Ultrasound scan: to look at the length of your cervix and to look at your baby’s growth and well-being
•  Antenatal steroids: after 23 weeks we will give you steroid injections to help the development of your baby’s immature lungs. 
• Magnesium sulphate: after 23 weeks we will give you an infusion to help the development of your baby’s immature brain
• We look after babies from other hospitals in the Northwest as not all maternity units have a neonatal intensive care unit able to look after a very premature baby for a long period. Even those that do may have their cots full when they are very busy. You may be transferred while the baby is still in the womb to another neonatal unit for a suitable cot, if this is considered better for your baby. Also, if your baby remains well on our neonatal unit they may be transferred back to the hospital where you were initially booked so that another baby that needs intensive care with us can have it.

 Problems Premature Babies May Have

Babies born extremely prematurely have very immature organs. They are at increased risk of problems in later childhood even if they survive the neonatal period. These are some of the potential problems:

• Damage to the lungs (chronic lung disease) causing breathing problems
• Damage to their brain from bleeding or cyst formation (small “holes” in the brain)
• Damage to their bowels
• Damage to their eyes (retinopathy), which may affect their vision
• Hearing problems

Outcomes

Babies born early may be stillborn, may die soon after being born alive, may survive and be healthy or may survive but have long term problems and disabilities. The chance of survival increases with each additional week of pregnancy and the risk of disabilities reduces. The charts below show what proportion of babies fall into each group for babies born at either 22, 23, 24 or 25 weeks.

The information in these charts comes from two large studies (EPICURE 1 in 1995 and EPICURE 2 in 2006), which assessed the outcome of large groups of babies that were born during these weeks of pregnancy in the U.K.

The definitions they used for different types of disability are shown below.

22 Weeks

Only 1 in 100 babies survive with likely severe disability:

23 Weeks

2-3 in 10 babies survive of whom two thirds have moderate to severe disability:

24 Weeks

4-5 in 10 babies survive of whom half have moderate to severe disability:

25 Weeks

6-7 in 10 babies survive of whom 4 in 10 moderate to severe disability: 

 

Mild Disability - Children with mild learning problems or other impairments such as squints, which do not interfere significantly with everyday life

Moderate Disability - Children who have reached a reasonable level of independence, e.g. cerebral palsy but still able to walk, lower than average IQ, hearing loss correctable by a hearing aid, impaired vision without blindness

Severe Disability - Children with problems that require dependency on carer’s, e.g. cerebral palsy preventing a child from walking, inability to feed them, profound hearing problems and blindness.

Choices

There are some important choices that we need to make together.

The Way Your Baby Is Born

In extremely preterm babies there is no evidence that the baby’s health is improved by Caesarean section over a normal vaginal birth. The operation is more difficult very early in pregnancy and when the baby is very small. The two main reasons for not opting for a Caesarean section are that it doesn’t improve how you baby does and it is associated with serious risks to the mother’s health and future pregnancies.

Our usual advice is that Caesarean section is not appropriate before 24 weeks of pregnancy unless the mother’s life is at risk. A Caesarean section may be considered after 24 weeks of pregnancy in specific situations, such as transverse lie (baby lying across in mum’s womb instead of in head down position) because of the associated risks to the baby.

After 26 weeks we would normally offer Caesarean section for all the usual reasons that it would be considered in later pregnancy. Between 25 and 26 weeks some parents may wish the baby to be delivered by Caesarean section if there was evidence of the baby becoming unwell during labour, but some might choose to allow the baby to deliver naturally. We will discuss your particular circumstances with you and help you with this decision

Heart Rate Monitoring For Your Baby in Labour

This is usually advised from 26 weeks of pregnancy a small, safe and non­-invasive device is strapped to mum’s belly to pick up baby’s heartbeat in the form of a trace on a piece of paper). This form of monitoring may be used at 25 weeks following careful discussion with the parents.

Before 26 weeks, we would not normally monitor the baby with heart rate traces unless a plan had been agreed with the parents to consider Caesarean section in labour if the trace showed the baby was developing problems.

What Will Happen When My Baby Is Born?

