Scope Of Care
Northern Neonatal Network Care Pathways – December 2017
North Cumbria University Hospitals NHS Trust – Cumberland Infirmary, Carlisle & West Cumberland Hospital, Whitehaven
Scope of care
North Cumbria University Hospitals NHS Trust provides neonatal services on two sites – at the Cumberland Infirmary, Carlisle and the West Cumberland Hospital, Whitehaven. These Units are geographically more distant and remote from the other Network NICUs/SCBUs, Whitehaven in particular, providing challenges to the transport teams from Newcastle and Middlesbrough as well as obstetric ante-natal transfers. There is a degree of collaboration and co-operation between the two Units and both are overseen by the same Divisional/Directorate management team, although there are currently no systems in place for staff rotation.
The current services provided on each site are as follows :
SCBU, Cumberland Infirmary, Carlisle
Current Unit capacity
12 Special Care cots (currently reduced to 8 Special Care cots as at December 2017).
Annual number of deliveries
1727 (April 2016- March 2017).
Annual number of admissions
222 (April 2016- March 2017).
Current threshold for routine ante-natal transfers
Generally obstetricians will try to transfer < 30/40.
Current threshold for routine post-natal transfers
Similar to ante-natally, babies born < 30/40 are likely to be transferred as they are more likely to be ventilated, but sometimes babies not ventilated who are < 30 weeks gestation will be kept at Carlisle if there are no feeding issues.
Other thresholds for routine post-natal transfer
Babies who can be cared for and requiring investigations that can be undertaken at Carlisle will usually not be transferred. Examples of those who we will require transfer include: Surgical babies, babies with HIE if ventilated or if fits can’t be stabilised, feeding difficulties and where TPN is needed, diagnostic difficulties requiring opinion and or for certain tests (EEG, Echo).
Routine investigations/tests/screening currently undertaken
Cerebral, abdominal & hip Ultrasounds, ROP screening, Hearing testing. CT and MRI might be done on a case-by- case basis but require special arrangement. Often PACS transfers for tertiary radiology opinion.
Surgical procedures undertaken or post-surgical care provided if not?
Many surgical cases will go home direct from Newcastle. Carlisle SCBU will care for Stent babies and have done so both on SCBU and children’s ward. Some babies who have had a tracheostomy may be cared for on the Children’s ward in view of on-going care needs. Instances of this are very rare.
Cooling for H.I.E undertaken?
The SCBU is currently passively cooling babies through environmental measures. No specific equipment is being used for this.
T.P.N. provided on-site?
Neonatal community outreach team/services provided?
The Community Children’s Nursing team arrange installation of oxygen and supervision of patients at home on O2, Tube feeding (NG and PEG) babies and those requiring ongoing care Tracheostomy care will also be cared for by them; however, this is not a neonatal nurse team from the SCBU.
Transitional Care provision on-site?
This is very limited. Babies needing antibiotics IV can reside with mother on postnatal but come through to SCBU for treatments. Heel prick SBRs or glucose samples are done by midwives but venous samples are required to be done on SCBU. Babies can have Phototherapy on post natal ward with this proviso while SBR levels are monitored. Babies needing tube feeds are admitted to SCBU. NAS withdrawal babies are cared for on the postnatal ward if Mothers are able to stay in hospital, otherwise they come to SCBU if needing treatment or there are safeguarding issues.