Unit Scope of care

Northern Neonatal Network Care Pathways – December 2017

Newcastle Hospitals NHS Foundation Trust –  Royal Victoria Infirmary, Newcastle

Scope of care

The Newcastle upon Tyne Hospitals NHS Foundation Trust provides neonatal medical services on its site at the Royal Victoria Infirmary. Also on the RVI site is the Sub-Regional Surgical Unit, that provides a full range of surgical and neurosurgical services. The Trust also provides at its Freeman Road Hospital site a full cardiac surgery and cardiology service, including one of the few ECMO (Extra Corporeal Membrane Oxygenation) services in the country.

The current services provided on the RVI site are as follows:

NICU, Royal Victoria Infirmary, Newcastle

Current Unit capacity

16 Intensive Care cots

18 Special Care cots

Annual number of deliveries

6721 (Calendar year 2016)

Annual number of admissions

709 (Calendar year 2016)

Current threshold for incoming antenatal transfers

Generally obstetricians from the eight SCBUs will routinely try to transfer <30/40 gestation mothers here as one of the four receiving NICUs in the Network and especially if they are following agreed pathways via fetal medicine or other monitoring for subsequent surgical/cardiac purposes. This is done by direct discussion with receiving consultant obstetricians and neonatologists if a suitable Intensive care cot is available.

Current threshold for incoming postnatal transfers

Babies < 30/40 that have to delivered at one of the SCBUS are routinely transferred to the RVI for Intensive Care after using the Northern Neonatal Transport Service (NNeTS) according to the appropriate Care Pathway. Babies delivered at the SCBUs may be managed there if they are stable on very short-term CPAP and don’t need TPN, but otherwise would generally be transferred to the RVI as one of the four NICUs for any ongoing high dependency or intensive care after using the Transfer Hotline.

Other thresholds for incoming postnatal transfer

This will be discussed with the RVI clinicians and decided on a case by case basis, but examples of babies who will generally require transfer include: any baby requiring intensive or ongoing high dependency care that is outside the gestation threshold above, babies with HIE needing active cooling and surgical cases (see below), including congenital/cardiac anomalies for further assessment that may then require active interventions and potentially subsequent transfer to the Freeman, as well as babies requiring ventilation or TPN where this is not available at the referring hospital.

Transfer services provided?

The Northern Neonatal Transport Service (NNeTS) is hosted at the RVI. It provides a full emergency transport service for all babies (including paediatric/PICU cases up to approx. 6kg) within the Network. All intensive care modalities including inhaled nitric oxide and therapeutic cooling are available during transfer. All requests for transfers should be made via the dedicated Neonatal Transfer Hotline number.

Routine investigations/tests/screening currently undertaken

ROP screening is performed on-site. Routine cranial ultrasounds are also done on site, as well as CT and MRI Scans. Other services and diagnostic facilities are listed below.

Surgical procedures undertaken and/or post-surgical care provided?

The RVI is the Regional referral hospital for neonatal surgery and also undertakes neonatal neurosurgery. Laser surgery for advanced ROP (Retinopathy of prematurity) is also provided by arrangement/referral through the consultant neonatologists/ophthalmologists.

Cooling for HIE undertaken?

Therapeutic cooling for babies with HIE is undertaken here and babies requiring this therapy can be transferred from one of the SCBUs if this is required/indicated after discussion with one of the neonatologists and subsequent transfer arranged through NNeTS.

T.P.N. provided on-site?

Yes.

Neonatal community outreach team/services provided?

The RVI provide a neonatal community nursing service on a Monday-Friday basis, covering babies needing home tube feeding, home oxygen therapy and where required in discussion with the Unit Discharge team. Babies with long-term problems that will require ongoing care will usually be handed over to the Paediatric Community team at an agreed age, usually 3 months post-gestational corrected age.

Transitional Care provision on-site?

Any baby deemed appropriate for transitional care will be nursed with their mothers on the normal Postnatal Wards.