Preterm babies have all parts of their bodies formed but are very small and thin. Their skin is much darker than a baby born nearer their due date. They can cry when first born but they can also be stillborn. Unfortunately, the earlier the baby is born, the less chance there is of it surviving and being healthy. We are here to help you make the decision about what we should do for your baby when they are born:

22 weeks – Your baby is sadly highly unlikely to survive at this gestation and intensive care is not usually offered.   When intensive care is not offered you will have the opportunity to hold them.  They may be stillborn or there can be signs of life like breathing or a heartbeat that lasts for several hours sometimes.  We will make sure they are not suffering. We understand this is a very difficult time and a senior neonatologist will speak to you, if you request, to discuss your specific circumstances and whether resuscitation and intensive care could be considered.

23 weeks – At this stage of pregnancy, there is greatest uncertainty about the outcome for a baby. Intensive care support will be offered if parents specifically request it and the senior neonatologist present feels it to be appropriate based on your specific circumstances. Otherwise we will wrap your baby up and you can hold them if you wish.

24 weeks – Resuscitation and intensive care support is usually offered unless parents and doctors agree that there is little hope of survival due to other things that have happened in your pregnancy or that have been found on scan.

25 weeks and over – Your baby will be given full intensive care support. They will be helped with their breathing, kept warm, and transferred to the neonatal intensive care unit for ongoing care.

A neonatal team of doctors and nurses (about 4 people) will be present at the birth of your baby. More people will be present if you are having more than one baby. They will involve you in decisions about the amount of medical support that is in your baby’s best interests and will keep you fully informed of your baby’s progress after delivery. If your baby is strong enough they will be transferred to the neonatal unit very soon after birth.

You will be able to see them before they go and will be able to see them on the neonatal unit once they are stabilised. They will not be weighed until they get to the neonatal unit. Fathers sometimes feel excluded from the birth of a preterm baby experience and are often also worried about their partner who can be very ill. The neonatal team will include you throughout the process – please feel free to become involved and ask lots of questions.

Research

Much of the care provided on the unit is based on research about medicines and other treatments.

The unit works to improve the care received by the babies and so we always have a number of research studies open on the unit.

You may be approached about one or more research studies while your baby is on the unit, or before your baby is born.

We hope you will consider allowing your baby to join these studies.

We will respect your decisions about whether your baby joins any studies and it will not affect the care that your baby receives if you decide to not take part.

The unit works to improve the care received by the babies and so we always have a number of research studies open on the unit.

We hope you will consider allowing your baby to join these studies.

We will respect your decisions about whether your baby joins any studies.

Advice and Recommendations

Further information

This leaflet is intended to give you information and answer some of your immediate questions. Please feel free to discuss any further questions and concerns with your midwife or doctor. The following resources may be useful:

Bliss – www.bliss.org.uk

Tommy’s – www.tommys.org

EPICURE – www.epicure.ac.uk

Nuffield Council for Bioethics – www.nuffieldbioethics.org

The leaflet is detailed below, or you can download the 'Feeding your baby on the Neonatal Unit' leaflet in PDF.

Breast milk

Breast milk is best for all babies. It is especially important for babies who are admitted to the neonatal unit. If you had planned to bottle feed your baby, this is still possible and you will be supported with this.

However we strongly recommend that you express your breast milk so that it can be given to your baby.

Why breast milk?

Your baby may be born prematurely, or have an antenatally diagnosed condition which will require care on the neonatal unit.

Breast milk contains antibodies and lymphocytes that boost your baby’s immunity and will help your baby to resist infections. Your breast milk is specifically tailored to your baby therefore you will make the appropriate antibodies and immune cells in your milk.

Breast milk is also much more easily digested than formula and is safer for your baby’s tummy.

As your baby grows, breast milk will continue to provide many health benefits that cannot be replicated in formula milk. Breast feeding / breast milk reduces your baby’s risk of:

• Infections, with fewer visits to hospital
• Childhood leukaemia
• Sudden infant death syndrome (SIDS)
• Diarrhoea and vomiting
• Childhood obesity
• Atopic diseases (asthma, eczema)
• Cardiovascular disease in adulthood

Benefits for you

When your baby is admitted to the neonatal unit, you may be separated from them in the initial period following delivery. Understandably, this can be a difficult and emotional time. You can begin expressing straight away and the sooner you start the better. This is something that only you can do for your baby and can be very comforting.

Depending on your baby’s gestation, or antenatal diagnosis, it is sometimes recommended that you begin expressing (colostrum harvesting) before your baby is born. Please ask your midwife for more information and it is important that you don’t start expressing without guidance from your midwife first due to the risk of induced labour. 

