Support for Clinicians

Welcome to the Support for Clinicians pages on the NWNODN website.  These pages have been put together to provide information and resources for all clinicians.   We welcome feedback on the usefulness of these pages – please ‘like’ us below – or you can send your feedback to us at

Welcome to the North West Perinatal/Neonatal Palliative Care page

Over 8000 babies are cared for at across the NWNODN every year. Sadly some of these babies will die either in hospital or be discharged with a life-limiting illness to community settings where they can best be supported with palliative and end of life care. It is crucial that these babies receive holistic end of life and palliative care whilst their families and carers are supported through a very difficult and challenging time.

The following documents provide a framework and set of tools to assist health care professionals with their care provision, trying to ensure the right conversations take place at the right time, in the right place and with the right people. This then should hopefully result in the very best care possible being provided.

Guide to using the resources:

There is an overarching North West Perinatal/Neonatal Palliative Care Guideline and two care plans for care within the hospital setting and care provided in a hospice or home. Additional supporting documents have been placed into subgroups to help guide the user quickly to the information they require.
The resources found within this page have been produced as a result of a wide, multi-disciplinary and cross-organisational collaboration. We hope these documents and the information they contain will be welcomed as helpful tools for anybody providing palliative and end of life care in a multitude of settings and places, but always with the baby and their family at the centre. Please send us your comments and feedback after using this page and resources to

Hospice Support

Transport Guideline

This page has been developed to provide information and guidance to Infant Feeding Leads and those with an interest in infant feeding working within neonatal care across the NWNODN.

Please select to jump to a section

NWNODN Infant Feeding Resource

Educational Resources for Healthcare Professionals

Information & Resources for Families

Support-for-Mothers-Expressing-Breast-Feeding

Formula-and-bottle-feeding

NWNODN Infant Feeding Specialist Interest Group

NWNODN Infant Feeding Resources

The documentation below has been developed by the NWNODN Infant feeding group for use in all neonatal units across the north west.

North West Human Milk Bank click here for information on how to donate breast milk.

Educational Resources for Healthcare Professionals

For World Breast Feeding Week 1st  – 7th August 2021 East Lancashire Teaching Hospital Neonatal BFI Team have kindly shared a set of slides they have put together to raise awareness of breast feeding.   Please click the link: World Breast Feeding Week 2021

NWNODN Infant Feeding Information and Assessment Document: Breast feeding the preterm infant

eLearning for Health (eLfH) Breastmilk Provision for Preterm and Sick Neonates eLearning resource

Healthcare professionals will need to register with eLfH to access these on-line learning resources.

Information Resources for Healthcare Professionals:

Drugs In Breastmilk Information Service (Infant Feeding Network): if a parent or healthcare professionals has a e specific question about medications or treatments, please message the Drugs in Breastmilk information service Facebook page or email  or telephone  0300100 0212 to speak to a pharmacist directly.

UNICEF Breast Feeding Resources: These resources cover a range of issues around establishing and continuing successful breastfeeding.

UNICEF off the best start – this information leaflet  is a teaching aid for health professionals when discussing the benefits and management of breastfeeding with pregnant women, and when teaching new mothers how to breastfeed.

UNICEF: Maximising Breast Milk Video

WHO Optimal feeding of low-birth-weight infants – technical review – systematic review of issues in feeding of low birth weight infants. The review addresses the following key questions: what to feed, when to start feeding, how to feed, how often and how much.

Information & Resources for Families

Benefits of breastfeeding

The UK has one of the lowest rates of breast feeding ion the world.  more than 73% of mothers start breastfeeding Unfortunatley despite the many benefits for baby and mother, this number falls dramatically in the first few months of a baby’s life.These are some of the reasons why:
  • your breast milk is perfectly designed for your baby
  • breast milk protects your baby from infections and diseases
  • breastfeeding provides health benefits for you
  • breast milk is available for your baby whenever your baby needs it
  • breastfeeding can build a strong emotional bond between you and your baby

Formula milk does not provide the same protection from illness and does not give you any health benefits.

Health benefits of breastfeeding for your baby

Breastfeeding has long-term benefits for your baby, lasting right into adulthood.Any amount of breast milk has a positive effect. The longer you breastfeed, the longer the protection lasts and the greater the benefits.Breastfeeding reduces your baby’s risk of:

Giving nothing but breast milk is recommended for about the first 6 months (26 weeks) of your baby’s life.

After that, giving your baby breast milk alongside family foods for as long as you and your baby want will help them grow and develop healthily.

Breast milk adapts as your baby grows to meet your baby’s changing needs.

