WHAT INFORMATION IS GIVEN IN THIS LEAFLET?

Welcome to the Neonatal Unit!

Visiting the Neonatal Unit

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Who will be looking after my baby?

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What are Support Services?

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Equipment on the Neonatal Unit

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What will I be able to do for my baby?

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Feeding my baby

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Routine Screening Tests

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Transfers to and from other hospitals

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Family facilities

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Preparing for home

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CUDDLES

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Hospital Facilities

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WELCOME TO THE NEONATAL UNIT Congratulations on the birth of your baby! We would like to welcome you to the Neonatal Unit here at Glan Clwyd Hospital. To simplify things, throughout the booklet babies have been referred to as he/him. This booklet has been created to give parents an overview of the neonatal care your baby/babies may need. We hope it will answer some of your general queries. However, specific questions about your baby are best answered by the nurses and doctors caring for him. Please feel free to ask any questions that are important to you. Babies require admission to the Neonatal Unit (Also called NNU for short) for a variety of reasons. Some need long periods of intensive care, and others require only a short stay before they are well enough to be on the postnatal ward with you, or discharged home. We provide intensive care for babies from all over North Wales. We operate a special retrieval service, which means we are fully equipped to collect babies from other hospitals and bring them to Glan Clwyd to receive intensive care.

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The telephone number for the Neonatal Unit is: 01745 534686 We welcome enquiries from parents 24 hours a day. In order to maintain confidentiality we only discuss details of your baby’s condition with you, the parents. It is helpful for other family members to contact yourselves for information about your baby rather than ringing the unit. This also helps to reduce the number of times your baby’s nurse is called away from caring for your baby. Whilst your baby is a patient he will be recorded under his mother’s surname. This is in order to link baby and mother. It does not affect the name you choose to register the birth. Inside the unit is a board where we write the name of each baby and the name of the nurse caring for that baby each day. This makes it easy for you to see who is looking after your baby. The name board is obviously visible to other parents and visitors to the unit, so if for any reason you do not wish to have your baby’s name on the board, please speak to one of the nurses

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VISITING THE NEONATAL UNIT Our aim within the Neonatal Unit is to provide a family friendly visiting plan, whilst ensuring the safety, privacy and needs of your baby are maintained. Parents are welcome to visit the unit at any time. However, during confidential handover times, you may be asked to leave the unit, unless you are actively caring for your baby. You may also be asked to leave the unit during medical emergencies, and medical ward rounds when other babies are being discussed. You will, of course, be welcome whilst your baby is being discussed. Main Nursing Handover Times are: 7.30-8.30am and 7.30-8.30pm Visitors will be asked to leave outdoor coats outside the unit on the coat hanger provided. Please ensure that valuables are locked away, as the unit can take no responsibility for losses. All visitors should please wash and gel their hands at the sink prior to entering the unit. All visitors must ring the doorbell, and wait until a staff member welcomes them to the unit. This will enable staff to find out whether ward rounds, x-rays or medical procedures are underway. Close relatives and friends can visit the unit at the discretion of the parents. We ask that you keep it to two visitors per cot please (including at least one parent), in order to minimise noise levels and disturbance to the babies. To maintain confidentiality,

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information regarding your baby will only be discussed with you, the parents. Visiting for other members of your family is between: 3-4pm and 6-7pm All visitors must be accompanied by at least one parent. Unaccompanied visitors will not be admitted unless parents have made arrangements with the nurse in advance. Siblings of your baby are welcome to visit. No other children will be admitted to the unit, in order to limit the opportunities for cross-infection. Parents are encouraged to care for, and handle their baby, as much as his condition allows. In order to protect your baby from cross-infection, you will be encouraged to thoroughly wash and gel your hands prior to contact. Babies receiving intensive care should be handled by parents only, as they are so very vulnerable. The nurse caring for your baby will know how much handling is appropriate, in order to ensure he does not tire, as of course, the baby’s needs are paramount. At parents request, other family members may cuddle your baby, should their condition allow. Cuddles should preferably be timed to coincide with your baby’s cares. This maximises your baby’s rest periods. Bathing, nappy changing and feeds are reserved for parents only. This limits the opportunities for cross-infection, and provides precious moments for parents and baby to spend together.