Breast feeding and making breast milk also has health benefits for you.  The more you breast feed / express, the greater the benefits. Breast feeding lowers your risk of:

• Breast cancer, Ovarian cancer.
• Osteoporosis (weak bones)
• Cardiovascular disease
• Obesity and type 2 Diabetes

How to express

You will be given an expressing pack antenatally if possible, or as soon as your baby is admitted to the neonatal unit.  This contains a starter pack for hand expressing and information on how to use  the breast pumps. 

Breast pumps can be hired or purchased from many retailers, however whilst you and your baby are in hospital, breast pumps are provided. If you are discharged home before your baby, the neonatal unit can loan you a portable pump to use at home. There is no charge for this service.

Further information

Regardless of your intended feeding method, whilst your baby is receiving care on the neonatal unit, you can express your milk. This is highly recommended for your baby’s health. Please ask your midwife, your baby’s nurse, or the infant feeding team for more information and support.

The leaflet is detailed below, or you can download the 'My baby may have an infection – what does that mean?' leaflet in PDF.

This leaflet describes the treatment and tests for suspected or proven infection in a baby within 72 hours of birth. This is called “early onset neonatal infection”. Please ask your midwives, nurses and doctors if you have any questions.

How are infections in babies treated?

The most important treatment for infection in newborn babies is antibiotics. These are given through a drip. Your baby may need more than one drip during the course of antibiotics. As well as treating infection we will do some tests. These tests will help us work out whether or not your baby has an infection, what type of infection is involved and how long we need to continue the antibiotics for.

Other treatments are sometimes needed to help the breathing, heart and other parts of the body.

Your baby may need to be in a special care baby unit (SCBU) or neonatal intensive unit (NICU) at the start of treatment. If a baby is very well s/he may be able to spend some time with you during the course of antibiotics. If the baby is at all unwell then s/he will need to stay in SCBU or the NICU. On rare occasions some babies need more help than usual and need to be transferred to another hospital. Your healthcare team will tell you if this is a possibility.

Risks from early onset neonatal infection

Early onset neonatal infections in babies, whilst uncommon, can be very serious. With prompt and appropriate care, most babies will make a full recovery. 

Sadly, a small number of babies with early onset neonatal infection will die – approximately 1% or one in every 100 babies.  Approximately 20% or one in every 5 babies who recover from their early onset neonatal infection will have long-term disability and all will require a longer stay in hospital. The risks are higher if treatment is delayed or not started.

Treating your baby means they are more likely recover without any major complications.  Starting treatment as soon as possible can also reduce the amount of time spent in hospital.

Antibiotics for early onset neonatal infection

The two main antibiotics used to treat early onset neonatal infection are Benzyl Penicillin and Gentamicin, although sometimes different antibiotics are required.  The risks of treatment with antibiotics are very low. Benzyl Penicillin and Gentamicin, which in combination are highly effective at targeting the most common causes of early onset neonatal infection, are two of the antibiotics most commonly given to newborn babies.

Benzyl Penicillin is a very safe drug to use in babies - newborn babies are not allergic to penicillin like some older people are. The risks of Gentamicin are also small, but include hearing problems and kidney problems. We can reduce these risks by doing blood tests on babies to check the level of gentamicin. If your baby is well enough to stay with you during the treatment with antibiotics and does not need admission to SCBU or NICU, then s/he will receive the above two antibiotics for the first 2 days and then these will be changed if necessary based on the results of the tests.

Some people are concerned that giving antibiotics to babies can increase the risks of diseases such as eczema and asthma. However, there is no proof that antibiotics cause these problems.

The risks of infection are much greater than the risks of antibiotics. Experts, including your healthcare team, have looked closely at the evidence which shows that it is better to give a baby with suspected early onset neonatal infection antibiotics and then stop them as soon as it is safe.

What tests are needed?

If the healthcare professionals suspect your baby has an early onset neonatal infection, they will carry out some tests to find out the type and cause of the infection.

Blood cultures are used to detect infection in the bloodstream and establish the type of germ responsible for causing the infection. A small sample of blood is taken from the baby, usually extracted using a needle.  The sample is then sent to the laboratory where it can take up to 36 hours for bacteria to grow.  A C-Reactive Protein (CRP) test is done at the same time as the blood culture to measure a specific protein in the blood. CRP levels rise in response to inflammation so this can show whether infection is present and how an infection is responding to treatment.  Only 0.5mL of blood is taken for these tests – one tenth of a teaspoon.  Around 18 – 24 hours after the first tests, we will repeat the CRP.

