Infant Grapevine August 2011

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Understanding Newborn Behaviour and SupportingEarly Parent-Infant RelationshipsCourses organised by The Brazelton Centre in Great Britain

20-21 October 2011

Newborn Behavioural Observations (NBO)

24-25 November 2011

Neonatal Behavioural Assessment Scale (NBAS)

Venue: Addenbrookes Hospital, Cambridge

Contact: [email protected]: 01223 245791www.brazelton.co.uk

Reason ConferenceAnnual conference for neonatal nurses and doctors sponsoredby Chiesi Ltd, Fisher & Paykel and Radiometer. Topics include:

• Brain injury and regeneration• Developing a neuroprotective service• The preterm birth – cost to society• Inflammatory modulation in NEC• Problems in exclusive breastfeeding• Preventing CLD• Surfactant replacement – an update• Management of PPHN• Pulse oximetry and detection of CHD• Protection against litigation• Newborns in randomised trials

Cost: Full registration, including one night accommodation and conference dinner – nurses £305, doctors £415

Venue: University of Warwick, Coventry

Contact: CFS EventsTel: 0800 9177 [email protected]

Practical Paediatric GastroenterologyOrganised by the Academy for Paediatric Gastroenterology,this two-day course is designed to address practicalmanagement of common gastroenterological problems metin secondary paediatric practice. Topics covered include:

• Functional gastrointestinal disorders• Pre- and probiotics in gastroenterology• GI food allergy• GI bleeding• Gut motility disorders• Gastro-oesophageal reflux and vomiting• Constipation• Coeliac disease

Venue: Great Ormond Street Hospital

Cost: £200

Contact: Meeting Secretariat, Kenes [email protected]

Trouble up NorthThe annual North Trent and Yorkshire Neonatal Networkconference. Topics include:

• Headline on heads• The changing NHS – how do we change with it?• Long-term outcomes – are we measuring what matters?• New research evidence – has it helped?

Venue: Waterton Park Hotel, Wakefield, South Yorkshire

Contact: CFS Events Ltd103a High Street, StevenageHerts, SG1 3HR Tel: 01438 [email protected] online at www.cfsevents.co.uk

Meningitis and Septicaemia in Children and AdultsThis international conference organised by the MeningitisResearch Foundation will present the latest advances inprevention of meningitis and septicaemia as well as issues inclinical management of bacterial meningitis and sepsis.

Venue: Royal Society of Medicine, London

Cost: One day £135, both days £220. Discounts for early booking and for nurses and trainees.

Contact: Paul GeorgeMeningitis Research FoundationTel: 01454 281811www.meningitis.org/conference-2011

2011 Baby Friendly Initiative Annual ConferenceOrganised by UNICEF UK, the BFI conference is the UK’shighest-profile event covering infant feeding issues.

Venue: Liverpool BT convention Centre

Contact: Elizabeth Freeman Events and Services ManagerBaby Friendly InitiativeTel: + 44 (0)20 7375 [email protected]/conference

To book an advertisement in Infant Grapevine, contact Tricia Tayloron 01279 714516, [email protected]

Published by Stansted News Limited134 South Street, Bishop’s Stortford, Herts, CM23 3BQ

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GuernseyExperiencedRSCN/RNCpreferably with neonatalqualification/skills

Services for Children and Young People

www.health.gov.gg

These are challenging but rewarding posts forexperienced children’s nurses, preferably with aneonatal qualification/skills to work in our smallbut friendly paediatric ward and neonatal unit.As our dedicated team provide acute inpatient carefor children from birth up to the age of 18 years,you will get the opportunity to work with all thedifferent age groups and your chosen specialty.

We think you’ll soon get a taste for island life, withour warmer climate, beautiful beaches, spectacularcoastline and continental atmosphere.

For further information please contactJeannette Cooper, Clinical Manager on 01481 707355.

Closing Date: 19 August 2011

For an application pack please visit:www.health.gov.gg or call 01481 707444. (24 hour answerphone).

