THE NEONATAL UNIT (NNU) Information Leaflet
Your Health. Our Priority.
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Neonatal Unit, Women’s Unit | Stepping Hill Hospital
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Contents Congratulations on the Birth of your Baby................................................................... 3 Finding us ................................................................................................................... 3 Prevention of Infection ................................................................................................ 3 Visiting your Baby ....................................................................................................... 4 Why Your Baby is on the Unit ..................................................................................... 4 The Staff Caring for your Baby.................................................................................... 5 Radiologists and Radiographers ................................................................................. 5 Opthalmologists .......................................................................................................... 5 Immunisations ............................................................................................................. 5 Hearing Screening ...................................................................................................... 6 Physiotherapist ........................................................................................................... 6 Head Scans ................................................................................................................ 6 Religious Support ........................................................................................................ 6 Bliss ............................................................................................................................ 6 Caring for your Baby ................................................................................................... 7 Touch ………………………………………………………………………………………….7 Kangaroo Care............................................................................................................ 7 Feeding your Baby ...................................................................................................... 7 Pacifiers/Dummies ...................................................................................................... 9 Pain Relief................................................................................................................... 9 Equipment Used ....................................................................................................... 12 Photographs.............................................................................................................. 15 Mobile Phones .......................................................................................................... 15 Toys .......................................................................................................................... 15
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Registering your Baby ............................................................................................... 15
Congratulations on the Birth of your Baby We know that this is a very worrying time for you, having your baby on the Neonatal Unit and being separated from him/her. At the moment your baby requires all the love and attention that you can give, but also the specialist medical care that we can give. This booklet has been written by the staff on the unit to answer some of the questions that you may have. If there is anything else that you would like to know, however small it may seem, please ask. Direct Telephone Line to the NNU 0161 419 5520 Please feel free to phone at any time of the day or night, if you wish to know how your baby is. For security purposes we will only give information to parents.
Finding us The Neonatal Unit is part of the Child and Family Services at Stepping Hill Hospital. The entrance to the hospital is off Bramhall Moor Lane directly opposite Sainsbury’s Hazel Grove. The Unit is situated on the ground floor of the Maternity building. Buses to the hospital from Stockport are 192, 375, and 391. Hazel Grove and Great Moor train station are within walking distance to the hospital. In order to maintain your baby’s safety, the unit is locked and access permitted through an intercom system. Please be patient when waiting for someone to answer the intercom, as staff will not always be able to leave the baby they are looking after to answer the door.
Prevention of Infection Premature or poorly babies can be vulnerable to infection it is important that we maintain very high standards of hygiene.
Please make sure you and your visitors use the alcohol hand gel before entering the ward
Please remove the outdoor coats or work clothing and leave on coat hook in the patients lounge. (Remember to remove any valuables and place in a locker
On entering the nursery it is important to remove watches, bracelets, and rings and roll sleeves up to your elbow before washing your hands in hot soapy water. (Please follow steps on the soap stand) this is to remove any germs that the gel may not kill
Gel should be used again if you touch anything before you touch your baby. It should also be used after handling your baby to protect the staff and other babies on the unit
Please wash your hands with soap and water after nappy changes as gel will not remove any faeces on your hands.
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Visiting your Baby You are welcome to visit your baby anytime. Doctor’s rounds usually start in the intensive care nursery at 9am- and 11am approx. However these can sometimes last longer depending on the number of babies on the unit. Nursing shift changes morning 07.00 -07.15 Lunchtime 12.00 – 12.15 Evening 20.00 -20.15 There may be times at the discretion of the Nurse in charge, when you may be asked to limit your visiting further. Other relatives and friends may visit your baby between 5pm – 7pm but you must be with them for security reasons. DO NOT ALLOW ANY ONE TO VISIT WITH A COUGH OR COLD OR WITH SIGNS OF. DIARRHOEA OR VOMITING. This is for the protection of all babies on the unit. We request only 4 visitors per cot in order to minimise infection risk and also for access in case of emergencies. This also helps keep noise to a minimum. Brothers and sisters of your baby can visit with you but no other children are allowed. This is to protect your baby from infections carried by school age children. Children must be supervised at all times.