A lumbar puncture (also called a spinal tap) may also be needed to test for meningitis. Meningitis is a rare but serious infection and results from this test ensure babies can be treated with the right antibiotics, if needed. During a lumbar puncture a small, hollow needle is placed between bones in the baby’s back. This allows us to take fluid from around the nerves and the spine. We get the main results within 24 hours. More detailed results can take 3 – 5 days.

Other tests may also be performed, for example a chest X-ray to obtain a picture of your baby’s lungs to look for signs of infection.

The results of these tests will be used to determine whether your baby has a definite infection.

When will you get the results of the tests?

By 36 hours, we will have a good idea what is going on. If the blood culture is negative (that means no important bacteria have grown from baby’s blood in the lab) and the CRP is normal (that is there is no sign that your baby is fighting infection) and your baby is well, then we may be able to stop the antibiotics.

If your baby turns out to have an infection, we will get more information between 3–5 days after the antibiotics were started. Most babies need antibiotics for 5 – 7 days. Some babies will need more blood tests.

If your baby appears well, shows no sign of infection and the tests are all clear, then antibiotics can be stopped after 36 hours.

Can I hold and cuddle my baby during treatment?

During the treatment, as long as your baby is well enough, you will be encouraged to hold and cuddle your baby. We will tell you if your baby is not well enough to be held or cuddled.

Can I breastfeed during treatment?

Yes, if your baby is well enough to feed. If your baby is not well enough to feed then we will help you to express your breast milk if that is what you want to do.  The nurses can help you with this.  If you are not breastfeeding your baby, you will be able to feed your baby if s/he is well enough.

When can the baby come home?

Once your baby is well enough and finished the antibiotics, you can discuss going home with the doctors looking after your baby.  There may be a number of other factors which influence the time you or your baby can go home. 

Your baby’s healthcare professionals are able to provide you with further information including what signs to look out for (see below) and who to contact if you are concerned. If you do have concerns once at home then seek medical advice urgently.

Will my baby have problems in the future?

If the antibiotics were stopped after 36 or 48 hours, then your baby did not have an infection after all. We do not expect these babies to have any problems due to early onset neonatal infection as they grow up.

If the antibiotics are carried on for more than 48 hours, it is possible that your baby has an infection. Mild early onset neonatal infections do not cause problems in later life.

A few babies who have a serious infection have problems in later life. A serious infection involves being on a ventilator for more than 24 hours, or needing extra medicine to help the heart beat stronger. Meningitis is a serious infection. If your baby has a serious infection your health care team will discuss any long-term implications with you.

Future pregnancies:

If your baby had a Group B Strep infection, then in all future pregnancies you should be given antibiotics during labour. This is because there is an increased risk of a future baby developing early-onset neonatal infection if a previous child has had a definite GBS infection. You should make sure that you inform your midwife and GP that you have had a previous baby who had Group B Strep infection.

In all other cases future pregnancies should not be affected.

What should I look out for after we go home?

You should look out for:

• Altered behaviour or responsiveness
• Floppiness (altered muscle tone)
• Refusing to feed, vomiting or their tummy looking bloated
• Signs of breathing difficulties
• Being unresponsive
• Excessive crying
• Changes in skin colour
• Abnormal temperature (below 36oC or above 38oC)
• Rapid breathing or pauses in breathing (apnoea)

If you have any concerns about your baby having any of the above symptoms, then seek medical advice (for example, from NHS Direct, your GP, or your local Accident and Emergency Department).

Who can I talk to about my baby’s illness?

Please ask the staff any questions. 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.

P O Box 203, Haywards Heath RH16 1GF. 01444 416176. Email: info@gbss.org.uk  Web: www.gbss.org.uk

Bliss – an organisation that supports families that have had a sick or premature baby

9, Holyrood Street, London SE1 2EL. 020 7378 1122. freephone helpline 0500-618140. Email Hello@bliss.org.uk Web: www.bliss.org.uk

The leaflet is detailed below, or you can download the 'Risk of having a premature baby delivering between 26 and 30 weeks of pregnancy' leaflet in PDF.

Purpose

This leaflet is written for parents who are at risk of having a premature baby delivering between 26 and 30 weeks of pregnancy. This leaflet contains important information about the possible outcomes for you and your baby and what to expect when a baby is born prematurely.

What happens next?

