Support of The Parents With Neo-Natal Units Essay

The Neonatal Intensive Care Unit (NICU)
The birth of a baby is a wonderful and very complex process. Many physical and emotional changes occur for both mother and baby.

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Baby in a neonatal intensive care unit
Baby in a neonatal intensive care unit (NICU)
Before birth, the baby depends on functions from the mother. These include breathing, eating, elimination of waste, and immune protection. When a baby leaves the womb, its body systems must change. For example:Support of The Parents With Neo-Natal Units Essay

The lungs must breathe air.

The cardiac and pulmonary circulation changes.

The digestive system must begin to process food and excrete waste.

The kidneys must begin working to balance fluids and chemicals in the body and excrete waste.

The liver and immune systems must begin working on their own.

Your baby’s body systems must work together in a new way. In some cases, a baby has trouble making the transition outside the womb. Preterm birth, a difficult birth, or birth defects can make these changes more challenging. But a lot of special care is available to help newborn babies.

What is the neonatal intensive care unit (NICU)?
Newborn babies who need intensive medical care are often put in a special area of the hospital called the neonatal intensive care unit (NICU). The NICU has advanced technology and trained healthcare professionals to give special care for the tiniest patients. NICUs may also care areas for babies who are not as sick but do need specialized nursing care. Some hospitals don’t have the staff for a NICU and babies must be moved to another hospital. Babies who need intensive care do better if they are born in a hospital with a NICU than if they are moved after birth.Support of The Parents With Neo-Natal Units Essay

Some newborn babies will require care in a NICU. Giving birth to a sick or premature baby can be unexpected for any parent. The NICU can be overwhelming. This information is to help you understand why a baby may need to be in the NICU. You will also find out about some of the procedures that may be needed for the care of your baby.

Which babies need special care?
Most babies admitted to the NICU are preterm (born before 37 weeks of pregnancy), have low birth weight (less than 5.5 pounds), or have a health condition that needs special care. In the U.S., nearly half a million babies are born preterm. Many of these babies also have low birth weights. Twins, triplets, and other multiples often are admitted to the NICU. This is because they tend to be born earlier and smaller than single birth babies. Babies with health conditions such as breathing trouble, heart problems, infections, or birth defects are also cared for in the NICU.

Below are some factors that can place a baby at high risk and increase the chances of being admitted to the NICU. But each baby must be assessed to see if he or she needs the NICU. High-risk factors include the below.Support of The Parents With Neo-Natal Units Essay

Maternal factors include:

Being younger than age 16 or older than age 40

Drug or alcohol use

Diabetes

High blood pressure (hypertension)

Bleeding

Sexually transmitted diseases

Multiple pregnancy (twins, triplets, or more)

Too little or too much amniotic fluid

Premature rupture of membranes (also called the amniotic sac or bag of waters)

Delivery factors include:

Changes in a baby’s organ systems due to lack of oxygen (fetal distress or birth asphyxia)

Buttocks delivered first (breech birth) or other abnormal position

The baby’s first stool (meconium) passed during pregnancy into the amniotic fluid

Umbilical cord wrapped around the baby’s neck (nuchal cord)

Forceps or cesarean delivery

Baby factors include:

Baby born at gestational age of less than 37 weeks or more than 42 weeks

Birth weight less than 5 pounds, 8 ounces (2,500 grams) or over 8 pounds, 13 ounces (4,000 grams)Support of The Parents With Neo-Natal Units Essay

Small for gestational age

Medicine or resuscitation in the delivery room

Birth defects

Respiratory distress including rapid breathing, grunting, or stopping breathing (apnea)

Infection such as herpes, group B streptococcus, chlamydia

Seizures

Low blood sugar (hypoglycemia)

Need for extra oxygen or monitoring, IV (intravenous) therapy, or medicines

Need for special treatment or procedures such as a blood transfusion

Who will care for your baby in the NICU?
Some of the specially-trained healthcare providers who may care for your baby include:

Neonatologist. This is a pediatrician with extra training in the care of sick and premature babies. The neonatologist (often called the attending physician) supervises pediatric fellows and residents, nurse practitioners, and nurses who care for babies in the NICU.

