NICU and Special Care Nursery

Neonatal Intensive Care Unit (NICU) and Special Care Nursery (SCN)

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Important Information

For the protection of all the babies:

  • Hand washing (up to the elbows with jewellery off) is the most effective precaution in the prevention of infection whilst caring for your baby.
  • Please ask visitors to text or ring you on arrival, so you can let them in with your Proximity Card & accompany them into the unit.
  • Please limit visitors at the bedside to a parent & two others (max 3 at bedside at any one time)
  • Children (under 12 years) other than your own are not permitted in the unit.
  • If any visitor has an infection it will be necessary to exclude them from visiting.
  • 1-3 pm is a `baby rest time’ and parents only are permitted. This is a quiet time for babies to have a deep undisturbed sleep.
  • Prior to discharge please return your Proximity Card, in the supplied envelope to the ward clerk or your baby’s nurse

What to expect in the NICU/SCN

The NICU and SCN at Canberra Hospital provides care for babies who require extra attention following birth. Some reasons for admission include preterm birth, low birth weight, breathing difficulty, low blood sugar level, infection, birth trauma and some congenital abnormalities.

A specially trained team attends all high risk births where it is anticipated that the baby may experience difficulties. If time permits, members of the NICU team will meet with parents to discuss what they may expect after their baby is born.

Levels of care

The Unit provides three levels of care:

  • The NICU is for seriously ill or premature babies requiring intensive care.
  • It also provides high dependency beds for babies requiring extra observation and care.
  • The SCN provides care for stable babies prior to discharge. The focus of this unit is parent education and discharge planning.

Upon admission

Fathers/Support person are encouraged to accompany their baby to the unit. The admission process can be quite busy and overwhelming. Staff will endevour to keep you informed of all procedures and the progress of your baby at all times. If you feel unable to attend the unit at this time, staff will provide you with a phone number that will connect you directly to your babies room.

Many parents are concerned or even afraid of what their baby may look like if they are sick or pre-term. This is a normal reaction to an unfamiliar situation. Your baby will be placed in a cot, isolette, or on a warmer. Their temperature is monitored closely to ensure they are warm and comfortable.

Monitoring leads may be placed on your baby’s chest and abdomen to monitor heart and respiratory rates. A pulse oximeter sensor will be placed on your baby’s foot or hand to monitor the amount of oxygen in the body.

Some babies need help breathing. There are several kinds of respiratory support. Your baby’s nurse will explain everything to you.

Some babies need IV fluids. This may be provided by placing a cannula in your baby’s hand or foot. Some babies may also need to have catheters placed in the umbilical cord.

This may be used for more concentrated nutrition or to draw blood for laboratory tests.

This can be very frightening for families to see. Your babies nurse will explain what all the equipment attached to your baby is for and how you can be involved in caring for your infant.

Equipment

The complex equipment that is required to provide a high standard of care for babies can be overwhelming at first glance. We are happy to explain the function of the equipment to help you to understand your baby’s condition. Please feel free to ask questions.

Please remember the monitors are there to assist the staff in monitoring your baby and allow for us to reduce unnecessary handling and disturbance.

You can learn more about Equipment in our Parent Handbook; pages 40-44

Being with your baby

We recognize the essential role of parents as part of the team. Parents are not considered visitors, therefore you have 24 hour access to the NICU/SCN, via your Proximity Card, a locked cupboard next to your baby’s cot exclusively for your use & a recliner chair next to your baby’s cot. We also welcome and encourage parents, grandparents, and siblings to visit.

Proximity Cards

One Proximity card will be allocated to each family whilst your baby is in the unit so that you have 24 hour access to your baby.

Only the parents are to use the card.

The card must be returned, in the supplied envelope, when your baby is discharged. Please hand the envelope, with card inside, to the Ward Clerk or the Nurse caring for your baby.

The card is deactivated when your baby is discharged and only reactivated when given to the next parents requiring access to the unit.