The obstetrician (a doctor who looks after pregnant women) and neonatologist (a doctor who looks after sick new born babies) will discuss with you what it may mean for your baby if he or she delivers early. If possible you will also be invited to have a look around the neonatal unit where your baby will receive specialist care if delivered early.

With the kind of care that we are able to provide today, the majority of babies born prematurely will survive and do well. However, there are risks associated with babies being born between 26 to 30 weeks and, unfortunately, some babies do not survive or can have long-term health problems. The chance of complications depends on many factors including how many weeks into the pregnancy you are, any abnormalities found on antenatal scans, if it is a single or multiple pregnancy, if there is any infection present and how strong your baby is when they are born.

For all women at risk of a premature delivery we consider the following

• Ultrasound scan: to look at the length of your cervix and to look at your baby’s growth and well-being
• Antenatal steroids: we will give you steroid injections to help the development of your baby’s immature lungs
• Magnesium sulphate: we will give you an intravenous medicine to help protect your baby’s immature brain from injury

Outcomes

Most babies born after 26 weeks survive but a small number do not. For some of those who do survive, being born prematurely will mean that they have significant lifelong challenges or disabilities. The chance of survival increases with each additional week of pregnancy and the risk of disabilities reduces.

26 weeks: 8 out of 10 babies survive. Out of those that survive, 1 in 10 will have severe disability such as cerebral palsy, learning difficulties and problems with hearing and vision.

27 to 30 weeks: Approximately 9 in 10 babies survive and the risk of severe disability reduces with increasing gestation. However, babies who survive are still at slightly increased risk of long term mild to moderate disability.

What will happen when your baby is born:

•  A neonatal team made up of doctors, nurse practitioners and nurses will be present at your delivery. We know that it is better to leave the umbilical cord intact for the first two minutes after a baby is born. The team, when possible, will help your baby during this period on a small resuscitation trolley at the bedside called the Lifestart trolley. This means that you will have the opportunity to see your baby and what is happening during those first few important moments of life. A member of the team will explain what is happening so that you are not upset by what you see.
•  They will assess your baby when they are born and support their breathing and circulation if necessary. The earlier your baby is born, the more likely it is that they will need some help with their breathing.
•  The neonatal team will keep you informed of your baby’s progress. Once your baby is stabilised, if possible the team will offer you cuddles with your baby before transferring them to the neonatal unit.
•  On the neonatal unit they will be weighed, and monitors will be attached so that we can measure their heart rate and oxygen levels. They will need to have some intravenous lines put in to give them fluid and medicines. Some bloods tests and x-rays will be done. Premature babies are vulnerable to infection and therefore usually receive antibiotics shortly after birth. You will be able to see your baby on the neonatal unit as soon as these things are done.
•  Partners can sometimes feel excluded from the birth of their baby and are often also worried about their partner. The neonatal team will try and include you as much as possible - we want both mothers and fathers to feel free to ask questions and be involved as much as possible in the care of their baby.

Problems premature babies may have:       

Babies born prematurely have immature organs and are, therefore, at risk of problems at birth and later in childhood. Some of the potential problems include:

Feeding

•  Babies born prematurely have immature guts and require intravenous nutrition for a time while we slowly increase their milk feeds.
• We actively support a mother’s choice to breastfeed her baby whenever possible. Breast milk is the best option for your premature baby as it is much easier to digest and helps protect your baby from inflammation of the bowel and infections.
•  Very small babies only need tiny amounts of milk to start with. We will support you to express and provide facilities to do so. It is perfectly safe for your milk to be frozen and stored until the time when the baby needs it.
•  We do, however, also understand that the neonatal unit 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 stored and given to babies whose mothers may not have enough breast milk.

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

Research

Much of the care provided on the unit is based on research about medicines and other treatments. The unit works to improve the care received by the babies and so we always have a number of research studies open on the unit.

 You may be approached about one or more research studies while your baby is on the unit. We hope you will consider allowing your baby to join these studies. We will respect your decision and it will not affect the care that your baby receives if you decide not to take part.

 

 

The leaflet is detailed below, or you can download 'Why does my baby need a chest drain' leaflet in PDF. 