The Environment The nurseries have been designed with your babies’ development in mind; we will try to keep noise levels down so that babies can get into a deep sleep. This will help them to grow. The lighting is also kept at lower levels so that when awake your baby can open their eyes. It is best to allow your baby to sleep for as long as possible. If they wake and are unsettled you will be shown how to settle your baby using containment holding. If your baby is awake and looking round one of the best things you can do is talk gently or read to them. If they are in an incubator speak to them through the open incubator door, so that they can focus on your voice. Research has shown that having established periods of quiet time during an infant's day can be beneficial to their development. During quiet time the general daily bustle of the ward will be actively reduced. You are welcome to spend this time providing kangaroo care, skin to skin care for your baby.
Why Your Baby is on the Unit There are many different reasons why new born babies come to the Neonatal Unit; most will need to be admitted because they have been born too soon. Some because they are sick or require closer observation. If your baby requires an operation or more specialist intensive care treatment they may have to be transferred to a surgical or specialist hospital. It is very important that you know why your baby is with us. Everything will be explained to you but please remember that this is your baby and to ask as many questions as you
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wish. We recognise that having an ill baby on the NNU may be overwhelming and that you may need time to adjust to both the environment and all the information that is given to you. Remember to write down any questions you think of on the green communication sheet in your baby’s file, so that you don’t forget them, and don’t worry if you have to ask the same thing more than once, we recognise that there is a lot to take in.
The Staff Caring for your Baby We have a dedicated team of nursing staff on the unit. These include nurses, and assistant practitioners. All staff are specially trained to care for sick new born babies; however due to shift patterns and skill mix it is not always possible for the same nurse to care for your baby. We also have students allocated to the unit, all of whom are supervised by qualified staff. Your baby will have a named Consultant that will take responsibility for the care of your baby and follow them up after discharge if required. If you wish to make an appointment with your Consultant to discuss your baby’s care Please ask the nurse who is looking after your baby and she will arrange it for you. There will be a Consultant available to oversee the day to day care of your baby every day. Working with the Consultants is a team of doctors known as Associate Registrars, Specialist Registrars and Senior House Officers (SHO’s). You will see different doctors caring for your baby, as they work on a shift system similar to nurses. We also have a housekeeper who makes sure the unit is clean and tidy and everything is in its place, especially for emergencies. The ward clerk will often answer the phone when you call and let you in when you buzz the intercom.
Radiologists and Radiographers Many of the babies admitted will require x-rays or scans; these will be performed by specially trained staff. Parents and visitors are requested to leave the room while x-rays are being taken.
Opthalmologists Babies under 32 weeks’ gestation or less than 1500 grams in weight have their eyes examined to make sure that they are developing correctly. The first examination is usually at 4-5 weeks of age. Then if necessary, weekly or fortnightly examinations are carried out until the ophthalmologist discharges your baby. This may be after discharge.
Immunisations Any baby still in hospital at 2 months old is offered immunisations. All other babies will have their immunisations at their GP surgery. There is no need to delay the immunisation dates.
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Hearing Screening All babies in Stockport undergo hearing screening. This will be carried out on the unit, when your baby is 36 weeks, or as close to going home as possible when they are no longer requiring tube feeds.
Physiotherapist Visits the ward weekly, undertakes neurological / developmental assessment on babies referred that are less than 30 weeks gestation at birth or weight less than 1500g and advises on positioning. Babies that have been assessed are followed up by the physiotherapist on discharge.
Head Scans Some babies will have a scan of their heads to make sure the structures of the brain are developing correctly; these are carried out on the Thursday nearest to your baby’s birth and two weeks following this. You will be informed if your baby is to have a scan. The senior doctor will usually discuss the results with you the following day, however if you require further information please speak to a nurse or doctor on the unit.
