Neonatology

Respiratory workload and medical staffing in uk local neonatal units (LNUS) and special care units (SCUS)-time for a rethink (2019)

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Type of publication:
Conference abstract

Author(s):
*Tyler W.; Fox G.F.; Fenton A.C.

Citation:
Archives of Disease in Childhood; May 2019; vol. 104

Abstract:
Introduction: The majority of UK neonatal care occurs in SCUs and LNUs with a smaller volume of highly complex care delivered by NICUs. Whilst the significant shortfall in nursing numbers nationally has been highlighted, medical staffing has received little attention. Aim To determine levels of medical staffing in UK LNUs/ SCUs, days of respiratory support provided and admissions weighing <1.5 kg. Methods Questionnaire sent to every LNU and SCU requesting details of medical tier staffing. ODNs provided the number of
respiratory care days (RCD – invasive and non-invasive mechanical respiratory support) delivered 2013-15 and numbers of admissions weighing <1.5 kg. Results 78 (86.7%) LNUs and 38 (95%) SCUs responded. 11/ 90 LNUs delivered <365 RCDs annually. Of these 9 admitted <25 infants weighing <1.5 kg. 6/40 SCUs delivered >365 RCDs annually. Significant numbers of LNUs and SCUs employed nontraining grade medical staff and ANNPs to cover rotas; neonatal CST holders or equivalent support many units (Tables 1 & 2). The 8/11 low-activity LNUs who responded provided partially separate Tier 1 staffing from paediatrics, consistent with SCU staffing recommendations only. Half of the high activity LNUs and all high activity SCUs did not achieve staffing standards for NICUs or LNUs respectively. Conclusions A wide range of activity is undertaken by UK LNUs and SCUs, with moderate overlap of workload between unit types. These data should inform potential unit redesignation as part of the current national reviews. Current medical and ANNP staffing is a major barrier to implementing change. (Table Presented).

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Evaluating the value of intrapartum fetal scalp blood sampling to predict adverse neonatal outcomes: A UK multicentre observational study (2019)

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Type of publication:
Journal article

Author(s):
Al Wattar, Bassel H; Lakhiani, Aarti; Sacco, Adalina; Siddharth, Aditi; Bain, Alexandra; Calvia, Alexandra; Kamran, Atiyah; Tiong, Bing; Warwick, Bethan; MacMahon, Caroline; Marcus, Diana; Long, Emma; Coyle, Gillian; Lever, Gillian Elizabeth; Michel, Gina; Gopal, Gomathy; Baig, Hana; Price, Hannah Louise; Badri, Hawra; Stevenson, Helen; Hoyte, Helene; Malik, Humaira; Edwards, Jade; Hartley, Jennifer; Hemers, Jennifer; Tamblyn, Jennifer; Dalton, John Alexander William; Frost, Jonathan; Subba, Kamana; Baxter, Kathryn; Sivakumar, Kavitha; Murphy, Kelly; Papadakis, Konstantinos; Bladon, Laura Rachel; Kasaven, Lorraine; Manning, Louisa; Prior, Mathew; Ghosh, Mausumi; Couch, Melanie; Altunel, Melis; Pearce, Melissa; Cocker, Michael; Stephanou, Michael; Jie, Michelle; Mistry, Minesh; Wahby, Mohammed Osama; Saidi, Nabila Shahid; Ramshaw, Nicola Louise; Tempest, Nicola; Parker, Nina; Tan, Phoebe L; Johnson, Racheal Louise; Harris, Rachel; Tildesley, Rachel; Ram, Ramya; Painuly, Ritu; Cuffolo, Romana; Bugeja, Roberta; Ngadze, Rose; Grainger, Rosie; Gurung, Sabitra; Mak, Sammy; Farrell, Sara; Cowey, Sarah; Neary, Sarah; Quinn, Sarah; Nijjar, Simrit Kaur; Kenyon, Sophie; Lamb, Stephanie; Tracey, Susan; Lee, Tara; Kinsella, Therese; Davidson, Trecia; Corr, Trent; Sampson, Uzo; McQueen, Victoria; *Parry-Smith, William; Castling, Zora; AB-FAB study group

Citation:
European Journal of Obstetrics, Gynecology, and Reproductive Biology; Sep 2019; vol. 240 ; p. 62-67

