### Our vision is to deliver compassionate, quality care for unwell term and preterm babies. 

We will provide family- centred care, working in partnership with parents and families. Parents will be empowered with knowledge, supporting them to gain confidence and skills to independently  care for their own baby.


Our Vision 

### Forum for Women & Whānau is a consumer forum of the ON TRACK Network 

ON TRACK connects with people from across the country who are interested in clinical trials research that aims to improve the health and wellbeing of mums and babies. This includes midwives, obstetricians, neonatologists, nurses, researchers, hospital managers, funding agencies, policymakers, and most importantly, consumers – the mums and babies we do the research for. 
 
Our ON TRACK Network consumer forum is called 'Forum for Women & Whānau' and was established in 2019. It aims to provide an accessible space for women and whānau to interact, comment and engage with clinical trials research and the Network’s activities.  It aims to have a wide, diverse and inclusive membership reflective of the backgrounds, experience, ethnicity and geography of New Zealanders.  It is open to everyone.

The Forum enables mothers and parents to share stories about clinical trials experience; provides information about the value of participation in clinical trials; information about current clinical trials; results of recent clinical trials; and offers opportunities for everyone to learn more about clinical trials research and Network activities. We would love to see you there (facebook link below). 

Forum for Women & Whānau

### An umbilical line is placed in one of the umbilical cord vessels.

Your baby’s umbilical cord has two arteries and one vein.

An umbilical venous catheter (UVC) is a small plastic tube placed into the umbilical vein, which is connected to an IV pump and delivers fluid, medication or blood.  

An umbilical arterial catheter (UAC) is a small plastic tube placed into one of the arteries. This line is used to take blood samples painlessly and monitor blood pressure. 

The UVC or UAC can stay in for about a week.

**Why would my baby need an umbilical line?**
Umbilical lines are used if your baby is very preterm, unwell or if it is difficult to place an IV cannula. He/she might need IV medication or even IV nutrition for a long time. Some types of medication or fluids cannot be given through an IV cannula and only via a line into a vein deep in the body. Once the cord has dried up it is no longer possible to place an umbilical line.

If your baby has an umbilical line they need to lie on their back and will not usually be able to get up for cuddles. 



Umbilical line



### Babble™ is developed for parents who have a baby in the Neonatal Unit, or parents who are expecting a baby that might need admission to the Neonatal Unit. 

Babble is a source of reliable information about what you can expect when your baby is admitted to a Neonatal Unit. Also, it provides an opportunity to write and store journals and photo's of your baby, and to share it with your extended family. 

The app is free of charge; all parents of newborn babies and their extended families are able to download Babble. 

All photo's are taken with the (written) consent of the parents or people involved.

The content of the app has been developed by Neonatal staff of Palmerston North Hospital (MidCentral DHB) and Kidz First (Counties Manukau). 

At the moment, Unit specific information of 2 Neonatal Units is available:
1. Palmerston North Hospital, MidCentral DHB
2. Kidz First, Middlemore Hospital, Counties Manukau

National Governance group of the Babble app:
Chair: Dr. Nathalie de Vries, Paediatrician Palmerston North hospital, MidCentral DHB
National coordinator: Mel Harris, RN Neonatal Unit, Palmerston North Hospital, MidCentral DHB
Dr. Chris McKinlay, Neonatologist, Kiz First, Middlemore Hospital, Counties Manukau
Julie I’Anson, RN Neonatal Unit, Kidz First, Middlemore Hospital, Counties Manukau


__Disclaimer:__ 
The content of Babble is not meant to replace the information given by health professionals. It is intended to be additional information to what we discuss with you during your baby’s journey of care. Our advice may differ on an individual basis.

__Feedback:__
Please email us, if you would like to report a problem or provide feedback regarding the information on the app. Also, if you would like to tell other parents your story, feel free to email us at: <Babble@midcentraldhb.govt.nz>.
Your input and feedback is highly valued.


__Software development:__ Nodero, Palmerston North; <https://nodero.com>

__Design:__ Blacksheepdesign, Palmerston North; <https://www.blacksheepdesign.co.nz>

![MidCentral Logo](asset://6a7ad7ba-bb2b-11e6-99b9-bb142c076772)




About Babble

### MidCentral Neonatal Unit has many supporters who enable us to provide the extra special touches that make all the difference to the babies, parents and families.

The Manawatu Turbos rugby team carried out some fundraising in 2014 to raise funds for Lazyboy chairs for the parents of NNU babies.

Paula’s Furniture (Lazyboy) donated some Lazyboy chairs to the NNU in 2014 in a joint venture with the Turbos.

Kind Hearts donate baking, other food and toiletries to our families

Rose City Quilters and other quilting groups donate handmade bassinette quilts for every baby in the NNU.

The Red Cross and over 100 other knitters donate knitted hats, bootees, singlets, cardigans and knitted blankets to our NNU babies.


Our Supporters

### Many professionals will be involved in the care of your baby.



__Paediatric Consultant.__
Your baby will be allocated one Paediatric Consultant for their entire hospital stay. The Consultant oversees the management of your baby. A time can be negotiated so you can talk directly to the consultant at least once per week.  