Religious Support Ministers of all religions are available to offer support and help if you would like it. The nurse looking after your baby will be able to arrange this for you. If you would like your baby to be baptised or blessed, this can also be arranged. Your own minister or priest is welcome to visit the unit with you.
Bliss Bliss champions are volunteer parents who visit the unit regularly. They are available to provide a listening ear or support to other services offered by Bliss the baby charity. They can also help with information about the unit and the transition to home. Their visiting times are displayed on their board in the parent’s kitchen. The Buddy is also a parent volunteer trained by the charity Bliss to provide telephone support. To contact them telephone 0161 234 2788.
Family and Baby (FAB) Each week a support worker from the local children’s centre visits the unit. She will help develop links with your local centre so that you are aware of support services that are available after your baby has been discharged. She also provides a support group for babies that have been in neonatal care on a Monday afternoon at Hazel Grove Children’s centre. More details of the group will be given to you at discharge. There is also a support group available in Buxton run by one of our Bliss Champions.
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Caring for your Baby Touch When your baby is born your first instinct will probably be that you want to touch them. This is completely natural; your instinct may be to gently stroke your baby. However extremely premature babies can be sensitive to touch. If you wish to touch your baby (making sure your hands are not cold) then gently place your hand on their back or tummy and on their head. If you are not comfortable doing this, put your finger in your baby’s hand. (Please read Bliss your special Care Baby Leaflet page 32 for more information) While your baby is in Intensive care only parents should touch and handle babies to minimise the infection risk. Try not to over stimulate your baby; letting them have time out when they can rest, sleep and grow. Once your baby is well enough to be nursed in a cot in the special care nursery you can allow grandparents to cuddle your baby after you have taught them to wash their hands correctly. Remember your baby is still quite frail so try to minimise the amount of people handling them. Once your baby is stable a nurse will show you how to perform cares; this is what we call changing their nappy or performing mouth care. When a baby is extremely premature this can look like a daunting task. The staff will help you to become confident in performing cares at your own pace. Parents contact is much more soothing for the baby than different staff as they will recognise your voice and smell. (For further information see page 36 your special care Baby Leaflet.)
Kangaroo Care This is when your baby is nursed against your chest with the baby’s skin in contact with yours. This is also sometimes known as Skin to skin care. Kangaroo Care has many benefits for you and your baby. There is a leaflet and DVD available that will explain this in more detail. Please ask the staff looking after your baby if you have not already been given this.
Baby Passport In your babies nursing notes you will find your babies passport. This is designed so that you can keep a record of any milestones your baby achieves during their stay. This may be something as small as their first drop of your milk to having their first cuddle you decide on the milestones and there are stickers to remember the date and times by. You can then take some of the passport home as a record of your babies stay.
Feeding your Baby During your baby’s stay with us they will be fed in different ways depending upon your baby’s age, weight and how well they are.
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Breast Feeding Breast Milk is the easiest milk to digest if you baby is early or sick One of the best ways that you can help your baby is to provide them with your breast milk. If your baby is not feeding fully you may be asked to express your breast milk. You will be shown how to hand express and how to use an electric pump. You will be given a diary to record your breast milk in and help you see how it increases over the first few days and weeks of expressing. Labels and Tamper proof lids are provided for your breast milk bottle. The first 14 days you replace the white lid on the breast milk bottles with a yellow tamper proof lid this is to make sure the colostrum is used first. After the 14 days you change to a green lid thereafter. We also sometimes offer babies a cup feed if you they are awake and you are not available to breast feed.