Full list of Services provided;

  • Advanced Ventilation including oscillation and iNO therapy.
  • All maternal care services (diabetes, renal, spinal, cancer, HDU, ITU etc).
  • Community outreach neonatal nursing team. Regional Genetics Service.
  • Extracorporeal membrane oxygenation. (at Freeman)
  • Full specialist paediatric cardiology and cardiac surgery services.
  • Genetics service.
  • Neonatal airway service with neonatal bronchoscopy.
  • Neonatal ophthalmology (ROP screening) and laser treatment for retinopathy.
  • Neonatal surgery and neurosurgery on site in addition to full range of paediatric sub-specialities including respirology, gastroenterology, infectious diseases & immunology, orthopaedics, endocrinology, plastic surgery, neurosurgery, dermatology and PICU.
  • Neonatal Transport Service 24/7, includes iNO & aircraft capability.
  • Perinatal pathology.
  • Regional cleft lip & palate service.
  • Renal dialysis including neonatal haemodialysis.
  • Specialist fetal medicine including 4D scanning, fetal cardiology and laser surgery for twin-twin transfusion.
  • Specialist neonatal/paediatric radiology including MRI and ultrasound brain imaging.
  • Specialist neurodevelopmental follow up (BSID 3) of at risk infants & babies born <32 weeks gestation.
  • Therapeutic hypothermia for hypoxic ischaemic encephalopathy.
  • Video 12 channel EEG and aEEG facilities with expert neurophysiology interpretation.

Northern Neonatal Network Care Pathways – December 2017

City Hospitals Sunderland NHS Foundation Trust – Sunderland Royal Hospital 

Scope of care

City Hospitals Sunderland NHS Foundation Trust provides neonatal services on its site at the Sunderland Royal Hospital.

The current services provided on the site are as follows :

 NICU, Sunderland Royal Hospital

Current Unit capacity

7 Intensive Care cots

17 Special Care cots

Annual number of deliveries

3268 (April 2016 – March 2017 figures)

Annual number of admissions

328 (April 2016 – March 2017 figures)

Current threshold for incoming ante-natal transfers

Generally obstetricians from the eight SCBUs will routinely try to transfer <30/40 gestation mothers here as one of the four receiving NICUs in the Network. This is done by direct discussion with receiving consultant obstetricians and neonatologists if a suitable Intensive care cot is available but through the dedicated Neonatal Transfer Hotline number.

Current threshold for incoming post-natal transfers

Babies < 30/40 that have to delivered at one of the SCBUS are routinely transferred to Sunderland for Intensive Care after using the Transfer hotline according to the appropriate Care Pathway. Babies that require admission will then usually be transferred to Sunderland by the referring hospital by the regional transport service.

Other thresholds for incoming post-natal transfer

This will be discussed with Sunderland clinicians and decided on a case by case basis, but examples of babies who will generally require transfer include: any baby requiring intensive or ongoing high dependency care that is outside the gestation threshold above, HIE’s needing active cooling, some surgical cases (see below), congenital/cardiac anomalies for further assessment if they do not require immediate transfer to the Sub-Regional Unit (RVI/Freeman), babies requiring ventilation or TPN. Other babies that could normally be cared for at one of the other 3 NICUs and admitted there but cannot be accommodated because of lack of a suitable NIC cot may also be transferred here.

Transfer services provided?

No

 Routine investigations/tests/screening currently undertaken

ROP screening is performed on-site. Routine ultrasounds of the cranium are also done on site, as well as CT/MRI Scans. Other services and diagnostic facilities are listed below.

Surgical procedures undertaken and/or post-surgical care provided?

Laser surgery for advanced ROP (Retinopathy of prematurity) is provided by arrangement/referral through the consultant neonatologists/ophthalmologists.

Cooling for H.I.E undertaken?

Therapeutic cooling for babies with HIE is undertaken here and babies requiring this therapy can be transferred from one of the SCBUs if this is required/indicated after discussion with one of the neonatologists and subsequent transfer arranged via the Hotline with the regional transport service.

T.P.N. provided on-site?

Yes.

Neonatal community outreach team/services provided?

Neonatal community outreach is provided by a team of 3 community paediatric nurses who work in close liaison with the neonatal consultants. Services provided by the community outreach team included monitoring of babies who are on home oxygen and nutritional support for those babies requiring long term nasogastric tube feeding.

Transitional Care provision on-site?

