The dietitians work as part of the multi-disciplinary team across the neonatal unit and in addition provide support for both the transitional care ward (Charles Wolfson ward) and the neonatal community team. Some babies who are born very early will also be followed up as outpatients as part of the neonatal neurodevelopmental clinic.
Intensive care / high dependency care
Every baby admitted into intensive care or high dependency care will be assessed by a dietician. They will advise the neonatal team on how to meet your baby’s nutritional requirements and how they can best support your baby’s growth and development. Babies in intensive care or high dependency may be on a combination of parenteral nutrition, which is delivered directly into the baby’s veins, and enteral nutrition, which is provided via the gastrointestinal system and includes breast, bottle and tube feeding. Your baby’s method of feeding and nutritional needs will be closely monitored and adjusted according to their requirements.
Special care (SCBU)
Babies are moved to SCBU when they are closer to going home. Whilst in SCBU the dietitian will continue to monitor your baby’s growth and give advice and support around oral feeding.
Charles Wolfson ward
When your baby is well, and is getting ready to go home, they may be transferred to the transitional care ward. This means you can stay with your baby all day and night, caring for them as if you were at home, with the support of the nursing team. A dietician will continue to review and monitor your baby’s growth when you are on the Charles Wolfson ward. They will also provide advice and support regarding the best nutrition for your baby.
Dietetic support at home
Some babies may go home under the neonatal outreach team, often these babies will go home with a nasogastric tube in place to support their feeding. A dietician will continue to provide advice and support for both the outreach nurses and parents about the baby’s growth and development.
Paediatric surgery and urology
The paediatric surgery and urology clinical nurse specialist team consists of 7 nurses. We have many different roles across the neonatal and paediatric service including inpatient wards, outpatients clinics and the emergency department:
Their role on the neonatal unit includes:
- Providing teaching and support for the parents
- Providing specialist education and training for staff and students
- Liaising with community teams, local dieticians, health visitors, social workers, GPs and local hospitals to promote effective communication between professionals from a surgical perspective
- Performing specialist nursing procedures such as urinary catheterisation, gastrostomy, tube changes / care, bladder scanning and rectal / bowel washouts. They will also support parents through the training of these procedures.
They work Monday to Friday, 08.00 - 18.00 but can be contacted until 19.00 if urgent.
They will also aim to be present on the ward round on most days and are always contactable via bleep. If your baby has had surgery or requires surgical care, the clinical nurse specialists will aim to be present for your baby’s ward round. They are always happy to speak with parents and the nurse caring for your baby can contact them via bleep. Bleep number for under 1’s is 154-617.
Neonatal occupational therapists
Neonatal occupational therapists aim to create an environment that promotes baby’s health development and growth. The occupational therapists on the neonatal unit will support parents to understand their baby’s individual needs and how to respond to these. They have specialist knowledge of babies development and will support parents to become involved in their babies care to promote bonding.
Neonatal speech and language therapists
Speech and language therapists (SLTs) play a vital role on the neonatal unit and work closely with parents and the multi-disciplinary team across all levels of care. On the neonatal unit, the specialist neonatal SLT team focus on supporting early infant feeding and communication development.
The SLT may start working with a baby well before they are ready to have any feeds by mouth, to promote pre-feeding skills and to monitor the baby’s readiness to start breast or bottle feeding. SLT can carry out an assessment of a baby’s feeding and provide recommendations to develop their sucking and swallowing skills. This may include making changes to the environment, trying different positions, using different bottle teats, pacing, adjusting the volume, and timing of feeds. The SLT’s will continue to support baby’s oral feeding skills whilst they transition from tube to breast and and/or bottle feeding.
SLTs also support parents to understand their individual baby’s behavioural states, cues and responses. These are early communication attempts that are important for starting “conversations” and to enable the development of a close and loving relationship. The SLT may contribute to a baby’s individualised developmental care plan, alongside parents and other members of the therapy team to promote a baby’s learning and development.
Neonatal Physiotherapists have expertise in the movement and postural control of sick and preterm infants. Physiotherapists provide specialist age-appropriate support, advice, education to promote individualised positioning, and handling strategies to enhance development.
The physiotherapists are part of the developmental care team on the neonatal unit. They are able to assess babies for signs of neurological or physical conditions that may require further support. When developmental delay or abnormal movement patterns are identified physiotherapists can refer babies to community therapy teams to ensure they receive follow up care once discharged home. Physiotherapists can also provide parents with support and advice on how to care for their baby following surgery.
Neonatal pharmacy service
Pharmacy provides a variety of services to the neonatal department. A daily visit to NICU by two specialist paediatric pharmacist takes place Monday to Friday. The role of these pharmacists is to check all the prescriptions and ensure that dosages and administration of medicines are suitable for each baby. Checking the medicine dosages is extremely important as pre-term babies cope with medicines very differently to term babies, children and adults. Some medicines require blood tests to be taken to check that the correct amount of medication is being given. The pharmacists will check to ensure that these blood tests have been taken and to check the results and if necessary be available to advise on any dose changes.
The pharmacists are available to provide advice to the doctors, nursing team and also parents on any aspects of medicines management e.g. whether a mother can breastfeed or express breast milk if they are taking medication. Many of the medicines which we use for babies will have been designed for adult patients and the pharmacist will advise on how these medicines can be given to babies, or if special liquid preparations can be supplied.
The pharmacists are also qualified as ‘prescribers’ which allows them to prescribe new medicines that may be required or modify existing prescriptions to optimise the dosing for a baby.
As a baby is prepared for discharge the pharmacist will be involved with organising medicines to take home. In some cases the pharmacist may contact the community pharmacist where prescriptions will be dispensed after the baby leaves the hospital to help provide information to ensure that the baby does not run out of medication.
The pharmacists are also involved with assisting nursing and medical staff with reviewing policies and guidelines where medicines are involved to ensure that staff have up to date information and provide information to help staff administer medicines safely.
The neonatal pharmacists are supported by a number of other staff in pharmacy. Some babies may require TPN (Total Parenteral Nutrition) which is a way of feeding the baby by a drip. The TPN is prepared in a specially designed clean room in pharmacy by staff trained to prepare this solution. These staff will check the TPN orders which are requested by the doctors and provide advice to both doctors and nurses on TPN.
The inpatient dispensary is where a baby’s discharge medicines are prepared in addition to some of the inpatient medicines that are not routinely stocked on NICU. A number of different staff types work here including pharmacy assistants, pharmacy technicians and pharmacists. These staff ensure that medicines are dispensed safely and accurately. As the dispensary is involved with supplying inpatient and discharge medicines for the whole Trust, it usually supplies more than 200 prescriptions or medicine orders each day.
Our Central pharmacy department work hard to ensure that the neonatal clinical areas are stocked with the medicines which are commonly used. A pharmacy assistant visits NICU twice a week to check which medicines need to be supplied by pharmacy.
Finally, you may wonder what happens if someone needs a supply of a medicine or advice out of hours. A resident pharmacist is available via a bleep and is able to organise supplies of urgent medicines or provide advice to doctors and nursing staff.