Tube Feeding If your baby is too small or too tired to suck, a tube is passed through your baby’s nose or mouth into their stomach. A small piece of protective dressing is applied to your baby’s face and the tube is then secured to this using tape. To begin with small amounts of milk are given down this tube every hour. Then as baby improves milk is given every 2 hours then every 3 hours until your baby is fully fed. You can be taught how to tube feed your baby as soon as you wish to be. Please ask the nurse caring for your baby. We have a number of different techniques to help your baby achieve which ever method of feeding you have chosen. See the Best Start leaflet in your admission pack. The unit can provide breast pumps for you to use at home. We do ask for a small deposit of £5, refundable on return of the pump. Help and advice are readily available from staff.
Expressing Room This room is for mums who would like privacy while expressing their milk and the milk is then stored in the fridge or freezer in the milk kitchen. However if you wish to express next to your baby the breast pump can be wheeled to the cot side and screens provided for privacy.
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Bottle Feeding It is advisable to express breast milk for your baby even if you are aiming to bottle feed at a later date. As breast milk is easier for your baby to digest. However you may choose not to express milk and depending on how early your baby is will dictate whether they need a specialised formula that contains extra calories for growth or even the use of donor breast milk. If donor breast milk is advised a full discussion will take place between yourself and your baby’s doctor. You have to give consent before donor breast milk can be used. Your baby may not be able to co-ordinate sucking, swallowing and breathing in the right order at first so you will be taught how to safely feed your baby with a bottle. It is important to teach your baby how to feed from your own bottles as soon as possible. Please discuss which teats are suitable for your baby before you purchase any.
Pacifiers/Dummies Preterm babies who are tube fed are not provided with the opportunity to suck nutritively. Pacifiers / dummies help babies to learn to suck; they can also be used to aid pain. They will be removed once your baby is feeding either at the breast or the bottle if you would prefer. We will request your permission before we give any baby a pacifier.
Pain Relief We aim to reduce as much pain and stress to your baby during their stay on the neonatal unit. We have different methods that we use in order to achieve this. This varies from comfort holding to the use of breast milk or Sucrose on your baby’s tongue, the effect of which can be increased with the use of a pacifier or at the breast. Sucrose is a weak sugary solution which evidence has shown should not affect the development of your baby’s teeth. In some cases specific pain medication may be prescribed.
Attachment To help your baby attach to you it is helpful to provide either a small blanket or muslin cloth. If you keep one with you to help you when you express and keep the other with your baby. You can swap them around when you visit to provide you both with each other’s scent; while your baby is small their sense of smell is more highly developed than their eyesight What can I bring in for my baby: If you would like to provide cotton buds to soak in milk or water for mouth care. Nappies/ Nappy Sacks Wipes/ cotton Wool Clothes A small toy Please make sure everything is labelled as the hospital cannot take any responsibility for any items being misplaced The unit provides clothes but if you wish to bring your babies clothes in, please let one of the staff know and ensure that they are labelled with baby’s name. Your baby will be provided with a small bag in which dirty laundry will be placed for you to take home and wash.
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Basic nappies are supplied for your baby but if you wish to bring in more comfortable nappies then please feel free to do so. We do not use wipes on the babies for the first weeks but after that feel free to do so.
Progression through the Unit When your baby is first admitted, they will usually be cared for in the Intensive Care Nursery. As the condition of your baby improves they will progress into the Special Care Nursery. The decision to transfer your baby to special care may be made quite suddenly but we will do our best to forewarn you. Decisions are often made around your baby’s improvement in condition as well as safe staffing levels Once your baby is progressing well in special care and no longer needs monitoring and is starting to take a number of feeds well you may be asked to come and stay with your baby in the transitional care unit
Transitional Care Unfortunately due to the size of the unit and safety reasons partners are unable to stay overnight. However they can spend all day with you and your baby. Please use the kitchen and sitting room areas as you would at home in order to get your baby accustomed to normal light and noise levels. Mums can utilise this facility around their family’s needs.
Rooming in Once a decision has been made to discharge your baby home you may wish to take up the offer of you and your partner staying in one of our three parent’s rooms, so that you become accustomed to your babies needs at night. This facility is optional and can be used for a number of nights until you are fully confident you can care for your baby at home.