There are 2 mother and baby rooms where mothers can care for their babies with support from the neonatal nursing staff. These facilities are usually used for babies who are getting ready for home or babies who are well but readmitted from the community for management of jaundice or poor feeding.

Full list of Services provided;

  • Advanced Ventilation incl. NO therapy.

  • Functional Echocardiography.

  • Cardiology Diagnosis.

  • Cardiology Clinics

  • Cranial ultrasound and MRI scans.

  • EEG and aEEG facilities.

  • Fetal cardiology.

  • Ophthalmology including laser surgery for Retinopathy of Prematurity.

  • Regional genetics service

  • Specialist Neurodevelopmental Follow Up (BSID 3) of at risk infants.

  • Therapeutic Hypothermia

Northern Neonatal Network Care Pathways – January 2018

North Tees & Hartlepool NHS Foundation Trust – University Hospital of North Tees

Scope of care

North Tees & Hartlepool NHS Foundation Trust provides neonatal services on its University Hospital of North Tees site in Stockton. In addition there is a Midwifery led Delivery Unit on their Hartlepool site for very low risk pregnancies managed by a team of Midwives.

The current services provided on the North Tees site are as follows :

 NICU, University Hospital of North Tees

Current Unit capacity

3 Intensive Care cots

5 High Dependency Cots

12 Special Care/Transitional Care cots

Annual number of deliveries

2964 (April 2016 – March 2017)

Annual number of admissions

429 (April 2016 – March 2017 figures)

Current threshold for incoming ante-natal transfers

Generally obstetricians from the seven SCBUs in the region will routinely try to transfer mothers here as one of the four receiving NICUs in the Network. We receive >27weeks gestation. This is done by direct discussion with receiving consultant obstetricians and neonatologists if a suitable Intensive care cot is available but through the dedicated regional transfer Neonatal Transfer Team (NNeTS).

Current threshold for incoming post-natal transfers

Babies >27/40 that have delivered elsewhere are routinely are transferred to North Tees for Intensive/High Dependency Care after Consultant to Consultant referral according to the appropriate Care Pathway. Accepted admissions will then be transferred from the referring hospital to North Tees, co-ordinated by the regional transfer team (NNeTS).

Other thresholds for incoming post-natal transfer

This will be discussed with North Tees clinicians and decided on a case by case basis, but examples of babies who will generally require transfer include: any baby requiring intensive or ongoing high dependency care that is outside the gestation threshold above, HIE’s needing active cooling, some surgical cases (see below), congenital/cardiac anomalies for further assessment if they do not require immediate transfer to the Sub-Regional Unit (RVI/Freeman), babies requiring ventilation or TPN. Other babies that could normally be cared for at one of the other 3 NICUs and admitted there but cannot be accommodated because of lack of a suitable NIC cot may also be transferred here.

Transfer services provided?

Currently, transfers to other neonatal Units for repatriation or continuing clinical care are undertaken by the official regional transfer team (NNeTS).

 Routine investigations/tests/screening currently undertaken

ROP screening is performed on-site. Bedside echocardiography for structural screening and haemodynamic assessment and routine ultrasounds of the cranium are done on site. CT Scans and MRI (3 Tesla) scans are also routinely performed. There are paediatric radiology services available on site for case based discussion and other radiology investigations.

Other services and diagnostic facilities are listed below.

Surgical procedures undertaken and/or post-surgical care provided?

No

Cooling for H.I.E undertaken?

Therapeutic cooling for babies with HIE is undertaken here and babies requiring this therapy can be transferred from one of the SCBUs if this is required/indicated after discussion with one of the neonatologists and subsequent transfer arranged via the Hotline with NNeTS.

T.P.N. provided on-site?

Yes.

Neonatal community outreach team/services provided?

We have two community Sisters, one covers the Stockton and the other the Hartlepool area. The also review all the NAS babies who go home on Oromorph, they hold a Synagis clinic for those babies who will be vulnerable over the winter months and they help to run the weekly High Risk Clinic for babies who are born <30 weeks or any baby who may have long term problems.

Rooming in/Transitional Care provision on-site?

For mothers who wish to stay in to look after their baby prior to being ready for discharge and also for those mothers who need parent craft or establishing breast feeding.

Babies fitting transitional care criteria are currently cared for jointly with the post natal ward and Neonatal Unit.