Please ask your visitors to text you on your mobile when they arrive so that you can escort them into the unit.

Speaking Up For Your Baby

During your stay, you may be concerned about all the different systems and services available.

However, parents are equal members of their baby’s health care team, so it is important to understand everything your baby’s team is telling you. We encourage you to speak up and ask questions when you don’t understand something. We regard every question you ask as important.

During your baby’s stay in the NICU/SCN, we also encourage you to share information you have learned or observed about your baby’s care. Over time, you will develop working relationships with your baby’s doctors, nurses and other members of the team that are based on trust and mutual respect.

Take an Active Role

Although your baby is requiring our specialised skills and equipment, they equally need your parenting. They need to know you are there for them, to know your touch, smell & voices. To know, that you are their advocate in this early time of their lives.
To be involved with their care, whenever possible, will be invaluable when you go home with your baby. This will allow you to feel confident in knowing your baby, their needs & being their parent.

To learn more about what you can do, please refer to the Parent Handbook:

- Baby’s early development - page 27
- Kangaroo Care - page 30
- Learning baby’s signals - page 31

Please discuss how you would like to be involved with your baby’s care, with your baby’s nurse.

Weighing Your Baby

Your baby will be weighed twice a week whilst in the unit. Sometimes it may be necessary to weigh your baby daily or at different intervals depending on the nature of his/her condition.

Your Baby's Own Clothing

When your baby is in an open cot you are welcome to dress your baby in their own clothing and blankets or swaddling wraps.

Please be aware that whilst all care will be taken with these items we cannot be held responsible in the unlikely event of loss of clothing.

Parents are also responsible for taking them home, for washing.

Family centred care

Family Centred Rounds are an important part of the care patients and families receive in the NICU/SCN. Family centered medical rounds recognise the baby and their family as the focus of care and, as appropriate, involves the family in the decision making process.

These rounds provide an opportunity for your baby’s health care team to receive input from the family.

Canberra Hospital is a teaching hospital so discussions may include talk about possible outcomes and different courses of action. If you have questions about your baby’s care or about anything said during rounds, please speak with the staff caring for your baby after rounds.

Many caregivers are involved in each baby’s care and include the baby’s family, medical providers, nurses, and other allied health personnel. It is important that all caregivers share information so they can work effectively as a team. This sharing takes place during medical rounds.

The medical staff participate in rounds every morning to discuss each baby’s status and progress. You are encouraged to be at your baby’s bedside during medical rounds. Brief questions should be addressed at this time. Complex questions about your baby’s condition will be addressed individually with the doctor or in a family meeting.

Family Meetings

Periodic family meetings with the multidisciplinary team are an opportunity to discuss in more detail your baby’s overall condition, progress, and plan of care. If a family meeting is needed or requested, your nurse will make the arrangements. Understand that you don’t have to wait for a family meeting to ask questions about your baby’s care. Talk with your baby’s nurse or doctor at any time.

Visitor guidelines

In the interest of the babies and effective operation of the NICU/ SCN, we ask you to consider the following requirements when visiting;

  • General visitors may visit between 6am and 9pm.
  • All visitors must be accompanied by one or both parents while in the unit unless prior permission has been given by the parents and staff notified.
  • To maintain a quiet, healing environment for the baby, and for the developmental care of your baby, please limit the visitors to three people at the cot side at any one time.
  • In exceptional circumstances you may wish to bring in more visitors, please discuss this with your baby’s nurse.
  • Staff will only give information to the parents of the baby. Please make visitors aware of this and ask them to get information from you, the parents.
  • Depending on the baby’s and/or staff needs, visitors may be asked to limit the length of their visit. Families are encouraged to use the family lounge and other family spaces for long visits and for visiting with larger groups.
  • Please be aware that people using these areas may be asked to vacate the area if the parents of a baby choose to use it while their baby is having a procedure carried out.
  • If you chose this option, while your baby is having a procedure, please let your baby’s nurse know, so they can come and get you after the procedure.
  • Children other than the siblings of your baby are not permitted in NICU/SCN. Adult supervision is required for all children under the age of 12.