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Bedrooms are comfortable and well fitted out with bedroom furniture, television, en suite shower and toilet. Meals are provided for parents rooming in
Patient Kitchen
The kitchen is where parents can make themselves at home. Tea / coffee / juice are provided. Parents may bring their own food in. All parents’ food must be labelled and dated and kept in the fridge. (No hot drinks on the ward please). The lounge area has a television and a play area for siblings. Parents must supervise their children at all times.
Parents Lounge
This is an area where there are lockers to keep valuables in and the hang your outdoor clothing. There is also a coffee machine. Please place your money for the drinks in the box at the side. This pays for the replenishment of the machine without having to use money from the budget that could be used for items for the babies on the unit. This area can be used to meet friends and relatives outside of visiting times for the babies. This allows you time with your visitors without disturbing the babies.
Court Yard Garden
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The garden is situated opposite Transitional care. Where parents can take some time out relaxing.
Equipment Used Incubator This is a clear plastic covered cot, which provides an electronically controlled environment of warmth and humidity at the same time it allows us to see your baby easily.
You can open the doors and touch your baby. Once your baby is well enough and can maintain their own body temperature, he or she will be moved into a cot or heated crib. This could be after a few days or it could take several weeks.
Monitoring Equipment We have many, sometimes noisy, machines on the unit. Monitors are used to record your baby’s heart and breathing rates, blood pressure and temperature. Some of the monitors measure how much oxygen is in your baby’s blood. Quite often alarms will ring out when the monitor wishes to alert the member of staff to a particular reading. This does not always mean that there is something wrong. Quite often your baby has just moved and this can interfere with the readings.
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These Monitors are linked to central monitors so that your babies nurse can still see if from a number of different rooms. The nurse looking after your baby will explain what each number on the monitor means. Please do not touch any of the alarms yourself. If you are worried, please ask a member of staff. If you would like to know more about the monitors just ask the nurse looking after your baby.
Ventilator
A ventilator is an electronically operated breathing machine which can assist or completely take over a babies breathing if they are too small or too ill to breathe properly for themselves. A mixture of air and oxygen is blown through a tube going into baby’s mouth, down the windpipe and into their lungs to inflate them just as if they have taken a normal breath.
CPAP Driver These are machines that help support your baby’s breathing. Your baby will do all the breathing for his/her self but the CPAP driver helps to keep their lungs slightly inflated. This stops your baby using too much energy to inflate them by themselves. This then makes it easier for your baby to breath. The machine does this by blowing a mixture of air and oxygen through a tube attached to two soft plastic prongs or mask that are put into your baby’s nostrils.
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Optiflow This is Humidified oxygen or air therapy that is delivered at a rapid rate to your baby via nasal prongs. It has been found to ease the work of breathing in some babies.
Phototherapy Lights Babies quite often develop a condition called jaundice and their skin can turn a golden orange colour. It does not always need to be treated but when it does we use a phototherapy light. This is a bright blue light, which is placed over your baby’s incubator or cot. Your baby will not wear any clothes enabling maximum skin exposure to the light. Creams and ointments must not be used on the skin of infants receiving phototherapy. Your baby will wear eye shields to protect their eyes.
Apnoea Monitor
Apnoea monitor is a small pressure pad that is attached to our baby’s abdomen. When they breathe they press against the pad. The monitor will alert the staff if your baby stops breathing.
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Photographs We will give you a digital photograph of your baby when they are admitted to the unit. Please feel free to bring your own camera or phone in to take photographs but you are only allowed to take photographs of your own baby. If you wish to video your baby please let staff know when you are wish to do it so they can protect the confidentiality of other baby’s on the unit.
Car Parking While your baby is with us you can park in the hospital car park for free, please ask the Ward Clerk and she will issue you with a pass. We can only allow one pass per family.
