Management of the vulnerable baby on the postnatal ward and transitional care unit

https://doi.org/10.1016/j.earlhumdev.2010.05.004Get rights and content

Abstract

Many guidelines for the prevention and management of neonatal hypoglycaemia focus on the sick infant admitted to the intensive care unit and pay scant attention to what is known about normal neonatal physiology. It is questionable whether treatment guidelines for low blood glucose levels for sick infants can be applied to a population of well infants on the postnatal ward, especially if such guidelines interfere with the establishment of breastfeeding, which has well recognised long and short term health benefits for mother and baby. What then of the baby who is at risk of abnormal postnatal adaptation, but is not unwell? Can the complications which occur in such infants, such as hypoglycaemia, be safely managed without resorting to admission to a baby unit? Can such vulnerable infants be safely managed in an environment that promotes mother and baby bonding and facilitates breastfeeding?

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

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