FAQs

Problems during pregnancy

There are some problems in pregnancy which increase the risk of a baby needing admission to a neonatal unit. These include:

• any mother in premature labour, particularly if before 36 weeks.
• a fetus who has not been growing normally. This is called intrauterine growth retardation and is usually due to the placenta not functioning properly; if severe it can lead to problems in the baby.
• an abnormality that is detected in the fetus and which will need  the baby to be admitted for investigation and treatment - e.g. some heart defects.

Some problems in the mother increase the risk of the baby needing admission. These include:

• maternal diabetes - this increases the risk of the baby having problems with maintaining blood sugars and possibly breathing.
• raised blood pressure -  in pregnancy and particularly if part of the condition called pre-eclampsia, raised blood pressure often results in premature delivery.

Problems with baby

A small number of newborn babies are unwell, or have a high chance of developing problems, which mean that they need to come to the neonatal unit. The reasons a baby may be admitted to the neonatal unit are:

• intrauterine growth retardation (IUGR). This is the term used when a baby is smaller than expected at any given time in the pregnancy - if this is severe the baby may need to come to the neonatal unit for support. All babies born weighing less than 2500grams will come to the neonatal unit.
• prematurity. All babies born before 36 completed weeks of pregnancy will come to the neonatal unit for assessment and support.
• abnormalities which cause immediate problems in the baby. Ultrasound scans in pregnancy can detect problems in your unborn baby, for example, heart or kidney defects which will need investigation and treatment in the neonatal unit.
• For close monitoring. For example those who have low blood sugars which are not getting better with feeding or who have a suspected infection.
• Any baby who is giving staff cause for concern can be admitted to the neonatal unit for investigation.

Will my baby be OK?

This question is asked by all parents. It is difficult to predict how well a baby will do but most recover from their illnesses and go on to do well. No guarantees can ever be given but staff will be honest and open when answering questions regarding a baby’s outcome. We can give you figures for what has happened in the unit over the last few years but this is only a guide to how things may go for your baby.

Most babies who need admission to the neonatal unit do well. The length of time that a baby is in the unit will depend on the problems he has.

The term baby

There are many reasons why term babies may need to be admitted to the neonatal unit. For most of these babies their stay is at most a few days, although how well they do will depend on the reason for admission.

The baby born prematurely

As a general rule, a preterm baby will usually go home just before his expected date of delivery. There are however many exceptions and some babies stay in the unit for several months. A baby's organs are all formed very early on, but it is during the second half of the pregnancy that major organs such as the brain, lungs, heart and intestines mature and prepare for life in the 'outside world'. The earlier a baby is born the less mature and prepared his organs will be to cope with life outside his mother.

Finding out information about your baby

We will always try and make sure you know what is happening to your baby. Please do not be frightened to ask questions at any time. The nurse looking after your baby will often be able to update you on what is happening. There are always doctors available to come and talk with you. The consultant looking after your baby is also available. It is always possible to arrange a convenient time to meet up with the consultant. Just ask the nurse who is looking after your baby.

Who can see my baby and when?

We encourage parents to be with your baby as much as possible. Remember that you are important to him. Your friends and family are probably keen to meet your new baby; and offer what help they can whilst he is in hospital. However we have a duty to protect both you and your baby in any way we can. That means limiting the amount of visitors and therefore the potential for exposure to infection such as coughs or colds. It also means keeping the nurseries free from visitors around the change of nursing shifts so that information relating to your baby is kept as private as possible.

We operate an open visiting policy for parents, grandparents and brothers and sisters. No other children are allowed this is because children attend nurseries and schools and are more exposed to childhood illnesses.

Quiet time is 07.30 – 08.30 and 20.15 -21.15 hours, a dedicated time for the baby to rest.

There should be no more than two at a cot at one time, and one of them should be a parent.

N.B. In exceptional circumstances special visiting arrangements can be pre-arranged with Sister or the unit manager.

Why is my baby in an incubator

A basic need for any baby is to keep warm. Placing a premature or sick baby inside an incubator will help do this. Inside the incubator the circulating air is warm and humidified, thus preventing the baby from losing too much moisture by evaporation from their fine skin.

Nursing a baby in an incubator also allows the baby to use it’s valuable energy stores on breathing, feeding and growing. If you baby was born premature he/she will spend some weeks in an incubator. When the baby is around 34 weeks gestation and weighing 1.60kgs, he/she will be able to be nursed in an open cot.

 Why does my baby need help to breathe?

Sometimes babies need help with breathing. There are many reasons for this. It may be because they are immature, have an infection, have under-developed lungs or have inhaled something - for example meconium.