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WHO WILL BE LOOKING AFTER MY BABY? Nursing Staff There is a Manager in charge of the Neonatal Unit. Your baby will be cared for by a team of specially trained nursing staff. They are all skilled in looking after premature and sick newborn babies. Some members of nursing staff have undergone further training to become Enhanced Practitioners. These staff are experienced neonatal nurses who share certain duties and skills with the junior doctors. Some specialist nurses work on the doctors rota, they are called Advanced Neonatal Nurse Practitioners (ANNPs). They do not wear a uniform and they work at the same level as the doctors. We also have Health Care Support Workers who work under the direction of the trained nursing staff. All the nursing staff are clearly identifiable by their name badges.

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Doctors There are Consultant Neonatoligists, who are specialists in the care of premature or sick babies. There are also Consultant Paediatricians who are specialists in the care of babies and children, your baby will be under the care of one of these consultants, or one of the consultant neonatologists. There are a number of other doctors who work under the supervision of the Consultants. These are: Senior and Specialist Registrars Staff Grade Doctors Registrars Senior House Officers. You will see all these staff frequently on the unit; they are available in the hospital 24 hours a day.

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WHAT ARE SUPPORT SERVICES? Many people are involved in the support services provided for your baby. There are Pharmacists, Radiographers, Physiotherapists, Domestics, Social Workers, Ward Clerks, House Keepers, Specialist Engineers, Laboratory Technicians, Porters, Hospital Engineers, Radiologists and many, many more. You may not see all of these people, but without their help, we would not be able to provide the care we give to your baby. Referrals are sometimes made to other specialists within the hospital. This can include specialities such as orthopaedics and genetics. If your baby requires a specialist referral this will, of course, be discussed with you.

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EQUIPMENT ON THE NEONATAL UNIT Incubators & Cots Your baby may be nursed in an incubator. This enables us to closely observe him in a carefully controlled, warm environment. If required, we can give an ‘enriched oxygen’ air supply inside the incubator. Sometimes we nurse babies under a warm heater in an open cot. Again, this allows for easy observation and access to baby. Bigger babies may be nursed in a standard hospital cot. For very small babies ‘promotion’ to a cot is a long awaited happy event! ‘Hot cots’, which have special heated mattresses, may be used to ease the transition from incubator to standard cot. Breathing Equipment Sometimes it is necessary for sick babies to have help with their breathing. There are three different machines, which help babies breathe. They are called: Ventilators (sometimes known as a life support machine). Nasal C.P.A.P. machines. High flow oxygen machines. Some babies need help with their breathing for just a short time, a few hours or days, while other babies may require this support for weeks at a time.

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X-ray Equipment If your baby has to have an X-Ray, the Radiographers usually use a special portable X-Ray machine, which can be used on the unit. Occasionally, babies need to visit the X-Ray department downstairs for some X-Rays and scans.

Monitoring Equipment Many babies on the neonatal unit need continuous monitoring of their ‘vital signs’ such as breathing, heart rate and oxygen levels. There are a number of monitors that measure your baby’s ‘vital signs’. The nursing staff set alarm limits on these monitors to alert them to any changes in your baby’s vital signs. The alarms that sound on the unit will soon become familiar to you. Please try not to worry too much about all these technical details, the nurses caring for your baby will explain everything to you. It is also important to remember that the alarms often sound just because your baby is moving around, and they do not always mean there is a problem. Please do not silence or turn off the alarms of your baby’s monitors. If you have any concerns, please do not hesitate to call for a member of staff.

