Management of the vulnerable baby on the postnatal ward and transitional care unit
Section snippets
Moderately preterm babies
While the extremely preterm infant consumes a disproportionate amount of intensive care resource and medical and nursing attention, it is actually the moderately preterm infant (34 + 0 to 37 + 0 weeks gestation) who are numerically the larger group regardless of the particular demographics which inform the admissions to that neonatal unit (for example specialist referral centre, local neonatal unit, and neonatal unit with surgical services). Not only that, but work has shown that moderately preterm
Early breastfeeding
Early contact (as soon as possible after birth, allowing enough time for this to lead to the first breast feed) and early initiation of breastfeeding is enshrined in step 4 of the 10 steps to successful breastfeeding of the Baby Friendly Initiative, a worldwide joint WHO/UNICEF project to promote good practice in the establishment of breastfeeding [16] (Fig. 3). Much of the evidence about the benefits of early skin to skin contact between mothers and babies, and early initiation of
Impact of transitional care
The steps outlined above in the care of the vulnerable infant are neither complex nor difficult. However, the process of providing this care takes time — time to help with breastfeeding, time to perform blood glucose measurements, time to help the mother to express her milk and time to cup feed the infant. And time is often in short supply on the postnatal ward in our busy maternity units.
A transitional care ward can provide a ward or ward area where mother and baby can be cared for together.
Conclusion
Exclusive breastfeeding is possible for small or preterm infants, or infants of diabetic mothers. The health benefits for the mother and baby are considerable, both in the short and long term. The interventions required are neither complex nor expensive. What is needed firstly is knowledge — knowledge of the normal postnatal adaptation of the newborn guiding a sensible application of appropriate guidelines, and secondly dedication, dedication in helping mothers and babies achieve an optimal
References (24)
- et al.
Plasma glucose values in normal neonates: a new look
J Pediatr
(1986) - et al.
Factors affecting the duration of breastfeeding, measurement of breast milk intake in the first week of life
Early Hum dev
(1983) - et al.
Health consequences of nutrition in childhood and early infancy
Pediatr Neonatol
(2009) Maternal nutrition, fetal nutrition, and disease in later life
Nutrition
(1997)- et al.
Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding
Early Hum Dev
(2008) - et al.
Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit
ADC Fetal Neonatal
(2006) - et al.
JAMA
(2000) The pregnant diabetic and her newborn
(1967)- et al.
Cerebral metabolic rate for glucose during the first six months of life: an FDG positron emission tomography study
Arch Dis Child Fetal Neonatal Ed
(1996 May) - et al.
Patterns of metabolic adaptation for preterm and term infants in the first neonatal week
Arch Dis Child
(1992)
Nutritional factors that affect the postnatal metabolic adaptation of full-term small- and large-for-gestational-age infants
Pediatrics
Effect of diabetes in pregnancy on offspring: follow-up research in the Pima Indians
J Matern Fetal Med
Cited by (15)
The evolution of neonatal family centred care
2021, Journal of Neonatal NursingCitation Excerpt :There are also preterm infants in neonatal units who have progressed to low level care in preparation for discharge. These infants could be managed in a transitional care setting away from the neonatal unit (Battersby et al., 2017; de Rooy and Johns, 2010; Miah, 2013). A transitional ward decreases admissions to neonatal units, offering cost savings (O'Sullivan et al., 2015).
Evaluation of the introduction of a postnatal ward liaison neonatal nurse
2015, Journal of Neonatal NursingCitation Excerpt :For example, medication error rates of 24 per 1000 neonatal activity days have been noted in one United Kingdom neonatal intensive care unit (Simpson et al., 2004). The provision of transitional care in dedicated units has been implemented in many United Kingdom (UK) hospitals (De Rooy and Johns, 2010), with the Leicester Royal Infirmary recommending the provision of a postnatal ward liaison post following an audit of their neonatal services in 2006 (Hubbard, 2006). Caring for the baby alongside the mother has many advantages; it can assist infection prevention and control as overcrowding in NNC is associated with an increase in infection rates (Saiman, 2002).
Do neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding?
2014, MidwiferyCitation Excerpt :Discussion with parents before giving artificial milk provides the opportunity to explain the reason for temporary supplementation and reassure mothers that there is nothing wrong with their milk, thus facilitating breast feeding (Wight, 2006). None of the guidelines recommended all neonates be screened for hypoglycaemia, supporting that healthy, fully grown term newborns from pregnancies with no complications need not be screened for hypoglycaemia (de Rooy and Johns, 2010; Hoops et al., 2010). The overall score for essential point 6, 63 of 88 (Table 2), was above average, consistent with the consensus about which neonates are screened for hypoglycaemia (Harris et al., 2009).
Barriers to Couplet Care of the Infant Requiring Additional Care: Integrative Review
2023, Healthcare (Switzerland)At-Risk Newborns: Overlooked in Expansion From Essential Newborn Care to Small and Sick Newborn Care in Low- and Middle-Income Countries
2023, Global Health Science and Practice