Neonatal fellow. This is a pediatrician getting extra training in the care of sick and premature babies. He or she may do procedures and direct your child’s care.

Pediatric resident. This is a doctor who is getting extra training in the care of children. He or she may do or assist in procedures and help direct your child’s care.Support of The Parents With Neo-Natal Units Essay

Neonatal nurse practitioner. This is a registered nurse with extra training in the care of newborn babies. He or she can do procedures and help direct your child’s care.

Respiratory therapist. This is a person with special training in giving respiratory support. This includes managing breathing machines and oxygen.

Physical, occupational, and speech therapists. These types of therapists make sure a baby is developing well. They also help with care including positioning and soothing methods. Speech therapists help babies learn to eat by mouth.

Dietitians. Dietitians ensure the babies are growing well and getting good nutrition. They watch your baby’s intake of calories, protein, vitamins, and minerals.

Lactation consultants. These are healthcare providers with extra training and certification in helping women and babies breastfeed. They can help with pumping, maintaining milk supply, and starting and continuing breastfeeding.

Pharmacists. Pharmacists help in the NICU by assisting the care providers choose the best medicines. They check medicine doses and levels. They keep the team aware of possible side effects and monitoring that may be needed.Support of The Parents With Neo-Natal Units Essay

Social workers. Social workers help families cope with many things when a child is ill. They give emotional support. They help families get information from healthcare providers. They support the family with other more basic care needs, too. These can include money problems, transportation, or arranging home healthcare.

Hospital chaplain. The hospital chaplain may be a priest, minister, lay pastor, or other religious advisor. The chaplain can give spiritual support and counseling to help families cope with the stress of the NICU.

NICU team members work together with parents to create a plan of care for high-risk newborns. Ask about the NICU’s parent support groups and other programs designed to help parents.

Neonatology has had few clinical breakthroughs in the past several decades, except for ‘niche’ treatments, such as total body cooling,1 that are targeted towards a small number of neonates, and genome-informed precision medicine, whose clinical promises have not yet been realized.2 Few new medicines have come onto the market since surfactant was first approved in 1990. Incremental changes in clinical care have produced corresponding incremental improvements in survival, especially among extremely preterm infants. Although increased survival initially led to larger numbers of infants with developmental impairments, in the last two decades neurodevelopmental outcomes among extremely preterm infants have improved. However, many still face a variety of sequelae from visual and hearing loss, to cognitive impairments and social challenges, to cerebral palsy.3 A recent review confirmed that even those born in the late preterm period are not immune to developmental disabilities, especially in the cognitive domain.4 Future clinical and technological innovations will certainly occur, but we propose that the next major advances in neonatology have already begun by focusing attention on a ‘natural resource’ that, historically, has been undervalued and underutilized, the family-infant relationship. Although babies can survive without their families, optimal physical, cognitive and emotional development occurs only within the context of loving, positive interactions with parents and/or emotionally involved primary caregivers.Support of The Parents With Neo-Natal Units Essay

Neonatal intensive care units (NICUs) are changing around the world.5, 6 The goals of neonatology are evolving to include optimizing the functioning of the family unit within the hospital to support improved infant as well as parent/infant outcomes. Broadening the focus of neonatal care to the family–infant relationship requires an emphasis on relationships in the unit, both relationships within the family and partnerships among staff and family. These partnerships are based on the premise that intensive parenting should begin as soon as possible and be interrupted only when absolutely necessary. The physical and emotional well-being of the family unit are the guiding concerns because it is known that ultimately, the well-being of the family affects the well-being of the baby.Support of The Parents With Neo-Natal Units Essay

