Find out the answers to the most common questions we receive.
Why has my baby been admitted to The Neonatal Unit?
There are many reasons why a baby is admitted to the Unit.
The most common is if a baby is born too early (premature, before 37 weeks gestation).
Babies that are born early often require closer observation of their breathing and temperature control. Often this can only be done on the Neonatal Unit where there are the staff and appropriate equipment to enable this to happen.
Each baby is assessed individually after delivery by a Paediatrician and the nursing staff, a decision is then made depending on the baby`s weight and general condition as to whether admission is necessary. These findings are discussed with parents.
Another reason for admission is if mum has had ruptured membranes prior to delivery and has developed an infection. The baby may need to be admitted for investigations and a course of antibiotics.
Sometimes if there have been any problems around the delivery, the baby may need to be admitted for observation.
Sometimes there may be problems with baby's feeding and his/her blood sugar (glucose) levels are low and need constant monitoring eg. the baby of a diabetic mum.
So where does my baby go?
The Neonatal Unit is located close to Delivery Suite and comprises of several rooms known as nurseries. The most common room for admission is the Intensive Room/Hot Room. This is the largest of all the nurseries and can accommodate up to 7 babies. It has the most equipment necessary for close observation of your baby.
What happens after admission to the unit?
Your baby's condition is assessed and he/she is admitted to the room most appropriate to suit their condition. After admission, the baby will be weighed to give staff a baseline weight to work from. Even if the baby has been weighed on labour ward we will still weigh the baby again as often scales can give differing weights. The baby may be then nursed in an incubator. Incubators have a dual purpose, to keep baby warm and allow a good view of the baby.
What observations do you do?
We do what are known as baseline observations such as temperature, heart beat, breathing rates and blood pressure. These are recorded so that we can assess whether there is any deviation from the normal values. We listen for any noises that the baby makes whilst breathing. Obviously babies can cry!! But sometimes they can make a "grunting" type noise which can indicate that the baby has some distress with their breathing. Quite often just by allowing the baby to rest this problem will resolve.
Babie's breathing problems seem to respond better by being nursed on their tummy(prone). Do not be alarmed if you see this, because as soon as their condition allows they will be nursed on their back and they are only nursed on their tummy whilst being monitored.
Occasionally, some babies will need help from extra oxygen into the incubator. More technical support from a nasal continuous positive airway pressure machine (NCPAP) may sometimes be used. This allows oxygen/air under pressure into the nose assisting their breathing by holding the air sacs open, helping baby not to get tpo tired.
A breathing machine (ventilator) may be used. This involves a tube being passed into the lungs via the mouth (endotracheal tube) and then connected to the breathing machine that allows oxygen and air in measured amounts, the number of breathes at a measured time and pressure, to breath for your baby. The ventilator can allow baby to breath with assistance from the machine or to do all the work of breathing for his/her dependant on baby's condition.
How will you continue to monitor my baby?
This can be done in several ways - monitors or blood samples. You may think your baby is covered in "wires" when you first meet, but they all serve a purpose and allow staff to monitor the baby without having to constantly disturb them.
The most common monitors are heart beat and oxygen saturation monitors. The heart monitor requires 3 wires with stickers/sensors attached to baby giving a continuous read out of the baby`s heart rate and breathing. The sensors are a soft jelly type pad at one end and gentle to the skin. The oxygen saturation monitor has a probe which is generally wrapped around the foot or hand of the baby with a soft foam cover. This has a red light shining through the skin, which records the oxygen level in the baby's blood.
We often attach a skin probe to the baby to monitor their temperature. We also check baby's temperature by placing a thermometer under their arm at regular intervals. This will help us to vary the incubator temperature to maintain baby's temperature correctly.
A baby`s blood pressure is recorded by using a small blood pressure cuff (similar to the one used during your pregnancy but very small) around the arm or leg.
A frequent test measured by blood sample is blood sugar (blood glucose). Often the blood sugar can be low which indicates baby needs feeding. This may require the baby to have a tube inserted into the vein commonly called a drip or IV (intravenous infusion) to give extra fluids. This may be done if staff feel that the baby is not well enough to have oral feeds. If baby is unable to manage feeding on his/her own, by breast or bottle a tube can be passed into the tummy via the mouth (orogastric tube)or nose (naso gastric tube) and milk given via the tube directly into the tummy. The tube is gently stuck onto the face with tape that is like a second skin, soft and pliable…see the picture on About us.