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GIVING FLUIDS AND MEDICATION TO YOUR BABY Often babies on the neonatal unit need ‘intravenous fluids’. This is when fluids are given to the baby directly into the blood stream. This provides them with all the hydration and nutrition they need until they are well enough to cope with full milk feeds. These fluids are given through an Infusion Pump, which can deliver precise volumes of fluid into your baby’s small veins. This is commonly called a ‘drip’. Medications can also be given to you baby via similar devices called Syringe Pumps.

PHOTOTHERAPY If your baby becomes jaundiced, which is very common, particularly with premature babies, he may need treatment with a special lamp called a phototherapy unit. This bright blue light helps the body breakdown the jaundice. It is important to protect the eyes during this treatment. We do this with a special shield or eye mask.

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WHAT WILL I BE ABLE TO DO FOR MY BABY? Your visits to the unit are very important to your baby. He will recognise you and your partner’s voices, and may be soothed by hearing familiar sounds. No matter how small or sick your baby is, you can always hold his hand or stroke his soft skin. Whenever possible we will get your baby out for skin to skin or kangaroo care. This is very important for you and your baby. As your baby’s condition improves you will be able to do more and more for him. The nursing staff will show you how to care for your baby, even whilst he is still in an incubator. They will help and encourage you to do as much as you wish, including feeding and nappy changes. If you would like your baby to wear his own clothes please ensure they are clearly marked with his name, and ask the nurses to put a card on his cot to let the staff know the clothes are his. If you do bring in your baby’s own clothes please bear in mind that we cannot accept responsibility for their safe keeping, although we obviously do our best to ensure they do not get mislaid. We are unable to launder clothes belonging to individual babies on the unit. However we do have a unit ‘wardrobe’ which you are welcome to use. On occasions, when certain medical procedures are taking place, we may advise you to wait outside the unit. From our experience, we have found that this can help minimise your stress. It also allows the nurses and doctors to give their full concentration to your baby. Following any such event, the nurses and doctors will make sure you are fully updated.

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FEEDING MY BABY Premature or sick newborn babies often have a weak sucking reflex and may need some tube feeds to ensure they are adequately nourished. These feeds are given directly into the stomach via a fine tube inserted in either the nose or mouth. When your baby’s ability to suck improves, and he is eager to feed, the nursing staff will assist you to breast or bottle-feed your baby. We positively encourage breastfeeding on the neonatal unit, and will help you in any way we can to successfully breast feed your baby. We have breast pumps available on the unit so that, should you wish, you can express milk whilst with your baby. If you are at home, breast pumps can be loaned from us. We can also supply you with a hand breast pump We have a freezer on the unit to store your milk, and freezer cool bags for you to transport your milk from home. We always respect your right to choose whether to breast or bottle feed your baby. However, there is now evidence that babies born prematurely are better able to tolerate breast milk rather than baby formula preparations. With this in mind, it is our practice to encourage mothers of premature infants to express breast milk, which can then be given to your baby via a feeding tube. You may or may not then choose to continue breastfeeding in the longer term.

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We do sometimes use Donor Breast Milk (DBM). This can be given to your baby until your own breat milk is available. This is a valuable resource available to us and is perfectly safe to use as it goes through the same rigourous testing as blood products.

ROUTINE SCREENING TESTS Hearing Screening All newborn babies are routinely screened for hearing loss. This will be carried out by a Neonatal Hearing Screener. You are welcome to be present during screening. There are a number of Hearing Screeners and Supervisors, who are available on most days to answer any questions you may have. Eye Screening for Retinopathy of Prematurity Some premature and low birthweight babies may need eye screening to ensure that the retina at the back of the eye is developing properly. This is carried out on the unit by a Consultant Ophthalmologist. If your baby requires screening, it will be arranged between 4-6 weeks of age. You are welcome to be present during screening, and will be able to ask questions if you wish to. You will be given an information leaflet about this. Blood Tests All newborn babies in Wales have routine screening for a number of medical conditions. These include Phenylketonuria (PKU) and Hypothyroidism. You will be given an information leaflet about these tests. A small blood sample is required.