All staff receive an annualbonus of £1,000 payableevery February andstaff with arecognisedNeonatalqualificationwill receive aloyalty bonusof £3,000after twoyears service.G

Job ref: 101613 Salary:Band 5 or 6, dependent on

experience up to a maximum of £35,746 pa (pay award pending)

Hours: f/t 37.5 pw Subsidised accommodation or a five yearhousing licence provided.

infantFocus on a Unit

From excellent practice to inspired fund raising and from new facilities to cutting-edge equipment, Focus on a Unit is the place to let readersknow what your unit is doing.

❚ Is your unit undergoing a rebuild or refurbishment?

❚ Has your unit received recognition forexcellent practice or working towardsimprovement?

❚ Has your unit been involved in a uniquefund raising event?

❚ Is your unit overseas? Have you spent timein an overseas NICU? How does practice differ from the UK?

Let readers know what’sgoing on in your unit

74 V O L U M E 1 I S S U E 3 2 0 0 5 infant

F O C U S O N A U N I T

Following a move from its city centrelocation to purpose-built hospital

premises on the city outskirts, the doors tothe new Norfolk and Norwich neonatal unitopened in November 2001.

An American company designed andbuilt the new hospital and senior neonatalstaff were involved in the planning of theunit from within the consultation team.

Under the Government’s ManagedClinical Network Strategy, Norfolk andNorwich neonatal unit has become one ofthe region’s two level 3 units and a regionalreferral centre for neonatal surgery. It isintended that 95% of all babies born in theregion needing special care will be lookedafter by one of the eight units making upthe NSC neonatal network.

Although the unit was built with the samecapacity of 22 cots as the old one, it is muchmore spacious, resulting in a better workingenvironment for staff and cutting the risk ofinfection. Facilities for families and staff are

much improved, with five family rooms and a brightly painted siblings play room.New arrivals are placed in one of twoisolation rooms and staff are proud thatthere have been no episodes of MRSA in the unit since its opening.

Asked if there were any areas in which thedesign of the unit fell short, staff admittedthat a seminar room would have been veryuseful, especially as courses are run in theunit, with an enhanced practice course dueto start in September this year. Designersalso needed convincing that each cot reallyneeded 24 plug sockets and initial plans tosituate the nurseries in the centre of unit,with utility rooms taking the cherishedwindow spots, were soon altered afterpersuasion from unit staff.

Space was made in the NICU for a PACS(picture archive and communicationsystems) workstation, a filmless method of

sharing clinical images across a network and still quite unusual in neonatal unitsacross the UK.

Now, the strategic health authority hasidentified a need to expand and soalterations are under way to enlarge thenurseries to cope with 28 cots.

This expansion means that the unit willfinally get its seminar room, staff changingrooms and a much larger, brighter, lowdependency nursery ready to accept anincreased capacity of up to 17 babies.Finances have also been made available to employ two more ANNPs and more staff nurses.

The low dependency nursery is entirelynurse-led and staff believe this is an unusualand highly effective approach, so much sothat they have entered the Health EnterpriseEast, Innovation Competition 2005. Thereis a strong ethos on the unit that parentsshould have the facilities and the support to be as hands-on in the care of their infantsas possible.

Regular forums held for parents by theunit managers and Paediatric Matron provevery useful. With the help of outreachnurses, early discharge is routine withparents feeling supported enough to takebabies home while still tube feeding orneeding oxygen.

Having had the opportunity to participatein the design of their neonatal unit fromscratch it would seem that staff are pleasedwith their roomy new work environment.

A new beginning in Norwich

ANNP Julie Mullett in the bright and airy NICU.

FAR RIGHT: Staff nurseElizabeth Harman inthe busy lowdependency unit.

RIGHT: The siblings’playroom is bright andattractive.

BELOW: Parents MariaTaylor and Dave Hurley caring for one of theirpremature twins, born at 30 weeks’ gestation.

