The red hat pathway: reducing avoidable NNU admissions for hypoglycaemia

Although untreated neonatal hypoglycaemia may be a cause of long-term harm, anticipatory management of at-risk babies (eg with thermoregulation and feeding support) can prevent many unnecessary admissions. Staff at the NNU at Evelina London Children’s Hospital implemented the ‘red hat pathway’ to reduce the number of avoidable NNU admissions for hypoglycaemia by introducing the use of a red knitted hat for babies identified as at increased risk. The project demonstrates that many of these at-risk infants can be successfully managed on the postnatal ward and highlights how a simple intervention can have a significant impact on care delivery.

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Quality improvement in the NICU: increasing the use of own mother’s milk

Human milk (HM), particularly own mother’s milk (OMM), is one of the highest impact, low cost interventions in the medical field with research constantly finding new and more impressive data to support this. OMM should be considered a medical intervention and an institutional priority, especially for those babies in the neonatal intensive care unit (NICU). However, no other medicine is administered, tracked or reported on as haphazardly as HM in the NICU.

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Delivery room cuddles for preterm babies: should we be doing more?

Early delivery room contact between a preterm baby and a parent is now offered more frequently in units across the UK but it is yet to be accepted as standard care. This article presents data from the neonatal unit at Great Western Hospital in Swindon regarding time to first parental contact, a suggested standard operating procedure for facilitating a delivery room cuddle and four case studies written by parents about their first contact with their preterm babies.

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Each Baby Counts: the 2018 progress report

The Each Baby Counts 2018 progress report presents key findings and recommendations based on the analysis of data from 2016 relating to the care given to mothers and babies throughout the UK, to ensure each baby receives the safest possible care during labour.

The progress report found the nearly 700,000 babies born in 2016, 1,123 babies fulfilled the Each Baby Counts criteria. There were 124 stillbirths, 145 babies who died early and 854 babies who sustained severe brain injuries during labour at term (babies born after 37 completed weeks of gestation.

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Sail sign in neonatal pneumomediastinum: a case report

Pneumomediastinum is an uncommon cause of neonatal respiratory distress. Clinical history and examination of the neonate may be uninformative in determining the aetiology of the respiratory distress. Chest x-ray can be diagnostic of pneumomediastinum however is often difficult to interpret.

This case report discusses a 36 week gestation newborn delivered by emergency caesarean section, intubated and given intermittent positive pressure ventilation via Neopuff™ for apnoea before being extubated to CPAP. Chest radiography initially showed bilateral upper zone opacities, presenting a diagnostic dilemma; however subsequent films demonstrated a pneumomediastinum which was managed conservatively and resolved. The “sail sign” describes an uncommon radiological appearance of a pneumomediastinum in neonates and infants. With careful conservative management, a spontaneous resolution without longterm sequelae can be expected.

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A nurturing programme on the neonatal surgical ward

A recently introduced nurturing programme on the neonatal surgical ward at Birmingham Children’s Hospital makes use of volunteer members of staff who sit with babies to provide comfort, cuddles and reassurance when the parents are not present. The initiative is considered a huge success and deemed beneficial to the babies, their parents and the nursing staff.

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Keeping Mothers and Babies Together: implementing a single, simplified pathway for at-risk infants

Despite falling birth rates, admissions to neonatal units are increasing. National drivers aimed at reducing term admissions have concentrated on identifying reasons for admission and tackling each individually. National and local guidelines differ in their approach to managing infants at risk of postnatal compromise dependent on the specific risk factor identified, adding to the confusion and leading to significant variation in postnatal care delivery. A more radical approach to managing all infants at risk of postnatal compromise focusing on simplifying and standardising postnatal care for the late preterm and more vulnerable term infants is described.

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