Abstract:
OBJECTIVE To evaluate the value of fetal scalp blood sampling (FBS) as an adjunct test to cardiotocography, to predict adverse neonatal outcomes. STUDY DESIGN A multicentre service evaluation observational study in forty-four maternity units in the UK. We collected data retrospectively on pregnant women with singleton pregnancy who received FBS in labour using a standardised data collection tool. The primary outcome was prediction of neonatal acidaemia diagnosed as umbilical cord arterial pH < 7.05, the secondary outcomes were the prediction of Apgar scores<7 at 1st and 5th minutes and admission to the neonatal intensive care unit (NICU). We evaluated the correlation between the last FBS blood gas before birth and the umbilical cord blood and adjusted for time intervals. We constructed 2 × 2 tables to calculate the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) and generated receiver operating curves to report on the Area Under the Curve (AUC). RESULTS In total, 1422 samples were included in the analysis; pH values showed no correlation (r = 0.001, p = 0.9) in samples obtained within an hour (n = 314), or within half an hour from birth (n = 115) (r=-0.003, p = 0.9). A suboptimal FBS pH value (<7.25) had a poor sensitivity (22%) and PPV (4.9%) to predict neonatal acidaemia with high specificity (87.3%) and NPV (97.4%). Similar performance was noted to predict Apgar scores <7 at 1st (sensitivity 14.5%, specificity 87.5%, PPV 23.4%, NPV 79.6%) and 5th minute (sensitivity 20.3%, specificity 87.4%, PPV 7.6%, NPV 95.6%), and admission to NICU (sensitivity 20.3%, specificity 87.5%, PPV 13.3%, NPV 92.1%). The AUC for FBS pH to predict neonatal acidaemia was 0.59 (95%CI 0.59-0.68, p = 0.3) with similar performance to predict Apgar scores<7 at 1st minute (AUC 0.55, 95%CI 0.51-0.59, p = 0.004), 5th minute (AUC 0.55, 95%CI 0.48-0.62, p = 0.13), and admission to NICU (AUC 0.58, 95%CI 0.52-0.64, p = 0.002). Forty-one neonates had acidaemia (2.8%, 41/1422) at birth. There was no significant correlation in pH values between the FBS and the umbilical cord blood in this subgroup adjusted for sampling time intervals (r = 0.03, p = 0.83). CONCLUSIONS As an adjunct tool to cardiotocography, FBS offered limited value to predict neonatal acidaemia, low Apgar Scores and admission to NICU.

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Term admissions to neonatal units in England: A role for transitional care? A retrospective cohort study (2017)

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Type of publication:
Journal article

Author(s):
Battersby C.; Michaelides S.; Upton M.; Rennie J.M.; Babirecki M.; Harry L.; Rackham O.; Wickham T.; Hamdan S.; Gupta A.; Wigfield R.; Wong L.; Mittal A.; Nycyk J.; Simmons P.; Singh A.; Seal S.; Hassan A.; Schwarz K.; Thomas M.; Foo A.; Shastri A.; Whincup G.; Brearey S.; Chang J.; Gad K.; Hasib A.; Garbash M.; Allwood A.; Adiotomre P.; Ahmed J.S.; Deketelaere A.; Khader K.A.; Shephard R.; Mallik A.; Abuzgia B.; Jain M.; Pirie S.; Zengeya S.; Watts T.; Jampala C.; Seagrave C.; Cruwys M.; Dixon H.; Aladangady N.; Gaili H.; James M.; Lal M.; Ambadkar; Rao P.; Hickey A.; Dave D.; Pai V.; Lama M.; Miall L.; Cusack J.; Kairamkonda V.; Jayachandran; Kollipara; Kefas J.; Yoxall B.; Whitehead G.; Krishnamurthy; Soe A.; Misra I.; Pillay T.; Ali I.; Dyke M.; Selter M.; Panasa N.; Alsford L.; Spencer V.; Gupta S.; Nicholl R.; Wardle S.; McBride T.; Shettihalli N.; Adams E.; Babiker S.; Crawford M.; Gibson D.; Khashu M.; Toh C.; Hall M.; Sleight E.; Groves C.; Godambe S.; Bosman D.; Rewitzky G.; Banjoko O.; Kumar N.; Manzoor A.; Lopez W.; D'Amore A.; Mattara S.; Zipitis C.; De Halpert P.; Settle P.; Munyard P.; McIntyre J.; Bartle D.; Yallop K.; Fedee J.; Maddock N.; Gupta R.; *Deshpande S.; Moore A.; Godden C.; Amess P.; Jones S.; Fenton A.; Mahadevan; Brown N.; Mack K.; Bolton R.; Khan A.; Mannix P.; Huddy C.; Yasin S.; Butterworth S.; Edi-Osagie N.; Cairns P.; Reynolds P.; Brennan N.; Heal C.; Salgia S.; Abu-Harb M.; Birch J.; Knight C.; Clark S.; Van Sommen V.; Murthy V.; Paul S.; Kisat H.; Kendall G.; Blake K.; Kuna J.; Kumar H.; Vemuri G.; Rawlingson C.; Webb D.; Bird; Narayanan S.; Gane J.; Eyre E.; Evans I.; Sanghavi R.; Sullivan C.; Amegavie L.; Leith W.; Vasu V.; Gallagher A.; Vamvakiti K.; Eaton M.; Millman G.