The lungs are 2 cone-shaped organs and are protected by a smooth covering called pleura that allows the lungs to expand without rubbing on the inside of the rib cage. There is a small space between the lung and the rib cage called the pleural space. The pleural space can be filled up with air, fluid or blood because of lung disorders, an

operation or due to mechanical ventilation. A build-up of air, fluid or blood can stop, one, or both lungs from completely inflating which will affect your baby's breathing and could require them needing a chest drain if there is a:

• Pneumothorax - an air leak in the lungs. It is when air is trapped in the space which adds extra pressure on the lung(s), causing them to collapse. This leak may start suddenly, or it may develop slowly over time.
• Pleural effusion when there is a build-up of fluid in the space.
• Haemothorax, if the pleural space is filled with blood.

Signs your baby may need a chest drain  

Your baby will be carefully monitored and is likely to have had a significant increase in their oxygen or ventilation requirement, have increased breathing effort, may have bluish discolouration of the skin and or lips. Transillumination of the chest using a cold light source may be performed to inspect the area surrounding the lungs for free air.

In an emergency, if your baby’s breathing is laboured or the circulation of blood is affected, the air must be removed from the chest cavity by using a needle and syringe, which is done at the bedside, as an emergency and by an appropriate trained person. Otherwise, a chest x-ray will be performed, first to confirm if there is any collection of air or fluid. If there is a large amount of collection, a chest tube will be inserted in the pleural space to reduce the pressure from the lung(s) and allow the lung to re-inflate.

The team will inform you if your baby needs chest drain insertion.

What is a chest drain?

A soft and flexible plastic tube will be inserted in a small incision made in the side of the chest, into the area between the lung and the chest wall. The soft plastic tube will be held in place with steri-strips and transparent dressing.  Steri-strips are narrow adhesive strips that help to close the edges of a small wound. The tube will be connected to a collecting container and may have suction applied to help air or fluid to drain.

Chest drain procedure

A Doctor or an Advanced Neonatal Nurse Practitioner (ANNP) will perform the insertion of the chest drain. This is carried out under sterile condition while your baby is still in its incubator. Your baby will be given local pain relief and medicine to make them comfortable. After the procedure, your baby will have an x-ray to check the position of the tube and to make sure that the lung is re-expanding, and will be given pain medication regularly. They will also be monitored continuously with respect to their breathing and oxygen requirements and pain / discomfort.

Are there any risks?

Though there are risks with any procedure our team will carefully monitor your baby for signs of infection, bleeding, the drain falling out or becoming blocked while the chest drain is in place. The amount of fluid will be carefully measured and recorded.  

What can we do for our baby?

You can continue to spend time with your baby, take them out for cuddles and attend to their cares and feeds whilst the chest drain is in place, our team will assist you as you care for your baby. The length of time the chest drain will stay in place will depend on your baby's condition, response to treatment or if there is no more air or fluid draining from the chest. 

Removal of chest drain

Once your baby’s condition is stable and there is no drainage from the tube, the tube will be clamped for several hours before it is removed. The insertion site will be held together with steri-strips and protected by sterile dressing. You can stay with your baby during the procedure but if you choose not to that is fine too.

Your baby will be continuously monitored for any untoward signs of re-accumulation such as increase work of breathing, increase in oxygen requirement or restlessness.  The insertion site will be observed for any signs of infection. Most babies with chest drain recover with no long-term effects such as infection, injury or trauma on the chest wall. The incision will leave a small scar once it has healed but it will not affect your baby’s development.

If you have any questions or if there is anything you do not understand in this leaflet, please do not hesitate to speak to the Neonatal team.

 

 

 

The leaflet is detailed below, or you can download the Active surveillance of 'Donor Breast Milk' leaflet in PDF.

This information leaflet is based on ‘Guidelines for the establishment and operation of human milk banks in the UK’ UKAMB (United Kingdom Association for Milk Banking)

What is Donor Breast Milk?

Donor breast milk is breast milk expressed and donated by a mother that is then processed by a donor milk bank to be given to your baby. It is the next best milk to your own.

Which is the best milk for my baby?

Your own breast milk is the best milk for your baby. Preferred second choice is donor breast milk, although we understand that producing a lot of milk in the first few days may be difficult in some mothers.

Why and when to use Donor Breast Milk

For babies who can receive donor milk it is a precious resource so its use is concentrated on babies who will benefit most. These include:

• Premature babies born before 30 weeks or weighing less than 1500grams
• Those who have had surgery on their intestines (their guts)

Breast milk is more easily digested than formula milk and it helps protect your baby from infection. There is evidence that breast milk reduces the risk of Necrotizing Enterocolitis (NEC) which is a condition that can affect the bowel of preterm infants and which can make babies very unwell.