Another test is a blood gas. This can be done with the blood sugar test and tells us whether baby is coping with his breathing and helps the Neonatal staff to make decisions about the care baby needs.
Will I have to wait long to see my baby?
Neonatal staff are very sensitive to the needs of parents following admission of a baby to the Unit so we try to make this transition as smooth as possible.
Parents are obviously kept aware and informed of the need to admit baby to the unit and parents can visit as soon as possible. They often come with baby depending on the reason for baby being admitted to the Neonatal unit.
Often though baby's admission is straight from birth and mum is being transferred up to the Postnatal Ward. If mum is too ill to visit we will go to see her. As soon as baby is well enough he/she will be taken to stay with mum for a short while if she is unable to visit.
Parents can stay with their baby as long as they need to. Grandparents can visit with consent from the parents. Other visitors are as per parent's wishes and two at a time. Only brothers and sisters of the baby are allowed to visit as young children often carry infections and we try to keep these risks down to a minimum.
Occasionally, the visit to the unit may have to be delayed if the baby is poorly and needs a lot of attention. Neonatal staff try to liaise with labour ward staff during these circumstances so that parents are aware of the situation.
As part of our care of the family we take photographs of your baby to keep. We also provide an introductory booklet which tells you a lot about the day to day running of the unit. There is also information supplied by Bliss which is a group that offers support for parents
We always put name bands on the baby and a cot card is placed at the end of the incubator or cot with the baby's name and date of birth.
Each baby has a named consultant who is responsible for the medical care your baby receives in the Neonatal Unit and also for follow up when discharged. The name of the consultant is written on a card alongside the space where your baby is.
The name of the nurse caring for your baby is on a board either within the room or outside the room depending on where your baby is situated.
There are four rooms: the intensive nursery, high dependency nursery, middle nursery and end nursery /going home nursery. If your baby is moved we will let you know and baby's first name will be on a board within the nursery or outside again depending on which room baby is in.
Why does my baby need a lumbar puncture?
If your baby is at risk of infection (for example if your baby is premature or the waters broke around baby at least 24 hours before delivery) or he/she is unwell, a lumbar puncture may be included as part of the infection screen.
A lumbar puncture is typically done to look for meningitis, an infection of the membranes covering the brain and spinal cord. Although meningitis is a rare occurrence it is important to detect and treat the condition as soon as possible.
A lumbar puncture is a procedure in which a small amount of fluid that surrounds the brain and spinal cord, called the cerebrospinal fluid (CSF) is removed and examined.
Fluid collected from a lumbar puncture is immediately sent to the laboratory and analysed for evidence of an infection. Initial results are available within 2-3 hours although the final results are not ready for at least 48 hours.
During this time your baby will receive antibiotics for at least 48 hours until all the results are available and a decision can be made about continuation of antibiotic therapy.
If you have any other questions or concerns about your baby having a lumbar puncture, the medical and nursing staff will be happy to answer your questions.
Why does my baby need Vitamin K?
The Department of Health recommends that all babies receive Vitamin K to prevent Vitamin K Deficiency Bleeding (VKDB) or Haemorrhagic Disease of the Newborn (HDN). This is a rare but serious disease which can affect 1 in 10,000 babies if they are not given Vitamin K. Vitamin K is found in low amounts in some babies and is essential for helping blood to clot (stop bleeding).
Half of all babies who do bleed will do so into their brain (intracranial bleeding) and this can cause damage to the brain and sometimes can result in the death of the baby.
Some babies are more at risk than others but this sometimes does not show itself until the damage is done, which is why it is advisable for all babies to receive Vitamin K.
By 6 months old, a baby can manufacture enough Vitamin K to not require any further treatment.
Babies brought to the Neonatal Unit from labour ward will be given Vitamin K with mum’s consent into the muscle of the leg or directly into the bloodstream if the baby has a line in its blood vessels (intravenous cannula). If coming from the Post Natal Ward the Neonatal nurse will check that the baby has received Vitamin K already.