Citation:
BMJ Open; May 2017; vol. 7 (no. 5)

Abstract:
Objective: To identify the primary reasons for term admissions to neonatal units in England, to determine risk factors for admissions for jaundice and to estimate the proportion who can be cared for in a transitional setting without separation of mother and baby. Design: Retrospective observational study using neonatal unit admission data from the National Neonatal Research Database and data of live births in England from the Office for National Statistics. Setting: All 163 neonatal units in England 2011-2013. Participants: 133 691 term babies born >=37 weeks gestational age and admitted to neonatal units in England. Primary and secondary outcomes: Primary reasons for admission, term babies admitted for the primary reason of jaundice, patient characteristics, postnatal age at admission, total length of stay, phototherapy, intravenous fluids, exchange transfusion and kernicterus. Results: Respiratory disease was the most common reason for admission overall, although jaundice was the most common reason for admission from home (22% home vs 5% hospital). Risk factors for admission for jaundice include male, born at 37 weeks gestation, Asian ethnicity and multiple birth. The majority of babies received only a brief period of phototherapy, and only a third received intravenous fluids, suggesting that some may be appropriately managed without separation of mother and baby. Admission from home was significantly later (3.9 days) compared with those admitted from elsewhere in the hospital (1.7 days) (p<0.001). Conclusion: Around two-thirds of term admissions for jaundice may be appropriately managed in a transitional care setting, avoiding separation of mother and baby. Babies with risk factors may benefit from a community midwife postnatal visit around the third day of life to enable early referral if necessary. We recommend further work at the national level to examine provision and barriers to transitional care, referral pathways between primary and secondary care, and community postnatal care

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Improving documentation of communication with parents in neonatal unit. A service development experience (2016)

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Type of publication:
Conference abstract

Author(s):
Kasim Aldaleel O., *Welch R.

Citation:
Archives of Disease in Childhood, April 2016, vol./is. 101/(A71-A72)

Abstract:
Introduction Effective communication with parents/patients is essential according to Domain 3 of the General Medical Council's (GMC) Guide for Good Medical Practice. Documentation of communication is crucial for clinical and medicolegal aspects. A local survey in our unit revealed a room for development, when 35.3% only of communication with parents was documented. Aim To improve documentation of communication with parents in the neonatal unit, in line with GMC Good Medical Practice Guide, aiming at 100% documentation of communications with parents. Method A development team was assigned with clear responsibilities and leadership. As part of PDSA (Plan-Do-Study-Act) cycle for improvement, tools were developed as an Act to improve documentation of communication with parents. The developed tools were; making documentation of communication with parents a handover component, making the documentation in the notes a personal responsibility of the doctor who spoke to parents and recording that, creating posters about documenting communication with parents and distributing them in different areas of the department as reminders and having a weekly updated Statistical Process Control chart (SPC chart) clearly visible in the unit. Results A Test of the Change was carried out after 2 months by a review of the last 6 weeks of the SPC Chart. The overall percentage of documented communication with parents was 72.85% (51/70) over 6 weeks period. The first week did not show significant change when 36% (4/11) of communications were documented. However, there was a steady improvement between the second and the fifth weeks, ranging from 71% to 80%, before reaching 92% in the sixth week. That was a positive test of change which was highlighted and implementation of these tools was agreed. High quality documented communications were selected and presented to trainees for learning benefits. Conclusion Having accurate medical records is medicolegally essential. Developing local tools to improve documentation of communication with parents is important when that documentation is sub-optimal. The SPC chart, posters, and communication documentation handing over are effective tools. However, other tools might be effective depending on each unit's needs.