WRITTEN BY Kate Woods

Why not contribute to our focus on a unit feature?Contact [email protected]

Is your unit special?



Queen Charlotte’s and Chelsea Hospital(QCCH) is the oldest maternity

hospital in the country. In November 2000the new QCCH was opened on the campusof the Hammersmith Hospital and the twohospital’s neonatal units merged.

This prestigious purpose-builtunit is adjacent to a dedicatedresearch institute and state-of-the-art facilities haveaccommodation for high and lowrisk maternity care and fetalmedicine together with one of thelargest neonatal units in thecountry, providing a wide rangeof tertiary services andunparalleled research facilities. Itis one of two perinatal centreswithin the North West LondonPerinatal Network and has 550-600 admissions a year.

The neonatal unit has a stronghistory of education and researchwith Imperial College London.One of the strategic goals is toreduce the numbers of infantswho grow up with neurologicalhandicaps after neonatal intensive care. Major investment in a 3-Tesla magnetic resonance imaging (MRI)scanner on the neonatal unit has beenpivotal in this ground-breaking work.

MRI is non-invasive and non-ionisingand provides excellent soft tissuedifferentiation of the immature brain,making it the modality of choice forinvestigating numerous pathologies of thebrain. Recently quantitative MR techniqueshave been used to assess the developingpreterm brain (FIGURE 1). These techniquesinclude 3D volumetric MR and measure-ments of cortical folding, which have beenused to determine the increase in braintissue volume, cortical grey matter volumeand cortical folding with increasinggestational age.

MR scans are also now being used toassess heart function. Detailed images canshow how much blood is filling the heart,how well the muscle is contracting and howmuch blood is pumped with eachcontraction. The effectiveness ofinterventions such as fluid bolus andinotropes can be assessed.

The scanning facilities within theneonatal unit impact enormously on thework and daily routine for babies, families,

nursing and medical staff. Rapid unit-basedaccess to the MRI scanner for the sickestand most vulnerable babies facilitatesclinical decision making at the most criticaltimes in confirming diagnosis, assistingwith prognosis or deciding appropriate

treatment plans. Agonising waits forfamilies for further information about theircritically sick baby can be reduced.

Parents are invited to view the MRscanner so they know what to expect. Mostscans are carried out without sedation.Babies are brought to the scanning roombefore a feed, monitoring equipment isapplied and they are carefully swaddled.Babies are allowed to fall asleep after a feedand placed in the scanner for up to anhour, with monitoring by a neonatologistthroughout. Babies are fitted with mouldedear plugs and wear earmuffs to protectthem from the noise of the scanner.

Moving forward with MRIWRITTEN BY

Heather Naylor



Training regarding MRI safety isundertaken by all nursing and medicalstaff. Parents are advised if the scan is beingperformed for clinical reasons or areinvited to take part in a research studyinvolving their baby by the MRI researchteam. Written information is available forparents explaining the procedure, and if forresearch purposes, the study they have beeninvited to participate in.

Studies being undertaken include:• Improving the quality of MR images in

newborns. • Computational analysis of MR images to

understand more about brain structureand development in relation to thedevelopmental problems faced bypremature babies.

• Serial MRI in newborns with perinatalbrain injury, to understand better thecauses and timing of an injury and theresponse of the brain to injury.

• MR assessment of cardiac function innewborns to improve heart andcirculation monitoring and support.

• Clinical trials of promising interventionsto reduce brain injury and promote braindevelopment including the TOBY trial ofwhole body cooling in full term infantssuffering birth asphyxia.Nurses on the unit play a pivotal role in

the support of infants examined by MR,helping parents with their decisions andaddressing any concerns. Nurses must alsoensure the baby is appropriately prepared,wearing non-metallic clothes and ensurethe use of MRI-compatible lines andequipment. In liaison with the MRI team,the baby’s care needs are assessed to ensurethese can be safely met during theprocedure.