NOW

The term Newborn Intensive Parenting Unit (NIPU) was derived to capture this evolution in goals. This model, which began in the ‘We Are Family’ Homeroom of the Vermont Oxford Network (VON) and has been the topic of presentations at the VON Annual Quality Congress, is based on evolving concepts of family-centered7 and family-integrated care (FICare).5, 6 One component of the NIPU is FICare, a model of care where parents are intimately involved in their sick or premature baby’s care for as many hours a day as possible. While FICare serves as the foundation of the NIPU, a set of potentially better practices (PBPs) represent the building blocks surrounding and supporting both parents and staff. We describe six areas of PBPs, along with their empirical foundations, which are derived from the ‘Interdisciplinary Recommendations for the Psychosocial Support of NICU Parents’8 published by the National Perinatal Association in collaboration with many other professional and parent organizations. These include: (1) family-centered developmental care, (2) peer support, (3) mental health support, (4) palliative and bereavement care, (5) post-discharge support and (6) staff education and support.Support of The Parents With Neo-Natal Units Essay

For NICU staff to successfully carry out the mandate implicit in the enhanced environment envisioned in a NIPU, they will often need new tools as well as additional or expanded supports, many of which are described in the PBPs. Quality support for parenting within families is dependent on educational and emotional support for staff, from the leadership to environmental service providers, and across all disciplines. In the culture of the NIPU, everyone is concerned with the well-being of each other. We anticipate that the NIPU model of care will lead to improved developmental outcomes for babies, better mental health outcomes for their parents, and enhanced well-being of staff.

Neonatal units specialise in the care of babies born early, with low weight, or with a
medical condition that requires specialised treatment. The level of neonatal care a baby
receives will vary from minimal intervention for a few minutes or hours through to
considerable support over many weeks, months or even years. The demand for specialist
neonatal care has increased by 9% in the last three years (2006/07–2008/09).2
In 2001, the Department of Health recommended that neonatal services be organised into
managed clinical networks, with hospitals working as teams to ensure that babies were
cared for in appropriate settings.2 Neonatal services are based upon Strategic Health
Authority populations and organised as 23 managed clinical networks across England,
although several are managedtogether in consortia relating to specialist commissioning  Support of The Parents With Neo-Natal Units Essay
groups. 2
Each network has, or is developing, its own care pathways, guidelines and
clinical audit programmes. Each unit within a network should also have access to 24-hour
transfer services to ensure that babies receive care in appropriate settings timed to
maximise clinical outcomes.
2
As outlined in section 3.8 of the Toolkit for high-quality neonatal services2
, neonatal care
takes place in three types of unit:
Special care units (SCUs) provide special care for their own local population.
Depending on arrangements within their neonatal network, they may also provide
some high dependency services. In addition, SCUs provide a stabilisation facility for
babies who need to be transferred to a neonatal intensive care unit (NICU) for
intensive or high dependency care, and they also receive transfers from other network
units for continuing special care.
Local neonatal units (LNUs) provide neonatal care for their own catchment
population, except for the sickest babies. They provide all categories of neonatal care,
but they transfer babies who require complex or longer-term intensive care to a NICU,
as they are not staffed to provide longer-term intensive care. The majority of babies
born at over 27 weeks of gestation will usually receive their full care, including short
periods of intensive care, within their LNU. Some networks have agreed variations on
this policy, due to local requirements. Some LNUs provide high dependency care and
short periods of intensive care for their network population. LNUs may receive
transfers from other neonatal services in the network, if these fall within their agreed
work pattern.
Neonatal intensive care units (NICUs) are sited alongside specialist obstetric and
feto-maternal medicine services, and provide the whole range of medical neonatal care
for their local population, along with additional care for babies and their families
referred from the neonatal network. Many NICUs in England are co-located with
C
Copyright 2011 Picker Institute Europe. All rights reserved. Page 7
sampling period.* Parents were ineligible for inclusion if their baby had stayed in a
neonatal unit for less than 24 hours, if the baby’s mother was aged under 16 years at the
time the sample was drawn or if the baby had been taken into care.
For the majority of units that use the BadgerNet platform for recording and managing
their neonatal data, Clevermed Ltd extracted the sample list for the units according to
inclusion/exclusion criteria as specified by the Picker Institute. The sample list could be
accessed by a member of the NHS trust staff who had the correct permissions to view
patient identifiable data. Other units, not using BadgerNet, compiled the samples from
trust records by following detailed guidance instructions provided by the Picker Institute.
All units were required to check with the NHS Demographic Batch Service that none of the
mothers or babies had died following discharge to ensure that questionnaires were not
mailed to recently bereaved families.
The survey was conducted in three ‘waves’ in order to obtain a sufficiently sized sample
to allow the results to be presented at unit-level:
Wave 1: sample compiled in July 2010 (babies discharged April-June)Support of The Parents With Neo-Natal Units Essay
Wave 2: sample compiled in October 2010 (babies discharged July-September)
Wave 3: sample compiled in January 2011 (babies discharged October-December)
Parents were sent a questionnaire to complete at home and up to two reminders were
sent to non-responders (the second reminder included another copy of the
questionnaire). If parents decided to take part in the survey, they could return their
completed questionnaire to the Picker Institute in a freepost return envelope. Parents
could also complete the questionnaire over the phone with the help of a researcher and
with the additional help of an interpreter if required.
Development of the questionnaire
The questionnaire used in the survey was developed by Picker Institute Europe in
consultation with Bliss and the neonatal network representatives. Previous questionnaires
examining parent satisfaction with and experiences of neonatal care were initially
reviewed, as were recent research studies (such as the POPPY project4
) and policy and
quality standards on neonatal care.
Focus groups were carried out with parents who had recently experienced neonatal care
to establish the issues that were of most importance to them. Following the literature
review and focus groups, a draft questionnaire was developed and a number of cognitive
interviews were conducted with parents to test the relevance and validity of the
questionnaire. Many revisions were made to the questionnaire during this testing phase,
and further amendments were made to the tool following consultation with Bliss and the
network representatives.
Please see Appendix 1 for further information on the development of the questionnaire.

