Specialist care of newborns

Newborn babies may need special, high-dependency, intensive or surgical care if they are unwell. This may be due to being born early (1 baby in 13) or if they are very small and have a low birth weight.

Pre-term births continue to increase. However, as maternity care has developed, the survival rate of unwell newborn babies is continuing to improve. Specialist neonatal care capacity needs to keep pace with these advances to improve short and long-term outcomes for these babies. NICE’s guidance covers the full care pathway from admission to specialist care and follow-up. It also ensures parents are involved as much as possible in the care of their baby.

Admission, transfer and discharge

The NICE quality standard on neonatal specialist care highlights that neonatal transfer services should be in place to provide babies with safe and efficient transfers to and from specialist neonatal care services. This is important as unwell newborns may have difficulty with breathing or keeping warm and require support as they are transferred.

A decrease in children born under 32 weeks admitted with a temperature of less than 36°C suggests an improvement in transfer services maintaining the core body temperature of babies. Data from the Royal College of Paediatrics and Child Health’s National Neonatal Audit Programme (NNAP) shows that this decrease continued over the last 3 years.

The NICE quality standard highlights that network commissioners and providers of specialist neonatal care should undertake an annual needs assessment and ensure that each network has adequate capacity.

While the NNAP audit shows that most children requiring specialist neonatal care who are transferred out of a unit remain in their own network area, the Department of Health Toolkit for high quality neonatal services sets the standard at 95%. So, there is still room for improvement.

Follow-up

The NICE quality standard  and guidance on developmental follow-up highlights that health outcomes should be monitored as part of long term follow-up to ensure children continue to get the care and support they need during their development. It also ensures that any developmental issues are identified as early as possible.

The NNAP audit shows that babies receiving specialist neonatal care have increasingly had their health outcomes monitored at 2-year follow-up.

For babies born at less than 30 weeks of gestation, there has been a decrease in those with neurodevelopmental impairment at 2-year follow-up.

Improvements in neonatal specialist care are likely to have contributed to the reductions in neurodevelopmental impairments, as improved services can reduce risk factors associated with conditions such as cerebral palsy.

Parents’ experiences of care

The NICE quality standard on neonatal specialist care highlights that parents of babies receiving specialist neonatal care should be supported to be involved in planning of the care pathway. This ensures they are fully informed, and they can engage in the personalisation of care for their baby.

In order to be involved with planning, more parents have a consultation with a senior member of the neonatal team within 24 hours of admission as shown in data from the Royal College of Paediatrics and Child Health’s National Neonatal Audit Programme.

In addition, the audit reviewed the presence of parents on consultant ward rounds which would ensure they are fully informed of decisions about the care of their baby. It found that, in 2017, around 83% of consultant ward rounds had a parental presence.

“From the moment we stepped foot inside the unit, every member of staff was amazing, they kept us informed of what was going on, allowed us to be involved in Taylor’s care routines and looked after us as well. We became experts in oxygen saturation levels, saw countless blood tests and transfusions and learnt about brain scans, chest and lung X-rays, and gravity feeding.” 

Breastfeeding

Breastfeeding has long-term benefits for babies which last into adulthood. However, it can be challenging for mothers of babies to initiate and continue to breastfeed in neonatal specialist care.

The NICE quality standard on neonatal specialist care states that mothers of babies receiving specialist neonatal care should be supported to start and continue breastfeeding, including being supported to express milk. This support gives mothers comfort and confidence in their ability to feed their baby. In addition the NICE guideline on postnatal care up to 8 weeks after birth recommends that healthcare professionals should have sufficient time, as a priority, to give support to a woman and baby during initiation and continuation of breastfeeding.

However, in recent years there has been little change in the active support and encouragement women report they received, as shown in the Care Quality Commission’s survey of women’s experience of maternity care.

This trend is reflected in data from the Royal College of Paediatrics and Child Health’s, National Neonatal Audit Programme. For babies born under 33 weeks who were discharged there has been little change in those receiving their own mother’s breast milk.

The audit also showed that babies that were born between 34 and 36 weeks had a similar rate of breastfeeding initiation at 62%. However, those born full term at 37 to 42 weeks had the highest rate at 75%. With up to 39% of babies not receiving their mother’s breast milk, more support is needed, particularly when babies are born pre-term.