Infection control

We ask that anyone who has a cold or infectious disease not visit our patients until he or she is well. If visitors or children are unwell, have a cold, a fever, diarrhoea or vomiting do not allow them to visit your baby.

If your other children, friends or relatives have chicken pox, German measles or any other infectious disease please discuss this with the medical staff caring for your baby before visiting the unit. It will be necessary to exclude an unwell child from visiting, for the duration of the illness. This is a very important way to protect all the babies in our care.

Handwashing

Handwashing is one of the most important precautions in the prevention of infection whilst caring for your baby. Ensure that you always wash your hands before entering the unit.

When first entering the baby’s room, parents and visitors are asked to perform a one-minute, fingertip-to-elbow scrub in the sink. Roll up your sleeves, remove watches, bracelets, and rings, ensure you clean your forearms up to the elbows and dry thoroughly. Alcohol rub should be used after touching any surfaces before touching the baby.

Cold Sores

If you have a cold sore please inform the medical or nursing staff caring for your baby. It may be necessary to take extra precautions to prevent cross infection.

Mobile Phones

To reduce bedside noise levels in the NICU/SCN, please make sure that your mobile phone is either set to vibrate or turned off. Use your mobile phone in the family spaces throughout the NICU/SCN and at the glassed end of the corridors. Not in your baby’s room.

To protect the privacy of our patients, please do not use your mobile phone to take pictures or video of other babies.

Patient privacy and security

We ask that you and your baby’s visitors respect the privacy of other families. Please do not discuss patient information in public and do not ask our staff questions about other babies or enter other babies’ rooms.

You may have an opportunity to meet other parents during your stay in the NICU/SCN. If you connect with another parent whose baby is in the unit and that parent wishes to invite you in to see their baby, you may enter that room with the parent. You must consider yourself a “visitor” in that baby’s room. The same would apply to inviting another parent in to see your baby.

Photos

Please enjoy taking as many photos of your baby as you wish. Professional photographers are available if you wish to use their services.
Many parents often return to donate photographs of their baby’s journey through the early stages of their life and our staff love to see how your babies are developing.
We do ask that your donated photos are in digital form as they may be used in art work and media events, if you give permission.
If you would like the hard copies of your photographs returned please contact staff in NICU/ SCN and we can arrange a time for you to come and collect them.

Security Doors
The security doors will be locked 24 hours a day. This ensures the safety of all babies, staff and visitors. Parents will be given a Proximity Access Card (1 per family).

During visiting hours, 6am - 9pm, please ask your visitors to text or ring you on your mobile when they arrive so you can let them in with your pass.

This avoids visitors ringing the doorbell, allowing the ward to remain a quiet place for the babies

Breastfeeding information

Canberra Hospital is a baby friendly accredited hospital and we encourage breastfeeding your baby.

Feeding and Providing Breast Milk for Your Baby

Many infants in the NICU/ SCN may be unable to breast feed at first. These babies must be fed through a gavage tube. After your baby gets stronger and continues to grow, he or she will be fed by mouth.

If your baby is able to take a milk feed, he or she generally can be given breast milk. If your baby cannot breastfeed you can express your milk and we can freeze it so that it can be stored and used later.

We encourage all mothers to provide breast milk for their baby. Even if your baby is too sick or small to nurse, you should hand express your breasts as soon as possible after delivery to assure a good milk supply.

The first milk, colostrum, even the smallest drops, are collected in labelled syringes & fed to your baby.

After 24 hours of hand expressing, your bedside Nurse or Lactation Consultant will provide you with a pump kit and help you begin expressing via a breast pump. We are always available to help you with any questions you may have.

Containers and labels are available in the NICU/ SCN. Ask your baby’s nurse for a supply to take with you. Mark each container with the date and time the breast milk was expressed. All expressed breast milk will be processed through the Nutrition Room. Your baby’s nurse can explain this more.