Research

North Tees neonatal unit is a research active unit with 1.0 WTE neonatal research nurse and a shared data assistant.

The unit is recognised for cardio-respiratory research and actively participates in a number of national, international and commercial trials.

Full list of Services provided;

  • Advanced Ventilation incl. NO therapy and HFOV
  • Brain Imaging.
  • Cardiology Clinics.
  • Cardiology Diagnosis.
  • Community Neonatal Nursing Service
  • Dedicated High Risk Infant clinic.
  • Functional Echocardiography.
  • Genetics Clinic.
  • Neonatal Ophthalmology.
  • Paediatric Dermatology Clinic.
  • Specialist Neurodevelopmental Follow Up (BSID 3) of at risk infants & premmies <32 weeks.
  • Therapeutic Hypothermia.
  • Video EEG and aEEG facilities are available

Northern Neonatal Network Care Pathways – December 2017

South Tees Hospitals NHS Foundation Trust – James Cook University Hospital, Middlesbrough

Scope of care

South Tees Hospitals NHS Foundation Trust provides neonatal services at The James Cook University Hospital in Middlesbrough.

The current services provided on the JCUH site are as follows :

NICU, James Cook University Hospital, Middlesbrough

Current Unit capacity

12.5 Intensive Care cots (Sept 2017 onwards)

20 Special Care cots (as from October 2014)

Annual number of deliveries

5137 mothers, 5261 babies (April 2016 – March 2017)

Annual number of admissions

458 (April 2016 – March 2017)

Current threshold for incoming ante-natal transfers

Generally obstetricians from the seven SCBUs will routinely try to transfer <30/40 gestation mothers here as one of the four receiving NICUs in the Network. This is done by direct discussion with receiving consultant obstetricians and neonatologists if a suitable Intensive care cot is available.

Current threshold for incoming post-natal transfers

Any baby requiring intensive or high dependency care postnatally for which local provision is not available. Babies <30/40 that have to delivered at one of the SCBUs are routinely transferred to JCUH for Intensive Care after using the Transfer hotline according to the appropriate Care Pathway.

Other thresholds for incoming post-natal transfer

This will be discussed with JCUH clinicians and decided on a case by case basis, but examples of babies who will generally require transfer include: any baby requiring intensive or ongoing high dependency care that is outside the gestation threshold above, babies with Hypoxic Ischaemic Encephalopathy needing active cooling, some surgical cases (see below), congenital/cardiac anomalies for further assessment if they do not require immediate transfer to the Sub-Regional Unit (RVI/Freeman), babies requiring ventilation or TPN.

Transfer services provided?

JCUH provide a full emergency transport service for all babies (including paediatric/PICU cases up to approx. 6kg) within the Network. All requests for transfers should be made via the dedicated Neonatal Transfer number.

Routine investigations/tests/screening currently undertaken

ROP screening is performed on-site. Routine ultrasounds of the cranium are also done

on site, as well as MRI and CT Scans. Other services and diagnostic facilities are listed below. All babies have a saturation reading prior to discharge home.

Surgical procedures undertaken and/or post-surgical care provided?

Some defined routine/dedicated surgical services for newborns are provided at JCUH, including some specialist procedures as listed below. Laser surgery for advanced ROP (Retinopathy of prematurity) is provided by arrangement/referral through the consultant neonatologists/ophthalmologists.

Cooling for H.I.E undertaken?

Therapeutic cooling for babies with HIE is undertaken here and babies requiring this therapy can be transferred from one of the SCBUs if this is required/indicated after discussion with one of the neonatologists and subsequent transfer arranged via the Hotline. MRI imaging and 12 channel EEG available for prognostication

T.P.N. provided on-site?

Yes with paediatric pharmacist input.

Neonatal community outreach team/services provided?

JCUH provide a comprehensive neo-natal community nursing service on a Monday-Friday basis, covering babies needing home tube feeding, home oxygen therapy and where required in discussion with the Unit Discharge team. Babies with long-term problems that will require ongoing care will usually be handed over to the Paediatric Community team at an agreed age, usually 1-2 years depending upon the condition.