*
The questionnaire was sent to a random sample of 60 parents of babies who were discharged home per unit
over the three month sampling period (or all parents if fewer than 60 babies were discharged in the sampling
period)
Copyright 2011 Picker Institute Europe. All rights reserved. Page 8
Summary of key findings
This section provides a broad overview of the main survey findings, focusing on those
areas where, at a national level, parents reported their most positive and least positive
experiences of neonatal care. Those questions showing the greatest variation across
neonatal units in parents’ experiences are also highlighted.
The survey results are discussed in further detail in the rest of the report, examining the
parents’ journey from their baby’s admission to neonatal care to their discharge home.
The results for each question included in the survey are shown in Appendix 4, and the
results are broken down for particular groups of respondents (such as by parents’ age) in
Appendix 6.
Positive parent experience
Parents reported positive experiences of neonatal care in the following areas:Support of The Parents With Neo-Natal Units Essay
99% said there were facilities for the storage of breast milk on the unit
95% reported that their partner/companion was able to see their baby as soon as they
wanted following their baby’s admission to the neonatal unit
93% said staff always washed or cleaned their hands before touching their baby
89% were able to visit their baby as much as they wanted to and 92% were able to
contact the unit by telephone whenever they needed
86% reported always having confidence and trust in the staff caring for their baby
86% said that staff always treated them with respect and dignity
85% said staff referred to their baby by his/her first name
84% of parents said staff clearly explained why their baby was being transferred to a
different hospital
80% were offered accommodation overnight at the hospital before their baby was
discharged
79% said a member of staff always explained the purpose of any tests their baby had
in a way they could understand Support of The Parents With Neo-Natal Units Essay

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