Signs of bleeding around the umbilical cord, blood in stools and urine are observed for in all babies. Prolonged yellow skin (jaundice) is always investigated as this can occasionally be due to HDN.
If you have any questions, please ask the nurse, midwife or doctor caring for your baby.
Further information is available at www.doh.gov.uk Search for Vitamin K.
What is colic?
Colic is the name for excessive, frequent crying in a baby who appears to be otherwise healthy. It's a common problem that affects up to one in five babies.
Colic tends to begin when a baby is a few weeks old. It normally stops by four months of age, or by six months at the latest.
Looking after a colicky baby can be very frustrating and distressing, but the problem will eventually pass and is usually nothing to worry about.
Does my baby have colic?
Signs and symptoms of colic include:
- intense crying bouts
- crying in the late afternoon or evening that lasts several hours
- your baby's face being red and flushed when they cry
- your baby clenching their fists, drawing their knees up to their tummy, or arching their back while crying
- If your baby has colic, they may appear to be in distress. But the crying outbursts are not harmful, and your baby should continue to feed and gain weight normally.
Advice for parents
Caring for a baby with colic can be very difficult for parents, particularly first-time parents. It's important to remember that:
- your baby's colic is not your fault – it doesn't mean your baby is unwell, you're doing something wrong, or your baby is rejecting you
- your baby will get better eventually – colic normally stops before they're four to six months old
you should look after your own well-being – if possible, ask friends and family for support as it's important to take regular breaks and get some rest
- Support groups, such as Cry-sis, can also offer help and advice if you need it. You can contact the Cry-sis helpline for advice on 0845 122 8669 (9am-10pm, seven days a week).
Tips for helping your baby
There's no method that works for all babies with colic, but there are a number of techniques that may help. These include:
- holding your baby during a crying episode
- preventing your baby swallowing air by sitting or holding them upright during feeding
- burping your baby after feeds
- gently rocking your baby over your shoulder
- bathing your baby in a warm bath
- gently massaging your baby's tummy
Some babies may also benefit from changes to their diet, such as adding drops to breast or bottle milk that aid digestion and release any bubbles of trapped air in your baby's digestive system.
Speak to a GP or pharmacist for advice before trying these.
Do I need to see my GP?
Colic may improve using the techniques mentioned above. You can also ask your health visitor for their advice.
See your GP if you're concerned about your baby, or if nothing seems to be working and you're struggling to cope.
Your GP can check for possible causes of your baby's crying, such as eczema or gastro-oesophageal reflux disease (GORD). GORD is a condition where stomach acid moves back out of the stomach and into the gullet (oesophagus).
If no other cause of your baby's symptoms can be found, your GP can advise you about the things you can do to help your baby, including what treatments are available.
When to seek immediate medical advice
You should get medical help immediately if your baby:
- has a weak, high-pitched, or continuous cry
- seems floppy when you pick them up
- isn't feeding
- vomits green fluid
- has blood in their poo
- has a fever of 38C or above (if they're less than three months old) or 39C or above (if they're three to six months old)
- has a bulging fontanelle (the soft spot at the top of a baby's head)
- has a fit (seizure)
- turns blue, blotchy, or very pale
- has breathing problems, such as breathing quickly or grunting while breathing
These symptoms can indicate a more serious problem. Read about spotting signs of serious illness in children for information about what to look for and where you should go for help.
What causes colic?
The cause or causes of colic are unknown, but a number of theories have been suggested. These include indigestion, trapped wind, or a temporary gut sensitivity to certain proteins and sugars found in breast and formula milk.
It has also been suggested colic may just be at the extreme end of normal crying in babies.
Colic occurs equally in boys and girls, and both in babies who are breastfed and those who are bottle-fed.
[Information supplied by NHS Choices]
Why is my baby having blood tests?
There are many reasons. Here is a list of some of the common blood tests your baby may have and the reasons required.
FBC (full blood count)
A count of particles contained in blood, red blood cells, white blood cells and platelets which are checked for anaemia, infection and clotting of the blood.