All discharges are reviewed at a weekly meeting with the neonatal team. Multi-disciplinary team meetings are arranged pre-discharge for selected babies with significant problems.

Transitional Care provision on-site?

Transitional care facility exists within ward 17 (postnatal wards).

Full list of Services provided;

  • Advanced Ventilation including oscillation and NO (Nitric Oxide) therapy.

  • All maternal care services (diabetes, renal, spinal, cancer, HDU, ITU etc).

  • Cardiology Clinics.

  • Cardiology Diagnosis.

  • Community Neonatal Nursing Service

  • Dedicated High Risk Infant clinic.

  • Functional Echocardiography.

  • MRI and ultrasound brain Imaging with paediatric radiologist reporting.

  • Neonatal Surgical Airway service with neonatal bronchoscopy.

  • Paediatric orthopaedics, plastic surgery, neurosurgery, dermatology, PICU and endocrinology on site.

  • Paediatric/Neonatal anaesthetic service

  • Perinatal pathgology.

  • Regional Genetics Service.

  • Specialist fetal medicine including fetal cardiology.

  • Joint weekly neonatal follow-up clinic with paediatric physiotherapy, dietetics and community nursing input.

  • Specialist Neuro-developmental Follow Up (BSID 3) of at risk infants & babies born below 32 weeks gestation.

  • Sub regional Neonatal Ophthalmology screening and laser treatment for retinopathy.

  • Therapeutic Hypothermia for Hypoxic Ischaemic Encephalopathy.

  • Video 12 channel EEG and aEEG facilities with expert neurophysiology interpretation.

Northern Neonatal Network Care Pathways – December 2017

Northumbria Healthcare NHS Foundation Trust – Northumbria Hospital CRAMLINGTON

Scope of care

Northumbria Healthcare NHS Foundation Trust provides neonatal services on its Northumbria Specialist Emergency Care Hospital (“The Northumbria”) site in Cramlington. It is unique in that it is a nurse-led Unit staffed primarily by a tier of dedicated Advanced Neonatal Nurse Practitioners (ANNPs) who provide the first line medical cover and rotate separately from the nursing staff, operating on a medical basis in that role. They provide all the initial stabilisation, diagnosis and treatment for babies admitted to the SCBU and oversee the delivery suite and post-natal ward providing the cover neonatal SHOs would normally give. They also prescribe drugs and IV fluids and will arrange transfers as necessary for any baby needing more intensive care. The ANNP team are supported by consultant paediatricians from the children’s unit and are available for advice support 24/7 as well as twice weekly ward rounds to the SCBU. The current services provided on this site are as follows;

 SCBU, Northumbria Hospital, Cramlington

Current Unit capacity

14 Special Care cots

Annual number of deliveries

3171 in 2016/17

Annual number of admissions

340 in 2016/17, (excluding Transitional Care activity). Babies from Trust’s 3 midwifery-led units (at Alnwick, Berwick and Hexham) may also receive special care at Cramlington.

Current threshold for routine ante-natal transfers

Generally obstetricians will routinely try to transfer <30/40 gestation mothers to a Level 3 NICU hospital.

Current threshold for routine post-natal transfers

Babies < 30/40 are routinely transferred to a Level 3 NICU for Intensive care. 30-32 week babies born at Wansbeck will usually be managed there if they are stable on CPAP. Babies < 1.5Kg are transferred out if they require TPN.

Other thresholds for routine post-natal transfer

Babies who can be cared for and requiring investigations that can be undertaken at Northumbria will usually not be transferred. Examples of those who we will require transfer include: Surgical referrals. Other main thresholds for transfer are babies with a need for long-lines, parental nutrition or active cooling for H.I.E. Babies with tracheotomies would also not be cared for within the SCBU at Northumbria.

Routine investigations/tests/screening currently undertaken

ROP screening is performed on-site by the consultant Ophthalmologist from Newcastle. Routine ultrasounds of the cranium, kidneys and hips are all done on site.

Surgical procedures undertaken or post-surgical care provided if not?

No surgical services for newborns are available at Northumbria.

Cooling for H.I.E undertaken?

The SCBU is currently passively cooling babies for HIE prior to transfer to a NICU for active cooling if required/indicated and in discussion with the RVI, Newcastle.

T.P.N. provided on-site?