Health benefits of breastfeeding for you

Breastfeeding and making breast milk also has health benefits for you. The more you breastfeed, the greater the benefits.Breastfeeding lowers your risk of:

Busting some breastfeeding myths:

Myth: “It’s not that popular in this country.”
Fact: More than 73% of women in the UK start breastfeeding, and 17% of babies are still being exclusively breastfed at 3 months.
Myth: “Breastfeeding will make my breasts sag.”
Fact: Breastfeeding does not cause your breasts to sag, but pregnancy hormones can stretch the ligaments that support your breasts. Wear a well-fitting bra while you’re pregnant.
Myth: “People do not like to see women breastfeeding in public.”
Fact: Most people do not mind. The more it’s seen, the more normal it will become. The law protects women from being asked to leave a public space while breastfeeding.
Myth: “Formula milk is basically the same as breast milk.”
Fact: Almost all formula milk is made from cows’ milk. It can contain bacteria, which is why it’s vital to make it up with water hot enough to kill any bacteria (70C). It does not protect your baby from infections and diseases like breast milk does.
Myth: “Some women do not produce enough breast milk.”
Fact: Almost all women are physically able to breastfeed. Early, frequent feeding and responding to your baby’s cues give you the best start to establishing your supply. See Is my baby getting enough milk?
Myth: “If I breastfeed I cannot have a sex life.”
Fact: There’s no reason why breastfeeding should stop you having sex with your partner. Your breasts may leak a little milk while you’re having sex, but you can try feeding your baby beforehand or wearing a bra with breast pads in. Your vagina may feel a little drier than usual because of your breastfeeding hormones. Using some lubricant and taking things slowly will help.
Myth: “Breastfeeding hurts.”
Fact: Breastfeeding is a natural way to feed a baby and it should not hurt. If you experience pain in your breasts or nipples, it’s usually because your baby is not positioned or attached properly. Ask your midwife, health visitor or a breastfeeding specialist to watch a whole feed to help spot the problem.
Myth: “My nipples are flat or even inverted, so I will not be able to breastfeed.”
Fact: Nipples come in all sorts of shapes and sizes. Holding your baby skin to skin after birth will help them find the best way to attach themselves. Your baby breastfeeds, not nipple feeds, so as long as they can get a good mouthful of breast, they should be able to feed perfectly happily.
Myth: “Babies do not need breast milk once they start solid foods at about 6 months.”
Fact: Breastfeeding still has lots of benefits for you and your baby after 6 months. It protects them from infections and there’s some evidence that it helps them to digest solid foods. It also continues to provide the balance of nutrients they need. The World Health Organization recommends that all babies are breastfed for up to 2 years or longer.

Information leaflets available to be given to families:
Bliss:

Support for Mothers Expressing/Breast Feeding

There are many resources available to support breast feeding and expressing, in addition to seeking advice from from your midwife or neonatal nurse the following resources are also available to you:

Start4Life Breastfeeding Friend  chat-bot for fast, friendly, trusted NHS advice anytime, day or night.

You can also ask our Start4Life Breastfeeding Friend questions anytime, day or night. It’s available on:

CATCH APP: free NHS app for parents with children 0-5yrs old

UNICEF: Other support organisations – national support

Local breastfeeding support group can be found here as well as the following peer support groups in the north west:

 

Liverpool Bambis: Breast feeding Peer Support for families living in Liverpool.

 

   

Breast feeding Together: Breast Feeding support in Wigan.

Breast Feeding Support in Trafford – Facebook page

UNICEF Breast Feeding Resources: These resources cover a range of issues around establishing and continuing successful breastfeeding.

Breast Pump Hire: many hospitals have breast pumps mothers are able to take home but unfortunately there is often not enough for every mum. there are organisations you can hire hospital grade breast pumps from, some are listed here:

Medela

Ardo

Formula and bottle feeding

We recognise whilst we promote breast feeding/expressing we understand some mothers may be unable to breast feed or choose to bottle feed.

UNICEF: Infant Formula & responsive Bottle Feeding – a guide for parents

Department of Health & UNICEF : Guide to bottle feeding 

Information for Healthcare Professionals:

First Steps Nutritional Trust: guides to infant milks for health professionals

UNICEF: Guidelines on providing information for parents about formula feeding

How the Baby Friendly Initiative supports parents who formula feed:

The Baby Friendly standards are designed to support the wellbeing and life chances of all babies, whether breast or bottle fed. Whilst breastfeeding is the best option for babies, and we work to support mothers to breastfeed, we also work to ensure that all babies receive high standards of care and the best possible chance to thrive regardless of feeding type.