Mobile Phones Please make sure your phone is on silent as we are trying to reduce the noise in the baby’s nursery. If you wish to answer or make a call please use the parent’s kitchen or lounge
Personal Child Health Record Book All babies receive a red child health record book which is used until your child goes to school. You may have immunisations, screening and routine reviews recorded. It also contains growth charts and other information. Mum and Dad can add details in this book too. Please ask staff if you have not received yours.
Toys You may wish to bring in a small cuddly toy for your baby. We will happily keep this in your baby’s incubator. Please label the toy with your baby’s name, the hospital cannot take any responsibility for the toys being mislaid.
Registering your Baby You must register the birth of your baby within six weeks; this can be done at the Town Hall. . For further details on who can register your baby see separate leaflet; “Registering your baby’s birth - A Guide for Parents”.
Our Service to you We are constantly striving to provide and improve our service to you and your baby. We value your opinion so during your baby’s stay with us you will be asked if you would like to complete a Feed Back Leaflet There is also a wishing tree in the parent’s lounge where you can make suggestions for further improvements.
Technical Terms you may Hear
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Antibiotics - Medicine which is given to help fight infection. Apnoea - A period of time when breathing temporarily stops. Bagging - Placing a plastic mask connected to a squeezable bag over the baby’s mouth and nose to help the baby to breathe. Bilirubin - A substance produced from blood cells that causes jaundice and give the skin a yellowish appearance. Blood Gas - A blood test that shows how much oxygen and carbon dioxide are in the blood. The results show how well the baby’s lungs are working. Bradycardia - When the heart rate temporarily slows down. Cyanosis - Lack of oxygen in the blood, which gives the baby’s skin, lips and nails a bluish colour. Drip - When fluids or blood are passed into a vein or artery using a needle or plastic tube. Electrolytes - Essential substances in the body, such as sodium, potassium and calcium which are necessary for life. These are sometimes added to the fluids that your baby receives. Endotracheal Tube (ET tube) - A Soft plastic tube placed down the baby’s mouth or nose into the windpipe and into the lungs. This is connected to a ventilator Extubate - This is the term used when the tube that is helping your baby to breathe is removed, allowing the baby to breathe on his/her own. Expressed Milk - Breast milk which has been expressed either by hand or electrical pump. Gestation - The baby’s age in weeks from your last menstrual period. Grunting - The noise a baby makes when it has difficulty with breathing. Haemoglobin - The part of the red blood cell which carries oxygen, this is also known as Hb. When it is low the baby may need a blood transfusion. Hypoxia - Low amount of oxygen in the baby’s body tissues. IV - An abbreviation for Intravenous (into the vein). Intubate - A tube is inserted into the baby’s airway to help them to breathe. Jaundice - Yellow, golden colour of the skin caused by high levels of bilirubin in the blood. Low Birth Weight - A baby weighing less than 2.5kg.
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Meconium - The first bowel movement that your baby has. Often very thick, sticky greenish looking. NGT or Nasal Gastric Tube – Tube passed by the nose to the stomach for feeding. Neonate - A baby during the first 4 weeks of life. Neopuff - A piece of equipment used to deliver oxygen at a set pressure via a mask. It is used to inflate the baby’s lungs if their oxygen level drops Oedema - Swelling caused by extra fluid in the tissues. Phototherapy - Treatment of jaundice using a light to reduce bilirubin levels. Preterm - A baby born before 37 weeks. ROP - This stands for Retinopathy of Prematurely. ROP is a condition that can affect the eyes of babies born more than nine weeks early. See Sawing –When babies oral milk increases and the fluid given by drip decreases until baby is fully fed hourly. Sucrose – is a sugary solution given to babies for short term pain relief.
Contact us Neonatal Unit, Stepping Hill Hospital 0161 419 5520.
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If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678. Email:
[email protected].
Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more.
Leaflet number Publication date Review date Department Location
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MAT98 March 2015 March 2017 Neonatal Unit, Women’s Unit Stepping Hill Hospital
Neonatal Unit, Women’s Unit | Stepping Hill Hospital