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Ultrasound Head Scan Some babies require ultrasound head scans during their stay on the neonatal unit. These are carried out by Medical Staff and the ANNPs on the unit. The procedure is painless and only takes a few minutes. This test looks at the basic structure of the brain. The information it provides can be useful, but a normal scan does not necessarily guarantee a normal long-term outcome for your child. If your baby has a head scan, one of the Senior Doctors will discuss it with you in detail.

Other routine tests In order to make sure the best available treatment is given to your baby, the nurses and doctors will carry out regular investigations such as blood tests. These help us make decisions about your baby’s care. We minimise any discomfort to your baby by using appropriate pain relieving medications. You will be fully updated on any results.

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TRANSFERS TO AND FROM OTHER HOSPITALS Some women who are at risk of delivering prematurely may be transferred from other hospitals to Glan Clwyd Hospital before giving birth, where possible. This is to make sure that continuing intensive care facilities are available for their baby if needed. Some babies may be transferred from other hospitals to our unit after birth, for continuing intensive care. If your baby was due to be born, or was born, at another maternity hospital - once he is well enough we will arrange for him to be transferred back to that hospital. This is to make sure that we have enough space and staff to care for any other babies who may need specialist intensive care. It is also more convenient for you as this usually means you will be closer to home. The transfer of your baby back to your local hospital is an important event, and is generally a step closer to you taking your baby home. Should you wish, the nursing staff will be happy to arrange for you to visit the unit at your local hospital before your baby’s transfer to that unit. Our unit provides care for premature and sick newborn infants. This treatment is wide ranging, from full intensive care, right up until discharge home in the case of local families. Some particularly specialist treatments may be provided at another hospital. These treatments include surgery, laser eye treatment and sometimes referral to Specialist Consultants for further opinion. 16

FAMILY FACILITIES Parents Entrance Foyer The neonatal entrance foyer is set out for parents and families to use. There is a comfortable seating area, information boards, a leaflet rack, lockers in which to place your valuables and hangers for your coats. There is a water cooler just inside the doors of the neonatal unit, by the nurses’ desk. Please help yourself to water. Family Room We have a family room on the unit, which you are welcome to use. This is an area where you can go to relax for a while. There are facilities for hot drinks, and television and DVD facilities. You are welcome to bring hot drinks onto the unit, but please ensure that they are not near your baby. Once your baby is well enough, you may use this room to spend periods of time with him away from the noise and activity of the unit. Ask the nurse looking after your baby if you would like to do this. You are welcome to use the family room as a play area for siblings, and we do provide a small selection of toys for this purpose. Young children must be supervised at all times, and we ask that you tidy up after yourselves and leave the room neat and clean. The Children’s Units downstairs also have a playroom, which siblings are welcome to use under the supervision of a parent. Please ask if you wish to use this facility, as we need to inform the staff in advance. 17

ˆ CROESO’ PARENTS’ ACCOMMODATION ‘TY We are very fortunate to have residential accommodation available for parents. Ty Croeso Dawn Elizabeth House provides accommodation for parents of babies and children on the neonatal unit and Children’s wards. The nursing staff can arrange for you to have accommodation. Please remember that room numbers are limited, however, if you have long distances to travel or your baby is very sick you will be given priority. There is a Manager of Ty Croeso and a number of volunteers also help with the running of the service.

Photography and Videoing You are welcome to take pictures with your own phone or camera, and video your baby. However, the sound should be switched off on the video in order to maintain confidentiality. If you wish to have pictures taken by the hospital baby photographer, you can arrange for these to be done in our Family Room once your baby is well enough. Please speak to the nurse looking after your baby to co-ordinate this with your baby’s care.