For bottle fed babies, this work includes:

  • Enabling closeness between parents and their baby, which supports brain development and mental health
  • Helping parents to choose an infant formula, make up feeds and avoid over feeding
  • Supporting parents to lower costs
  • Protecting families from commercial interests and advocating for the rights of all babies at a governmental level.

All maternity and community services which are accredited as Baby Friendly must demonstrate that their staff support families who bottle feed. The following statement, published in January 2017 and available for download below, will explain this work in more detail, and help health professionals to demonstrate the impact of the Baby Friendly standards on the welfare of both breast and bottle fed babies.

How the Baby Friendly Initiative supports parents who formula feed: Unicef UK Baby Friendly Initiative Statement January 2017 (download pdf)

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NWNODN Infant Feeding Specialist Interest Group

Clinicians working within the NWNODN are dedicated and committed to improving the number of babies that receive their mother’s milk and supporting those mothers who wish to breast feed and/or express their milk.

Regularly Infant Feeding Leads and healthcare professionals, with an interest in infant feeding from a variety of backgrounds across the NWNODN, come together to share and learn about best practice. The group have collectively developed resources to improve care around infant feeding

For more information or to join one of our meetings please contact: or click here to see our next meeting dates.

HIE occurs when the fetal brain does not receive enough oxygen. This can lead to severe impairment or death of the baby and is of course devastating for both families and staff.

This page has been developed primarily to help families and clinical staff to better understand Hypoxic-Ischaemic Encephalopathy (HIE) and cooling treatment.

The information contained within this page outlines practices undertaken across the NWNODN around HIE (network guideline & neonatal transport service), as well as national resources focusing on the education of clinical staff and support and information available to families affected by HIE.

It is hoped in time this page will be develop to encompass other conditions affecting neonatal brain development.

NWNODN Cooling Guideline & Recommendations

NWNODN Hypoxic Ischaemic Encephalopathy Guideline 

Please send feedback on this guideline to:

The NWNODN supports any local neonatal unit (LNU) to undertake Cerebro-functioning monitoring (CFM) and who wish to initiate active cooling until the neonatal transport team are able to transfer the infant to an appropriate NICU.

NICUs within the NWNODN will continue to provide therapeutic hypothermia (Cooling) and longer term care of these infants.

Please follow local guidelines on the use and interpretation of CFM.

Cooling in neonatal transport

Connect North West is the neonatal transport service for the NWNODN and one of the first neonatal transport teams in the UK to undertake active Cooling in transportBabies who require Cooling treatment for HIE will need to be cared for in one of the seven Neonatal Intensive Care Units (NICUs) across the network. Babies who require cooling but are born in a local neonatal unit (LNU), where long term cooling treatment isn’t available, will need to be transferred to a NICU by the specialist neonatal transport team, Connect North West.

If your baby needs to be transferred this will not usually mean a delay to starting treatment. Some LNUs have equipment  to initiate active Cooling whilst others will start passive cooling. Connect North West have a specialist transport incubator with all the equipment needed to start active cooling treatment. Occasionally where your baby may require additional specialist treatment for transfer, for example a different type of ventilation, cooling treatment may have to be commenced on arrival at the neonatal intensive care unit. The team will explain to you the process of starting the cooling treatment and your baby’s transfer.

The transport team will ensure your baby receives the best possible care during the transfer.

After completion of the cooling treatment at the NICU your baby may be transferred back to your local neonatal unit before discharge home but your baby’s nurse and consultant will discuss this with you.

Picture of the Cooling transport Incubator used by the neonatal transport team Connect North West:

 

Information for Healthcare Professionals

Admissions for management of HIE, known as asphyxia, was the fifth largest reason for admission of term babies to neonatal units in England between 2013-2015, accounting for 2.5% of all term admissions.

The number of term admissions where the primary reason for admission was recorded as ‘asphyxia’ totalled 3236 term baby admissions in the same period

Maternity and neonatal teams across England are working towards achieving the national ambition, set out by Secretary of State for Health, Jeremy Hunt, in November 2015 which aims to reduce the number of stillbirths, neonatal deaths, maternal deaths and intrapartum brain injuries by 20% by 2020 and 50% by 2030

National programmes of work aimed at reducing the incidence of HIE  by 20% by 2020 and 50% by 2030.

MBRRACE-UK Perinatal Mortality Surveillance report for births in 2016

Each Baby Counts  is the Royal College of Obstetricians and Gynaecologists (RCOG’s) national quality improvement programme aiming to halve the number of babies who die or are left severely disabled as a result of preventable incidents occurring during term labour by 2020.