There are many different ways in which we can help your baby to breathe, such as

A ventilator – this helps a baby breathe. It works in 3 ways:

• Using a pre-set pressure, it can inflate the lungs;
• when babies don't breathe sufficiently for themselves, it can give extra breaths and
• when required it can supply extra oxygen.

Nasal CPAP

This is when air flows through two fine tubes placed in the baby’s nostrils. This slightly raises the pressure and helps to keep the baby’s lungs inflated.

Vapotherm

This is similar to nasal CPAP but generally better tolerated. It warms and humidifies the air and oxygen and is delivered to the baby via soft nasal prongs.

Why can’t my baby have milk ?

There are many reasons why there might be a delay in starting a baby on milk feeds or for stopping milk feeds after they have been started. When babies are extremely ill, for example with breathing problems, their condition can be worsened by filling their stomachs with milk. Some babies may develop inflammation of the bowel and in this case feeds will be stopped to allow the bowel heal and recover. If a baby is not able to have milk then he will be fed by an intravenous drip. When well enough, milk will be introduced slowly .

Weighing babies

Weighing a baby is an important part of his/her care and management because treatments, such as drugs, are calculated on the weight. All babies are weighed on admission to the unit, then again on Day 4. After this they are weighed every other day. It is not unusual for a baby to lose weight by Day 4.

Can my baby see or hear me ?

Vision

• even when a baby is born at term his/her eyesight is still not completely developed.
• it is thought that babies only see in black and white for the first 2-3 months of life.
• the shapes they see are slightly blurred although they are naturally drawn to the shape of the human face.
• whilst your baby is developing in the womb his eyelids are fused shut from around week 10 to week 27 of pregnancy.
• if your baby is born before 27 weeks he/she may not be able to open his/her eyes. No special care is required and the eyes will open by themselves when they are ready.

Hearing

• hearing develops at an earlier stage than eyesight.
• babies born at around term can hear very well.
• babies born early can also hear well but can be very sensitive to the noises of a busy neonatal nursery.
• the loud, sharp noises of alarms, doors closing, chairs moving etc., can cause an ill baby stress.
• we can see this showing as irritability, fluctuation in heart rate and intolerance of handling etc.

Minimising noise and light:

• to try to minimise the disturbance caused by light and noise your baby’s nurse may put a sheet or special cover on top of the incubator.
• this dims the light reaching your baby’s eyes and helps to muffle some of the noise of the nursery. however the soothing sound of a human voice can be very comforting to a preterm baby, even when they are quite ill. don’t be afraid to talk softly to your baby, have a chat about your day or even read a story. This is all part of what is called developmental care.

What are medications for?

Caffeine

• Caffeine is found in chocolate, coffee and cola drinks
• It perks us up, which is why many people say they only wake up properly after their first cup of coffee in the morning!
• It has the same effect on babies, especially those born before 34 full weeks of pregnancy
• Almost all babies born before 34 weeks will experience some degree of Apnoea (pronounced ap-nee-ah) of Prematurity
• Caffeine is a stimulant and encourages your baby to keep breathing
• Caffeine can be given directly into his vein but once your baby is on milk it will be given by mouth.
• Side effects of caffeine are very rare and include restlessness, high heart rate and vomiting

Cefotaxime

• This important antibiotic is used in the treatment of many infections
• It is given to babies with breathing problems for the first 48 hours of their stay in the Neonatal Unit 
• After 48 hours, if blood cultures show an infection sensitive to Cefotaxime, the treatment will be continued for several days
• If your baby remains unwell, the consultant may decide to keep him on Cefotaxime, even if the blood cultures have not shown an infection
• Your baby’s nurse will inject the Cefotaxime into a cannula in your baby’s hand.
• Cefotaxime is given:
• 2 times a day in babies up to 1 week old
• 3 times a day in babies between 1 and 4 weeks old
• 4 times a day in babies over 1 month old

Side effects are extremely rare and include skin rash, diarrhoea and redness around the cannula where it has been injected.

Domperidone

• This is sometimes given to help babies tolerate their feeds and to treat Gastro-Oesphageal reflux. (GOR)
• It strengthens the stomach muscles and speeds up stomach empyting.
• Domperidone is initially given by mouth 3 times a day and may gradually be weaned down to 2 times a day befre eventually stopping altogether.
• Sometimes you will take your baby home on Domperidone and you will be shown how to give it prior to discharge.

It is commonly used in conjunction with Ranitidine, which:

• Again Ranitidine is used for GOR.
• It works by reducing the amount of acid produced in the stomach.
• Ranitidine is also given by mouth 3 times a day and may be weaned down to 2 times a day prior to discharge.
• Sometimes your baby will need to go home on Ranitidine and you will be shown how to give it prior to discharge.