__Charge Nurse.__
There is a full time Charge Nurse working Monday-Friday for any other questions or concerns.

__Registrar or SHO (junior doctor).__
The Registrar or SHO carries out the day to day medical care of your baby. They will review your baby on a daily basis and update plans for ongoing care. This will be done in conjunction with you as parents and the nursing staff. 

__Nurses.__
The nursing staff are allocated 3 – 5 babies per shift.  They are the health professionals you will see most often.  Their responsibilities include: Feeding, changing, washing, positioning your baby (and teaching you to do these tasks). They also monitor baby’s vital signs, carry out blood tests, provide education to parents and families and insert feeding tubes. Nurses also set up and monitor your baby's breathing support, set up and monitor IV drips and give medications.  Your discharge planning is coordinated by the nursing team.

__Key Nurse.__
You will be allocated one or two key nurse/s. Their main roles include:

- Getting to know you and your family
- Where possible, care for your baby when on duty
- Responsible for coordinating your baby’s care
- Plan with you nursing care to meet your baby’s needs
- Support you with learning to care for your baby
- Arrange referrals and follow up before discharge

__Receptionist/administrator.__
The Receptionist/administrator supports the Neonatal Unit staff by for example collating files and discharge papers. She welcomes families and assists them with all enquiries and directs visitors to the correct location.

__Lactation Consultant.__
Specialises in supporting Mums to breastfeed and express.  She has specialist knowledge regarding supporting premature babies, and those with feeding issues.

__Speech language therapist.__
The Speech Language Therapist (SLT) gets involved in your baby's care if there are any mouth abnormalities (eg: cleft lip or palate) or any feeding difficulties outside of what we would expect for the baby’s age/stage. They also often support the feeding of babies who are born extremely premature.

__Neurodevelopmental therapist.__
The Visiting Neurodevelopmental therapist (VNT) will be involved if your baby is born less than 30 weeks. They will usually visit once your baby is stable, recommend certain exercises/positioning , activities to support your baby's development.  They will visit at home after discharge to monitor your baby’s progress and to help them reach their full potential.

__Homecare team.__
The homecare team is attached to the Children’s Ward. The team consists of nurses who will come out to visit certain babies at home once discharged from the Neonatal Unit. They will meet you before discharge.

__Orthopedic Specialist.__
These doctors are bone specialists who visit the Neonatal Unit on Monday, Wednesday and Friday mornings. They do the hip check of your baby. If any abnormalities are detected they will recommend an ultrasound scan or any further treatment.

__Ophthalmologist.__
These doctors are eye specialists who visit the Neonatal Unit on Fridays and check the eyes of babies who are high risk for retinopathy of prematurity (ROP).
At risk babies include those who are born under 30 weeks and/or under 1250 grams birth weight. 

__Radiology Staff.__
Radiology staff do ultrasounds and X-rays. These will usually be done at the baby’s bedside in the NNU. 

__Newborn Hearing Screeners.__
All babies born in New Zealand are offered hearing screening shortly after birth.  The newborn hearing screener will check your baby's hearing in the NNU at the bedside shortly before discharge.  If these tests are not clear baby will need to come back to the audiology clinic as an outpatient after discharge from the NNU. 

__Social Workers.__
Every family who has a baby in the Neonatal Unit (NNU) has the opportunity to meet with our dedicated social work team.  We appreciate how difficult it can be to have a baby in the NNU. When babies are unexpectedly born early or sick it can put a strain on relationships, other children, jobs, home lives and finances.  Also, a long stay in the unit means that families are separated and parents can feel lonely and worried.  Our social workers are on hand to provide support and they may also be able to help with resources such as travel allowances, accommodation, and other assistance for families that qualify.

__Hospital Aide.__
We have an aide who works each day who helps with several jobs around the unit. They do not have contact with the babies but may help you with setting up equipment or showing you round.

__Housekeeping.__
We have cleaners in the unit everyday who help with rubbish, floors and surfaces. If you are staying in the Boarder rooms it is helpful to allow them to clean your room if required during the morning. Also, if you notice a mess within the unit or surrounding areas please alert staff so it can be addressed.  


Staff info

## World prematurity day

The neonatal unit at Midcentral DHB celebrated world prematurity day on the 16th of November with a fabulous morning tea. It was attended by past and present families of premature babies. Thank you to all those volunteers who bought along delicious baked goods to share. Special thanks to The Neonatal Trust for supporting the day and providing decorations. Over 5,000 kiwi babies per year require care in a NZ neonatal unit and 1 in 10 are born prematurely. It’s amazing to see our ex premature babies grow and develop at events such as this

World Prematurity Day

#### Having a baby/pēpē in the Neonatal Unit during the COVID pandemic can have an enormous impact on parents and family/whānau. We will explain a bit more about COVID-19 and what the implications are for you and your baby.

COVID-19 infection is caused by a novel coronavirus (the virus is called SARS-CoV-2). It causes flu-like symptoms such as fever, cough, sore throat, sneezing and runny nose, shortness of breath and temporary loss of smell. In some cases, it can cause a more severe lung infection that may need intensive care support. Pregnant women are at higher risk of severe COVID-19 and may require emergency caesarean, putting baby at risk of preterm birth. The best way to prevent getting COVID-19 and staying well in pregnancy is to get vaccinated. The Pfizer COVID-19 vaccination is safe in pregnancy and during breastfeeding. 