No. There are no on-site facilities for care of indwelling long lines and/or TPN.

Neonatal community outreach team/services provided?

Northumbria SCBU does not provide a neo-natal community nursing service, but there is a County-wide community children’s nursing service provides home care O2/tube feeding/palliative care.

Transitional Care provision on-site?

The adjacent postnatal ward offers all women en-suite rooms and partners are actively encouraged to stay overnight. Northumbria do provide some transitional care facilities on their post-natal ward with oversight by the neo-natal team. This would include babies needing phototherapy, IV antibiotics and also the management of NAS (Neonatal Abstinence Syndrome). Babies requiring regular tube feeds are admitted to SCBU. These are all under the care of the ANNP team.

Northern Neonatal Network Care Pathways – December 2017

Gateshead Health NHS Foundation Trust – Queen Elizabeth Hospital

Scope of care

Gateshead Health NHS Foundation Trust provides neonatal services on its Queen Elizabeth Hospital site. Because of the very close proximity of the Unit to the Royal Victoria Infirmary, Newcastle NICU, there is a strong link between the two sites and babies requiring ongoing intensive care will routinely be transferred there. The current services provided on this site are as follows;

SCBU, Queen Elizabeth Hospital, Gateshead

Current Unit capacity

8 Special Care cots – 2 High dependency/6 SCBU

Annual number of deliveries

1870 (April 2016 – March 2017 figures)

Annual number of admissions

259 (Jan 2016 – December 2017 figures)

Current threshold for routine ante-natal transfers

Generally obstetricians will try to transfer &lt;32/40 gestation mothers to a Level 2 or 3
NICU hospital.

Current threshold for routine post-natal transfers

<30/40 are routinely transferred to a Level 3 NICU for Intensive care.

Other thresholds for routine post-natal transfer

Babies who can be cared for and requiring investigations that can be undertaken at Gateshead will usually not be transferred. Examples of those who we will require transfer include: babies with significant congenital abnormalities, babies with HIE or Babies with difficult to control seizures. Severely growth restricted babies that are likely to need TPN. Surgical referrals. Those Babies requiring exchange transfusion (rather than a specific bilirubin threshold). Also, babies requiring a cardiac assessment

  • usually involving an unexpected post-natal finding or a PDA in a pre-term. Other cases will be discussed on an individual case by case basis with clinicians in one of the Level 3 NICUs, typically Newcastle.

Very occasional babies requiring liver assessment will be transferred to St James Hospital, Leeds.

Routine investigations/tests/screening currently undertaken

ROP screening is performed on-site by the consultant Ophthalmologist, (currently Miss Hillier) from Newcastle(RVI). EEG’s are not done on-site and would require transfer. MRI and CT scan may be done on an individual basis.

 Surgical procedures undertaken or post-surgical care provided if not?

No surgery is currently provided at Gateshead. If babies require laser treatment for ROP, they will be transferred to Newcastle.

Cooling for H.I.E undertaken?

The SCBU is currently passively cooling babies for HIE prior to transfer to a NICU for active cooling if required/indicated.

T.P.N. provided on-site?

No. There are no on-site facilities for care of indwelling long lines and TPN.

Neonatal community outreach team/services provided?

Gateshead does provide a neo-natal community nursing service – mostly related to oxygen dependant babies, feeding or developmental issues but once again these are often decided on a case by case basis.

Transitional Care provision on-site?

Gateshead does provide some limited transititional care facilities on their post-natal ward with oversight by the neo-natal team.

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 &amp; 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?

No

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.

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, West Cumberland Hospital, Whitehaven

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 &lt;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 forStent 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?

No

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.

