1.1 - Levels Of Neonatal Services Flashcards
Describe the six Victorian newborn services level of care
Primary newborn services
secondary newborn services
tertiary newborn services
Level one >2500grams + 37 weeks
Primary newborn services
- care for well uncomplicated term newborns
- Postnatal care only
- newborn > 37 + 0 weeks
- usually correlating to newborn birthweight > 2500 grams
Level Two >2500 grams & 37+ weeks
- care for mildly unwell, uncomplicated newborns at birth
- during immediate postnatal period
- care of newborn > 37 + 0 weeks
- usually correlating to newborn bw of >2500 grams
- may accept care of newborn marginally below the gestational age/bw listed above when clinically appropriate
- or as per specialist consultation with emergency retrieval or tertiary services
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Level three - 2000grams & 34 weeks
- care for mild-moderately uncomplicated newborn
- care of newborn >34 + 0 weeks
- usually correlating to newborn bw of >2000 grams
- includes:
- growing preterm and convalescing newborns and infants
- marginally under the gestational age/birthweight listed above
- when clinically appropriate or following specialist advice
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Level 4 - 1500 grams & 32 weeks
- care for moderately unwell uncomplicated newborn >32 + 0 weeks gestation
- usually correlating to newborn bw > 1500 grams
- growing preterm and convalescing newborn and infants
- may accept care of newborns marginally under the gestational age/bw if clinically appropriate or as per consultant
Level five - 1250 grams and 31 weeks
- care of moderately unwell preterm newborn inclusions moderately complex newborn 31 + 0 weeks
- usually correlating to newborn bw >1250 grams
- includes growing preterm and convalescing newborns and infants
- may accept care of newborns marginally under the gestation age/bw
- or following specialist advice and emergency retrieval or tertiary services
Level six Level 6A - continuous life support
- care neonate on life support
- extremely premature newborns
- non-surgical critical illness
Level 6b - extreme high risk newborn
- critically unwell neonate
- statewide specialists involved
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How can we proved family centred care on admission to the nursery
- incorporates and recognises the whole family in planning care for the neonate
- short term and long term health outcome for the infant
- enabling 24 hours access
How can we proved family centred care on admission to the nursery
Principles of FCC
- Involve parents in the daily care of the infant when stable ie nappy changes, feeding, S2S
- Creation of partnership between healthcare team and the families
- dignified and respectful interaction
- collaborating together to share information
- co-delivery and evaluating care provision
- tailoring care to the individual family to provide safe and appropriate infant care
- read chapter 21
attachment and bonding
- Planning the pregnancy
- Confirming the pregnancy
- Accepting the pregnancy
- Fetal movement
- Accepting the fetus
- Labour and birth
- seeing
- touching
- caregiving
first 1000 days
- highly influential on long term and social outcomes
- prematurely or critically unwell are at risk of developing:
- neurological impairment
- developmental delay
- behaviour disorders
- developmental and disability can impact negatively on an individual long term social, academic, occupational and financial outcome
- early intervention measure aimed at reducing their impact if vital for overall wellbeing
Admission of the neonate to the nursery
Understanding preparation requirement for admission to the nursery
Identify a variety of criteria for admission
- RDS
- TTN
- Low blood glucose levels
- Spesis
- premature babies
Statewide tertiary neonatal services
There are four hospitals that provide statewide tertiary neonatal services in Melbourne for the most complex neonatal care needs:
- Mercy Hospital for Women, Heidelberg
- Monash Medical Centre, Clayton
- Royal Children’s Hospital, Parkville
- Royal Women’s Hospital, Parkville.
Development care
reduction of baby’s stress and agitation
energy conservation and enhanced recovery
caregiver understanding of baby’s behavioural cues (signs of stability or stress)
encouragement and support of parents in the primary caregiver role
minimisation of potential harm due to the ex-utero environment
promotion of normal growth and development prevention of abnormal postures
stabilisation at each stage of baby’s neuro-developmental maturation and support of emerging behaviours and organisation
enhanced family emotional and social wellbeing.
Definition of development care
interventions taken to support the behavioural organisation of each individual baby,
enhancing physiological stability,
protecting sleep rhythms and promoting growth and maturation.
interventions include handling and positioning measures,
reduction of noxious environmental stimuli,
cue based care - including feeding.
Discuss the midwife’s role in supporting family centred care.
Midwifery practices
cluster care
create nesting for neurological
sleep and rest
nesting for limb development
low light
low stimuli
S2S
Establish BF and nutrition
warm baby
NGT if clinical warranted
CRM monitoring
care in isolette
thermoregulation
monitoring
Potential complication to baby
- cardiac complication from ongoing tachycardia
- increased cortisol levels (due to stress)
- weight loss due to increased energy expenditure
- bonding difficulties
- higher susceptibility to virus and infections
mentimeter
Development care interventions are designed to
allow optimal neurobehavioral development of the infant
KC or S2S placing the infant in a vertical position between the maternal or paternal breasts
Benefits both the parents and neonates
Clustering of care
completing several procedures together in a short period of time
Use of body containment (nesting and hands) with the infant
- Increases the infants feeling of security
- promotes quieting and self soothing
- enhances physiological stability
- promotes energy conservation