Blood glucose/blood sugar
Shows whether baby has had enough food/fluid to provide energy.
U&E (Urea and Electrolytes)
Salts contained in blood which need to be kept balanced depending on the amount of food/fluid baby receives and from the result can be altered with more or less food or fluid. Essential minerals found in blood. Cal&Mag. (Calcium and magnesium)
Indicates the amount of oxygen and carbon dioxide in the blood (measures effectiveness of breathing).
CRP (C-reactive protein)
Indicator of inflammation in the body.
SBR (Serum bilirubin)
Measure of the amount of bilirubin in the blood which indicates jaundice. See Q11 jaundice.
Blood is placed in a medium which can grow bugs (bacteria) if they are present and the microbiologist can tell us if baby needs treatment with antibiotics.
How is the blood taken?
Blood may be taken by the following ways:
- Heel prick (capillary sample)
- Venous sample from vein
- Arterial line in the umbilicus ( UAC Umbilical Arterial Catheter)
- Arterial line which may be in the hand or leg
Why should my baby have the Newborn Blood Spot Screening test?
This test is offered to all babies within the first week of life. It identifies babies who may have rare but serious conditions. Most babies screened will not have any conditions but, for the small numbers that do, the benefits of screening are enormous. Early treatment can improve their health and prevent severe disability or even death.
About 1 in 10,000 babies born in the UK has Phenylketonuria. Babies with this inherited condition are unable to process phenylanine, a substance in the blood and if not treated by a special diet very early in life, could lead to irreversible mental disability. If not screened and the condition is discovered later in life, the special diet will not make a difference.
About 1 in 4,000 babies born in the UK has congenital hypothyroidism (CHT). They do not have enough of the hormone called thyroxine which is essential for growth and can lead to serious, permanent physical and mental disability.
Sickle cell disorders
About 1 in 2,500 babies has (SCD) which is an inherited blood disorder of the red blood cells. The blood of babies with this disorder can change the shape of a sickle and become stuck in the small blood vessels. This can cause pain and damge to the baby’s body.
Screening means that baby can receive early treatment, including immunisations and antibiotics which will help his/her to lead a healthier life, preventing serious illness and helping the parents to know what to look for through eduction.
About 1 in 2,500 babies born in the UK has cystic fibrosis (CF). This is also an inherited condition which affects the digestion and lungs. Babies with this condition may not gain weight well and have frequent chest infections.
Following screening can have a high energy diet, medicines and physiotherapy
Further information is available at http://www.newbornscreening-bloodspot.org.uk
Is it better for me to breastfeed my early (premature) baby?
- Protects against germs
- Helps baby grow
- Is easy to digest
- Skin contact
- Good for you too
The body manufactures specialised proteins called antibodies to fight off infections. Mothers transfer these protective antibodies to their babies through the placenta, during the last 3 months of the pregnancy. This process is interrupted when a baby is born early. For this reason, premature babies are especially vulnerable to infection. The good news is that mothers also give their babies antibodies in breast milk. Breastfeeding your baby provides an extra line of defence against infection. Premature breast milk is extra rich in antibodies and growth factors, which are vital to normal development. Breast milk is very easy to digest and is absorbed more easily than formula. It has been observed that babies spend less time crying and more time in deep sleep as a result of skin to skin contact with their parents. It will take time to establish breastfeeding but once you have achieved this, your baby will benefit from the extra cuddles at feeding time.
Breastfeeding is good for your health too, it helps you to:
- regain your pre pregnancy figure, since extra fat stored by the body during pregnancy is used as energy to produce milk
- may help reduce the risk of breast and ovarian cancer
Breast milk can be given in various ways if you are unable to directly breast feed through tube feeding, cup feeding and by bottle.
When I take my baby home, how early can I take him/her swimming?
Babies under 3 months old or weighing less than 5.5 kilos need to be in water with a temperature of at least 32°C which will probably mean a hydrotherapy pool.
For older babies, the water needs to be at least 30°C.
Swimming provides free movement and a physical workout helping with coordination, eating and sleeping patterns. It also increases baby's awareness and understanding as well as being fun and socialable for yourself and baby, helping you all to play as a family.