If you chose not to breastfeed your baby, we will discuss artificial feeds with you.

Your baby may require artificial feeds when there is not enough breast milk available. We will discuss this with you first.

Looking after yourself

Whilst you are breastfeeding or expressing breast milk, we encourage you to have a well balanced diet and get plenty of rest and fluid.

Expressing Room

The Expressing Room is located in the SCN. The room provides an area where mothers of babies in the NICU/SCN can express breast milk in privacy and comfort away from clinical and public areas.

This room is available 24 hours for the use of the mothers who are expressing breast milk for their babies. Just remember to bring your kit to attach to the electric pump. Due to privacy, males are not permitted in the expressing room.

There are also mobile electric breast pumps available to use in your baby's room. Please ask your nurse if you would prefer to use one of these so you can express next to your baby.

Storage and Use of Expressed Breast Milk

It is essential that EBM is stored correctly:

• EBM can be stored in the body compartment of the refrigerator. Never store EBM in the refrigerator door
• EBM at Canberra Hospital is stored in the Nutrition Room freezer
• EBM should never be refrozen once it has been thawed
• Correctly label EBM with your name, date and time of collection using the baby labels that your nurse gives you.

Your EBM is collected from the NICU/ SCN refrigerators in the morning by the Nutrition Room technician. The milk is then poured into individual amounts for your baby’s feeds over the next 24 hours. The remaining EBM will be frozen for use later.

If your baby is in NICU and only taking very small amounts of EBM e.g. 1 or 2 mls - please express and then divide into smaller volumes. Syringes may be used to store these smaller volumes, therefore avoiding larger amounts being defrosted and wasted.

Please number these syringes.

Parents are asked not to place or remove milk from the fridges. This will be done by the nurse caring for your baby, who will double check that it is labelled correctly and given to the right baby.

For more information on breast feeding see the Australian Breast Feeding Association website.

Lactation Consultant (LC)

Is a specialist trained to focus on the needs and concerns of the breastfeeding mother-baby pair and to prevent, recognise, and solve breastfeeding difficulties. They have educational and clinical backgrounds in the health professions.

The NICU/SCN have Lactation Consultants who are also practicing midwives and nurses. If you would like to speak to a Lactation Consultant please ask your nurse and she will organise a time for the LC to come and speak to you.

Lactation Support

During your admission; Nursing staff and lactation consultants are available to:

• Provide you with current, accurate information about feeding infants
• Provide help and information about breast pump rental, breast milk expressing, handling and storage
• Provide one-on-one assistance when you begin breast feeding and ongoing support as needed
• Offer help if you have any concerns with expressing or breastfeeding
• Connect you with breast-feeding support and specialists in your area when you go home.

Going home - The discharge process

  • Going home with your baby is an exciting time. We want to make sure that both you and your baby are prepared for this happy event.
  • In general terms, your baby should be ready for discharge by his or her due date, can maintain a normal temperature in an open cot, has appropriate weight gain, takes all or most feedings by breast or bottle, and is off all IV medications.
  • Some babies will go home needing extra care and so will require additional support.
  • We have developed a guide to help us work with you to make sure your baby’s transition home is smooth.

Your baby’s care team wants to make sure you feel as prepared as possible to go home with your baby when the time comes.

Below is a list of activities you should be confident doing before you go home with your baby:

  • Taking your baby’s temperature
  • Changing your baby’s nappy
  • Bathing your baby
  • Dressing your baby
  • Feeding your baby by breast or bottle
  • Preparing breast milk or formula for your baby
  • Giving your baby medications
  • Placing your baby safely in a car seat
  • Putting your baby ‘back to sleep’ and on ‘tummy to play’
  • Ensured that your capsule/car seat is fitted in your car by an approved fitter
  • Completed a Cardiopulmonary Resuscitation (CPR) class