Whilst waiting for a mother’s milk supply to come in, donor milk is often the preferred alternative. It is sometimes normal for milk production to be very slow and minimal in the first few days following preterm delivery. We will continue to provide you support to express your own breast milk and use alongside donor milk for your baby. Expression of breastmilk should be started as soon as possible after birth, ideally within the first 2 hours.

We will ask for your consent before administering donor milk usually before 24hours of life as early feeding is important for baby to start feeding early. This is also because donor breast milk still contains many protective factors which help protect premature babies from infection. Protective factors are not present in formula milk which is prepared from cow’s milk.

Is Donor Breast Milk safe?

Donor mothers must meet strict health and lifestyle criteria and are required to have blood screening tests. Donor mothers have been shown how to express, collect and store their milk cleanly and safely. In addition, donated milk is tested for bacteria and pasteurised (heat treated) for added protection.

What Screening takes place?

Donor mothers are screened for:

• Lifestyle
• Previous Medical History - previous blood transfusion, chronic or acute medical conditions requiring medication, family history of TB, family history of Creutzfeldt–Jakob disease [CJD] (however there is no evidence that CJD is transmitted through breast milk)
• Infections/ Blood born infections - HIV 1 and 2 (viruses causing AIDS), hepatitis B and C, HTLV I and II (Human T- lymphotropic virus), Syphilis.

What is Lifestyle Screening?

A donor mother does not:
• Smoke
• Drink more than small amounts of alcohol
• Drink excessive number of drinks containing caffeine per day (coffee, tea or cola)
• Receive certain medications (traditional or herbal)
• Take Illegal/illicit drugs

What if I have more questions?

Talk to a member of the medical team or nursing team if you have questions about the use of donor human milk for your baby. Advice and support can be obtained from both midwifery and neonatal staff.

References

• National Institute for Health and care Excellence (NICE) (2010) Donor Milk banks: The operation of donor milk bank services https://www.nice.org.uk/guidance/cg93/resources/donor-milk-banks-service-operation-pdf-975747675589
• UKAMB (UK Association of Milk Banks) www.ukamb.org

 

 

 

 

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

Welcome to the neonatal unit at Liverpool Women’s Hospital.  As a team, we look after babies from the local area who require general neonatal care, as well as babies from the wider North-West and North Wales who need advanced treatments that only specialist centres such as us can deliver. 

If your pregnancy has been booked elsewhere, but your baby has been delivered here due to reasons of your own, or your baby’s, health, we will aim to transfer your baby back to the care of your booking hospital as soon as their level of care has reached that which may be delivered in your local neonatal unit.  Transfer back to your booking hospital is important to allow their team to get to know you and your baby, and to organise your baby’s post-discharge care plan.

If your pregnancy has been booked at Liverpool Women’s Hospital, we will aim to complete your baby’s admission on the neonatal unit here.  However, there are occasionally times when the unit becomes so busy, or the number of babies requiring intensive care increases to such a level, that the admission of further babies would compromise the care we can safely deliver to all babies on the unit.  In situations such as these, we would seek to transfer out any baby whose care may be alternatively safely delivered at a local neonatal unit, so that, like we did for your baby, we can offer intensive care to other babies.  This is so we may remain able to provide the specialist level care that families and babies from across the North-West and North Wales may urgently need.  In the rare event of this occurring, we will do our best to ensure that the unit your baby is transferred to is as close to home as possible.  We would also aim to accept them back to our care when the pressure on our service resolves.

If your baby is being transferred for any reason, we will closely liaise with the unit receiving your baby, to ensure comprehensive handover of their medical and family history, and ongoing care needs.  We understand that moving to a new unit can be a worrying step – all our transfers are carried out by a specialist neonatal transport team, who are experienced in caring for babies during transfers.  If possible, we would encourage, and can help facilitate, visiting the new unit for your baby prior to their transfer, in order get to know the new team and environment, and to tell them about your baby in your own words.

Whenever we transfer a baby to a local neonatal unit, we hope that they will not require intensive care level treatment again.  However, due to the unpredictability of neonatal care, we know this is not always the case.  If your baby should become unwell or need to return for specialist care from our team, we will readily accept them back for continuing care, and we will be sensitive to your concerns when the times comes again for transfer back to your local unit.

We understand discussions about transferring your baby may be difficult for you, and if you have concerns, please feel free to discuss them with the team.  Please consider, however, that your baby’s admission here may not have been possible without the same policy being applied to families before you.