Northern Neonatal Network Care Pathways – December 2017

South Tyneside NHS Foundation Trust – South Tyneside District Hospital

Scope of care

South Tyneside NHS Foundation Trust provides neonatal services on their site at South Tyneside District Hospital. The current services provided on the site are as follows;

 SCBU, South Tyneside District Hospital

Current Unit capacity

6 Special Care cots and 1 stabilisation cot

Annual number of deliveries

1231 (April 2016 – March 2017 figures)

Annual number of admissions

93 (April 2016 – March 2017 figures)

Current threshold for routine ante-natal transfers

Generally obstetricians will try to transfer < 32/40 gestation mothers to a Level 3 NICU hospital

Current threshold for routine post-natal transfers

< 32/40 are routinely transferred to a Level 3 NICU for Intensive care

Other thresholds for routine post-natal transfer

Babies who can be cared for and requiring investigations that can be undertaken at South Tyneside will usually not be transferred. Examples of those who we will require transfer include but are not limited to: babies requiring ventilation, Cardiac/surgical assessment/intervention before discharge, babies requiring Long Lines & TPN, Exchange transfusion, Intensive treatment for HIE, babies with Metabolic disorders requiring specialised treatment and also any baby identified as requiring transfer after discussion with regional colleagues

Routine investigations/tests/screening currently undertaken

ROP screening, Cranial and hip ultrasound scans, MRI, CT scans, ECG, Hearing screen

Surgical procedures undertaken or post-surgical care provided if not?

No surgery is currently provided at South Tyneside.

Cooling for H.I.E undertaken?

The SCBU is currently passively cooling babies prior to transfer to a NICU for active cooling if required/indicated.

T.P.N. provided on-site?

No

Neonatal community outreach team/services provided?

No, any babies requiring longer term post-discharge care are passed over to the paediatric community nursing team (e.g. oxygen-dependent babies).

Transitional Care provision on-site?

None – although some babies needing SBRs and IV antibiotics on the post natal ward currently receive this care via the midwives and are thus not routinely admitted to the SCBU just for these interventions alone. This is currently being reviewed and may become possible in the future so that more formal transitional care is provided at STH.

Northern Neonatal Network Care Pathways – October 2017

County Durham & Darlington NHS Foundation Trust – University Hospital of North Durham & Darlington Memorial Hospital

Scope of care

County Durham & Darlington NHS Foundation Trust provide neonatal services on two sites – at the University Hospital of North Durham (UHND) and Darlington Memorial Hospital (DMH). The Units at Darlington and Durham also receive referrals from the Midwifery-led Unit at Bishop Auckland General Hospital, which now no longer provides inpatient Special Care/neonatal services, although the delivery numbers are included in statistical returns from Darlington, as well as obstetric ante-natal transfers where non-intensive care in anticipated and the mother can be safely moved. There is a high degree of collaboration and co-operation between the two Units and both are overseen by the same Divisional/Directorate management team as well as the Lead Consultant Paediatrician, who clinically oversees both sites. There is also a rotation system in place for the nursing staff. The current services provided on the UHND site is as follows;

 SCBU, University Hospital of North Durham

Current Unit capacity

12 Special Care cots

Annual number of deliveries

3058 (April 2016 – March 2017 figures)

Annual number of admissions

215 + 58 repatriations (April 2016 – March 2017 figures)

Current threshold for routine ante-natal transfers

Generally obstetricians will try to transfer &lt;30/40 gestation mothers to a Level 3 NICU hospital, or < 32/40 weeks gestation if a multiple pregnancy.

Current threshold for routine post-natal transfers

< 28/40 are routinely transferred to a Level 3 NICU for Intensive care

Other thresholds for routine post-natal transfer

Babies who can be cared for and requiring investigations that can be undertaken at UHND will usually not be transferred. Examples of those who we will require transfer include: babies requiring ventilation, Cardiac/surgical assessment/intervention before discharge, babies requiring Long lines & TPN, Exchange transfusion, Intensive treatment for HIE, babies with Metabolic disorders requiring specialised treatment and also any baby identified as requiring transfer after discussion with regional colleagues

Routine investigations/tests/screening currently undertaken

ROP screening, MRI, CT scans, ECG, Cardiac scans (simple).

Surgical procedures undertaken or post-surgical care provided if not?

No surgery is currently provided at UHND.

Cooling for H.I.E undertaken?

The NNU is currently passively cooling babies prior to transfer to a NICU for active cooling if required/indicated.

 T.P.N. provided on-site?

No all babies requiring TPN are transferred to regional services

Neonatal community outreach team/services provided?