Although the development of neonatalservices has greatly improved the survivalof preterm and sick newborn babies,investment must continue to ensure theintegration of research with medical andnursing care to improve the effectiveness ofcare and long-term outcomes for thisvulnerable population and their families.

FIGURE 1 Development of sulcation andgyration with increasing GA.



The neonatal unit moved to its purpose-built premises in Preston, Lancashire, in

September 2004. Staff worked in closeconsultation with the architects, offeringadvice to achieve the design they requiredin their new unit. The level three unit nowprovides five intensive care cots and 16 highdependency and special care cots.

An innovative role within the unit is thatof the neonatal nursery assistant, a postdeveloped using the skills of three staffmembers who were originally employed asnursery nurses but had been downgradedto healthcare assistants as a result of a localdecision. After a review which highlightedthat the skills of such staff were not beingutilised, the neonatal nursery assistant rolewas introduced.

Neonatal nurseryassistants, who hold NVQlevel 3 – care of neonates,work independently and actas a named nurse in thespecial care area with theirown caseload of patients.They are accountable to thetrust and are supervised bythe shift leader in the sameway as registered nurses/midwives. Neonatal nurseryassistants are competent toadminister oral drugs andcare for infants suffering

from chronic lung disease who are oxygendependent and stable. The provision of pre-discharge parentcraft advice and continuityin the preparation of babies and theirfamilies for home is an important aspect oftheir responsibilities. One of the unit’sneonatal nursery assistants has beeninvolved in the implementation andrunning of the unit’s Synagis clinic, forprotection of babies at risk of respiratorysyncitial virus.

Once these staff had taken up their newroles, a rethink was needed to replace themand so the recruitment of a housekeepertook place – believed to be the first withinthe Trust. There are now three house-keepers who provide essential support forthe smooth running of the unit through

dynamic infection control andstock control processes. They alsoprovide physical and emotionalwelfare for staff and parents.House-keepers need no formaltraining to start but are given in-house training and need to havethe personal qualities enablingthem to provide support for staffand parents.

The unit’s staff come from avariety of nursing backgrounds

Capitalising on staff skillsto improve patient care WRITTEN BY

Anne Major and Kate Woods



with child, adult, midwifery and neonatalnursery experience. Adult-trained nursestend to become interested throughmidwifery placements within their trainingschedule and those with adult intensivecare training have skills which are highlytransferable. All of these nurses integrateinto the neonatal environment quickly andthe unit finds there is no difference in thespeed at which they learn to becomeneonatal nurses, compared with midwiferyor children’s trained nurses.

The results of two nurse-led parentsatisfaction audits have helped neonatalstaff to understand the needs of parents andthat information was used to shape theenvironment for parents within the newly-designed unit.

A resuscitation audit drove theimprovement of training for neonatalnurses and midwives, while a further nurse-led audit of documentation has improvedthe multidisciplinary documentation forinsertion of peripheral lines, in keepingwith the DH “Winning Ways” document.At the moment the University of CentralLancashire is conducting research intofamily centred care within the unit as partof a multi-centred project.

Preston maintains a good record of staffretention, with a waiting list of candidatesseeking to join the unit. A structuredsupport programme for pre- and post-registration students, including ChildBranch, Midwifery and Neonatal DegreeStudents, leads to increased satisfaction ofallocation time spent on the unit, which inturn leads to increased enquiries regardingemployment.

In addition, a neonatal clinical educatorsupports all grades of staff in their practicewith an induction programme, various in-house study days including administrationof IV drugs and neonatal-specificmandatory training, and one-to-onecoaching with clinical supervision. Theclinical educator also supports staff in theirpractice development, in clinical risk andchild protection.

Neonatal nursery assistantDorothy Watters and Alysia atbathtime.

Helping to keep the unitspotless: Housekeeper SuzanneSmith.

Whatever the subject, [email protected] or call01279 714504

Infant Grapevine August 2011

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