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Religion Support for all religious denominations is available. Staff can arrange a visit for you if you wish. Our hospital Chaplains make regular visits to the unit. If your baby is very poorly you may wish to have him baptised. The nursing staff can arrange this for you. Hospital Social Worker If you would like to speak to a Social Worker, the staff can arrange this for you. Social Workers are able to advise you about benefits and other entitlements. Chrysalis Counselling & Support Service This service provides information, support and counselling for families with a baby on the neonatal unit. It is part of the charity Hope House Children’s Hospices. You can access this service yourself or the charity takes referrals from professionals caring for families who may benefit from the service. It can also provide support for siblings who are struggling with the difficult circumstances of having their new brother or sister staying on the neonatal unit. Staff on the unit can give you more information.

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PREPARING FOR HOME Your baby’s stay on the unit may be longer than your stay in hospital. Your baby will be well cared for whilst you prepare your home for the happy day when you can take your baby home.

Family Room We have a family room on the unit where you and your partner can stay for a day or two before your baby goes home. The room has en suite bathroom facilities, a television, and there is a small kitchen for your use nearby. When you stay in the room you can have your baby with you night and day. Should you need any help or advice, the nursing staff are always close at hand. There is an internal telephone for you to call the unit.

Neonatal Community Nursing Team We have a Neonatal Community Nursing Team who visit some babies at home after they leave hospital. This service is mainly available for babies with ongoing specialist needs such as oxygen dependency, other long-term problems or those born quite prematurely. However, any parent who feels that they would benefit from this specialist community involvement, may request a home visit.

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CUDDLES ‘CUDDLES’ is the parents’ support group for our neonatal unit. The name stands for -

Caring Understanding Devotion to Duty for Lives Extremely Small

The group was formed in 1984 by parents whose babies had been cared for in the unit and staff from the unit. ‘CUDDLES’ is a registered charity and has an elected committee. The aim of the group is to support the parents of babies on the unit in the future. They raise money for the unit, and provide financial support to help with the cost of new equipment.

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Cuddles Parents’ Support Group Special Care Baby Unit Grw ˆ p Cefnogi Rhieni Uned Gofal Arbennig Babanod

They hold regular meetings and are constantly striving to find new ways to support the babies, their families, and the unit as a whole. ‘CUDDLES’ members are very active fundraisers, and have held many varied and exciting events raising large sums of money over the years. All around the unit are items of equipment purchased by the group for the benefit of the babies. ‘CUDDLES’ have purchased monitoring systems, a ventilator and incubator, an ultrasound scanner, and many other items of equipment. ‘CUDDLES’ have also helped fund decoration and refurbishment on the unit, including the family room. If you or your family are interested in joining ‘CUDDLES’ or helping the group in anyway please complete a ‘CUDDLES’ form, which are available on the unit. ‘CUDDLES’ always welcome new helpers.

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HOSPITAL FACILITIES Canteen Located on the ground floor Opening Hours Breakfast Weekdays Lunch

9.00am - 11.00am

12.00pm - 2.00pm

Evening Meal 5.30pm - 7.30pm

League of Friends Tea Bar Opening Hours Monday to Friday Weekends and Bank Holidays

10.00am - 5.0pm 2.00pm - 4.00pm

League of Friends Shop Located on the ground floor on the corridor between the main foyer and the main hospital lifts Opening Hours Monday to Friday

10.00am - 5.30pm / 6.45pm - 8.15pm

Weekends

2.00pm - 4.00pm / 6.45pm - 8.15pm

Bank Holidays

2.00pm - 4.00pm / 6.45pm - 8.15pm

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Registrar of Births Located on the corridor leading to Celyn ward. Registrar available on Mondays, Wednesdays and Fridays 

9.30am - 11.45am

Chaplains Sunday Service in the Hospital Chapel at 9.30am Ministers visit the unit regularly and are available from all denominations on request

Cash Machine / Royal Mail Post Box is available in the hospital

Thankyou Thank you to ‘CUDDLES’ our parent support group for funding the printing costs of this booklet. It has been produced in consultation with parents of Special Care Babies. This booklet is available in other languages and formats (e.g. large print, Braille or audio version) upon request.

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