Retinopathy of prematurity in English neonatal units: A national population-based analysis using NHS operational data (2014)

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Type of publication:
Journal article

Author(s):
Wong H.S., Santhakumaran S., Statnikov Y., Gray D., Watkinson M., Modi N., Kadalraja R., Kefas J., Srinnel S., Ramesh C., Rackham O., Brearey S., Thirumurugan A., Losa I., McBride T., Amegavie L., Zipitis C., Yadan M., Maddock N., Moise J., Edi-Osagie N., Heal C., Birch J., Al-Zidgali F., Hasib A., Kisat H., Soe A., Long D., Fedee J., Lama M., Gupta R., Rawlingson, De Boer R.C., Rao P., Blake K., Bhaduri A.K., Halahakoon C., *Deshpande, Mohite A., Tewary K.K., Palmer K., Gallagher A., Nycyk J., Simmons P., Morgen I., Underhill H.C., Mahesh Babu R.N., Dalton S., Dixon H., James M., Jayalal V., Dyke M., Babiker S., Soe T., Rubin S., Ogilvy-Stuart A., Evans I., Wickham T., Van Someren V., Watkin S., Blumberg R., Sharief N., Aladangady N., Sullivan C., Alsford L., Sharma B., Khan A., Hamdan S., Ahmed J.S., Foo A., Talekar R., Adiotomre P., Gibson A., Thomas M., Mathur R., Cruwys M., Mannix P., Ariff H., Garbasa M., Lal M., Bosman D., Fenton A., Bolton A.R., Abu-Harb M., Verber I., Olivier J., Larson J., Cherinet Y., Munyard P., Osbourne N., Raman M., Watts T., Hannam S., Walter S., Kuna J., Chang Y.L., Shephard R., Lindo D., Calvert S., Wigfield R., Wylie P.., Misra I., Shettihalli N., Khashu M., Hall M., Groves C., De Halpert P., Schapira D., Kinsey S., Butterworth S., Garg A., Whitehead G., Sanghavi R., Whincup G., Khader K., Mallik A., Amess P., Godden C., Reynolds P., Brannan N., Noble V., Rao A.S., Wardle S., Ratnayaka M., Holman J., Zengeya S., Jones S., Wach R., Tooley J., Mann R.J., Eaton M., Babirecki M., Seal S., Schwartz K., Gibson D., Jampala C., Pairaudeau P., Miall L., Shyamannr K., Qunib M.

Citation:
Archives of Disease in Childhood: Fetal and Neonatal Edition, May 2014, vol./is. 99/3(F196-F202), 1359-2998;1468-2052 (May 2014)

Abstract:
Objectives: To report on retinopathy of prematurity (ROP) screening compliance against a national guideline, factors associated with non-compliance and effect on ROP treatment. Design: National cohort study using operational NHS data from the National Neonatal Research Database (NNRD) for the period 2009-2011. Setting: 161 (94%) neonatal units in England. Population: Infants born below 32 weeks’ gestation and/or with a birth weight below 1501 g. Main outcome measures: ROP screening status (’on-time’, ’early’, ’late’, ’unknown’) and associated infant and neonatal unit characteristics, ROP treatment. Results: The proportion of infants screened on-time increased over the study period (p

Link to more details or full-text: http://fn.bmj.com/cgi/pmidlookup?view=long&pmid=24361602

Stabilisation and Transfer of Sick New-Borns Delivered in Stand-Alone Midwifery Led Units. (2014)

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Type of publication:
Conference abstract

Author(s):
*Tyler, W, Philpott, A, Brown, S, Rhodes, J

Citation:
Archives of Disease in Childhood — Fetal & Neonatal Edition, 02 June 2014, vol./is. 99/(0-0), 13592998

Abstract:
BACKGROUND: Women should be offered the choice of delivering at home, in midwife-led units (MLU) or obstetric units.(1) 20% of Shropshire mothers choose delivery in an MLU which refer into Shrewsbury and Telford NHS Trust (SaTH) obstetric/neonatal unit for additional care. The West Midlands neonatal transfer service (WMNTS) is not commissioned to transfer babies from MLUs; any transfer required is performed by the MLU midwife and the West Midlands Ambulance Service (WMAS). These staff must be confident in recognising, stabilising and transferring babies requiring a higher level of care at or immediately after delivery. AIM: To develop an educational package for midwives and paramedics caring for sick newborns. PROJECT: Representatives from midwifery, neonatal care, WMAS and WMNTS met to develop a training package. They were informed by the Scottish Transport Team who deliver a course for their remote maternity units. Support for the project was given by SaTH, WMAS and WMNTS. A one day programme was delivered at Shrewsbury MLU in December 2013. FEEDBACK: 16 midwives and 4 paramedics attended the course. All lectures, workshops and simulations were rated as good (20%) or excellent (80%). The course was rated as excellent (95%) or good (5%). FURTHER DEVELOPMENTS: Dates are set for three additional courses. All staff supporting stand-alone MLUs will access this training on a two-yearly basis. This programme will be offered to other MLUs in the West Midlands. REFERENCE: National Institute for Clinical Excellence. Intrapartum care. 2007. http://www.nice.org.uk/nicemedia/pdf/IPCNICEGuidance.pdf.