Both CDDFT units operate an outreach service across the county supporting discharged babies who:

  • Still require NGT feeds until full oral feeding is established (not long term NGT)
  • Require repeat/routine neonatal bloods
  • Are on phototherapy
  • Have not established a substantive weight gain pattern in hospital
  • Require regular monitoring of withdrawal medication (in alternative care only)
  • Oxygen dependant babies and those who require neuro disability monitoring are seen in the community by CDDFT paediatric nurses and community paediatricians

Transitional Care provision on-site?

Comprehensive transitional care provision with designated baby support workers support both neonatal nurses and midwives to identify appropriate babies requiring
transitional care and any extra support for vulnerable babies.The current criteria for transitional care includes:

  • Intravenous antibiotic therapy
  • Blood glucose monitoring for infants of diabetic mothers, low / high birth weight babies and babies of mothers who have had labetalol antenatally.
  • Any baby discharged to the postnatal ward from the NNU will be monitored on transitional care for at least 24 hours.

Northern Neonatal Network Care Pathways – October 2017

County Durham & Darlington NHS Foundation Trust – University Hospital of North Durham & Darlington Memorial Hospital

Scope of care

County Durham & Darlington NHS Foundation Trust provide neonatal services on two sites – at the University Hospital of North Durham (UHND) and Darlington Memorial Hospital (DMH). The Units at Darlington and Durham also receive referrals from the Midwifery-led Unit at Bishop Auckland General Hospital, which now no longer provides inpatient Special Care/neonatal services, although the delivery numbers are included in statistical returns from Darlington, as well as obstetric ante-natal transfers where non-intensive care in anticipated and the mother can be safely moved. There is a high degree of collaboration and co-operation between the two Units and both are overseen by the same Divisional/Directorate management team as well as the Lead Consultant Paediatrician, who clinically oversees both sites. There is also a rotation system in place for the nursing staff. The current services provided on each site are as follows;

 SCBU, Darlington Memorial Hospital

Current Unit capacity

12 Special Care cots

Annual number of deliveries

2030 (April 2016 – March 2017 figures)

Annual number of admissions

218 (April 2012 – March 2013 figures)

Current threshold for routine ante-natal transfers

Generally obstetricians will try to transfer < 30/40 gestation mothers to a Level 3 NICU hospital, or < 32/40 weeks gestation if a multiple pregnancy.

Current threshold for routine post-natal transfers

< 28/40 are routinely transferred to a Level 3 NICU for Intensive care.

Other thresholds for routine post-natal transfer

Babies who can be cared for and requiring investigations that can be undertaken at Darlington will usually not be transferred. Examples of those who we will require

transfer include: babies requiring ventilation, Cardiac/surgical assessment/intervention before discharge, babies requiring Long lines & TPN, Exchange transfusion, Intensive treatment for HIE, babies with Metabolic disorders requiring specialised treatment and also any baby identified as requiring transfer after discussion with regional colleagues.

Routine investigations/tests/screening currently undertaken

ROP screening, MRI, CT scans, ECG, Cardiac scans (simple).

Surgical procedures undertaken or post-surgical care provided if not?

No surgery is currently provided at Darlington.

Cooling for H.I.E undertaken?

The NNU is currently passively cooling babies prior to transfer to a NICU for active cooling if required/indicated.

 T.P.N. provided on-site?

No all babies requiring TPN are transferred to regional services

Neonatal community outreach team/services provided?

Both CDDFT units operate an outreach service across the county supporting discharged babies who:

  • Still require NGT feeds until full oral feeding is established (not long term NGT)
  • Require repeat/routine neonatal bloods
  • Are on phototherapy
  • Have not established a substantive weight gain pattern in hospital
  • Require regular monitoring of withdrawal medication (in alternative care only)
  • Oxygen dependant babies and those who require neuro disability monitoring are seen in the community by CDDFT paediatric nurses and community paediatricians

Transitional Care provision on-site?

Comprehensive transitional care provision with designated baby support workers support both neonatal nurses and midwives to identify appropriate babies requiring
transitional care and any extra support for vulnerable babies. The current criteria for transitional care includes:

  • Intravenous antibiotic therapy
  • Blood glucose monitoring for infants of diabetic mothers, low / high birthweight babies and babies of mothers who have had labetalol antenatally.
  • Any baby discharged to the postnatal ward from the NNU will be monitored on transitional care for at least 24 hours