A detailed analysis of all stillbirths, neonatal deaths and brain injuries that occurred during childbirth in 2015 has identified key clinical actions needed to improve the quality of care and prevent future cases. The report presents the detailed data behind these recommendations as well as resources and proposed actions to support improved clinical practice.

Five years of cerebral palsy claims: a thematic review of NHS Resolution data  – provides an in-depth examination of the causes of these rare but tragic incidents and the investigations that follow them. For the purposes of this study we focused on 50 cases of cerebral palsy where the incidents occurred between 2012 and 2016 and a legal liability has been established.

NICE Guidance Therapeutic hypothermia with intracorporeal temperature monitoring for hypoxic perinatal brain injury (May 2010)

Education/Learning Resources:

eLearning for Health (eLfH) – have a module on HIE ( part of the Avoiding Term Admissions Into Neonatal units (ATA) work).

The e-learning programme is aimed at  healthcare professionals involved in the care of newborns, both in the hospital and community settings, to improve outcomes for babies, mothers and families through the safer delivery of care.

It is one of the outputs from the Atain programme (an acronym for ‘avoiding term admissions into neonatal units’) to reduce avoidable causes of harm that can lead to infants born at term (i.e. ≥ 37+0 weeks gestation) being admitted to a neonatal unit. HIE (asphyxia) was identified by Atain as one of the four clinical areas to be addressed as a learning need alongside respiratory conditions, hypoglycaemia and jaundice.

Healthcare professionals will need to register with eLfH to access these on-line learning resources.

BeBop (Baby Brain Protection) was written and launched by the East of England Neonatal Neuroprotection Team. Initially the site was developed to help families and clinical staff better understand Hypoxic-Ischaemic Encephalopathy (HIE) and cooling treatment. The site has since expanded to include a broader range of conditions affecting the brain of premature and term newborn infants.

In addition to containing information for staff the site has a section for families (link provided in the families section of this web page).

The NWNODN would like to thank the East of England Neonatal Neuroprotection Team for allowing us to link with their site and utilise the resources it contains.

Information leaflets available to be given to families:

Bliss: HIE a guide for parents

Peeps HIE awareness Charity: Parent Information Leaflet

National Institute of Clinical Excellence (NICE) Controlled cooling to treat newborn babies with brain injurycaused by oxygen shortage during birth’ – Understanding NICE guidance

Information and support for families

Click here for support and information for families affected by HIE

FiCare (Family Integrated Care ) is a model of care started in 2013 by Dr Shoo Lee who was intrigued about the feasibility of introducing a ‘care by parent’ model of care to his NICU in Canada. Unlike previous family centred care approaches, this model of care places parents at the heart of care giving, being based on the Humane Care Model already widely operational in neonatal units in Estonia. The FiCare model is an extension of the principles of Family Centred Care. The goal of FiCare is to facilitate a partnership and collaboration between parents and the NICU staff, to promote parent-infant interactions, and to build parent confidence. FiCare represents a paradigm shift in thinking about the way in which healthcare is delivered. FiCare invites parents to become part of the primary care team, moving away from traditional care delivery by only highly trained healthcare professionals.

The support the development of FiCare in a consistent way across the north west, the NWNODN established a FiCare Special Interest Group (SIG).   The SIG is made up of doctors, nurses, allied health professionals and parents who work closely together to examine how this model can benefit all families and clinicians within our network.   The SIG have defined FiCare across the north west as:

“Family integrated care is a model that supports and educates parents and carers to become integral participants in their baby’s care from the time of admission to the neonatal unit in partnership with the neonatal team”

The aim of the SIG is to ensure that the offer of FiCare is consistently offered to every family every time in all neonatal units across the NWNODN enhancing outcomes, family experience and supporting pathways.    To do this, the SIG have developed an accreditation process through which north west neonatal units will gain recognition as a NWNODN FiCare Unit, having implemented an agreed set of essential elements within the NWNODN FiCare passport/package.

During 2021-22 the NWNODN and north west neonatal units will begin the programme of achieving accreditation, which is the commencement of the journey of continuous development in FiCare

Please contact your Unit FiCare Lead to find out more about the network approach to FiCare and the NWNODN Accreditation scheme, or contact the NWNODN direct

Document Downloads

https://www.neonatalnetwork.co.uk/nwnodn//wp-content/uploads/2021/08/An-Overview-of-FiCare.pdf

https://www.neonatalnetwork.co.uk/nwnodn//wp-content/uploads/2021/08/FiCare-Poster-NWNODN-Emma-Rhodes-June-19.pdf

https://www.neonatalnetwork.co.uk/nwnodn//wp-content/uploads/2021/08/FiCare-Poster-NWNODN.pdf