### Pregnant women who have COVID-19

Fortunately, if a woman gets COVID-19 in pregnancy the risk of transmission from mother to pepe while still in the womb appears to be low.   

#### Your baby in the postnatal ward:
If the baby is well after birth, he/she will room in with you on the postnatal ward. You will be given advice on protecting your baby. Generally, until you are shown to be no longer infectious (not able to transmit virus), this will involve hand hygiene and wearing a mask when feeding or caring for baby, and physical distancing when baby is sleeping (but in the same room). Each hospital will have specific guidelines to follow. It is safe to breastfeed your baby, provided these precautions are followed. 

#### Your baby in the Neonatal Unit:
Your baby might need admission to the Neonatal Unit for medical and nursing support. Your hospital is well prepared for that. To protect the staff and other babies, your baby will be nursed in a special room and/or in an incubator and staff will be wearing Personal Protective Equipment (PPE).  

Unfortunately, you will not be able to visit until you are no longer infectious. The hospital staff will keep in contact with you over the phone and will be able to take photos of your baby. The Neonatal Unit staff will be able to give your breastmilk to your baby. Ask your midwife how to express breastmilk. Check your local Neonatal Unit guideline for other visiting policies during COVID-19. 

Having a baby in the Neonatal Unit is stressful, and during a COVID-19 pandemic, we know that it can be really difficult to cope. Please talk to your midwife or the nurse of your baby; they are happy to help. 

#### Your baby at home:
Your baby can become infected, around birth, or after birth, or via other family members who have COVID-19. Usually, babies do not get very sick when they contract COVID-19 after birth. If your baby is having difficulties with maintaining temperature, feeding and breathing, please contact your midwife or GP immediately.

### Pregnant women with suspected COVID-19
Until you have been confirmed negative by a swab test, the same processes as above will generally apply. 

For more information, visit the Ministry of Health links below:
[Information for pregnant women](https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-novel-coronavirus-information-specific-audiences/covid-19-information-pregnant-women-and-those-who-have-recently-given-birth)
[Breastfeeding during COVID-19](https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-novel-coronavirus-information-specific-audiences/covid-19-information-parents-during-alert-level-3/breastfeeding-advice-women-who-have-confirmed-or-probable-case-covid-19)


COVID-19

## There are many reasons why babies are admitted to the Neonatal Unit. Often they need extra support, monitoring or medications. Below, we explain some of the common conditions.

Problems and diseases


### There are lots of treatment decisions that need to be made when a baby is in neonatal intensive care. This section provides guidance for parents facing difficult decisions for their baby. ###

Each baby is different and your baby’s care will be individualised so that they receive the best possible treatment for their situation. 
Not all treatments that can be provided are right for every baby. Sometimes the doctors and nurses looking after your baby may talk to you about whether a different type of care is recommended. 

**What are the different types of care for babies?**   
**“Life support treatment” or “life support”** is special medical treatments required to keep a baby alive. This can include breathing machines (ventilator), blood pressure medication (inotropes), blood transfusions, antibiotics, intravenous lines and intravenous nutrition.     
**“Routine treatment”** includes standard care that is provided to all babies such as milk feeds and temperature support. It may also include provision of oral medications.     
**“Comfort treatment”** refers to medicines and other care aimed at keeping a baby comfortable and free of pain. Sometime this may involve morphine and sedating medicines. 

**Why might my baby require a different type of care?**
Your baby may require a different type of care because:

 * They are not responding to current treatments
 * They have become unwell with a serious complication and are unlikely to get better
 * They have a serious condition that will have a major impact on their future quality of life
 
**Can my baby have comfort treatment and life support treatment at the same time?**   
Yes. In fact it is very common for babies to have both life support treatment and comfort treatment at the same time. However, when a medical treatment can’t cure and life support isn’t working, comfort treatment becomes the most important thing to provide. 
This may mean providing comfort treatment until such time as your baby passes/dies. You will be offered support through this process should this happen. 
Wairuatanga is important and your spiritual and religious beliefs are welcomed at any time during this process.

**Is it OK to stop life support treatment?**   
This is never an easy decision, but sometimes stopping life support treatment is the right thing to do. Some reasons may include 

 * Life support is not working and is not helping your baby
 * Life support may not be able to save your baby for long
 * Treatment is doing more harm than good because of side effects
 * Life support does more harm than good because of baby’s other health conditions
 
**Who makes the decision about the stopping life support?**    
Usually these decisions are made by the parents, doctors and nurses together. However, sometimes doctors make the final decision and sometimes whānau (families) will decide. 
For some whānau, it may be important that a Kaumatua and Kuia (or other community leader) be involved in these decisions. This depends on the type of decision, and on what whānau want. 
Stopping life support treatment is a difficult decision and is something that where possible should not be rushed. Life support treatment and comfort treatment can both be provided until it is clear that stopping life support treatment is the right thing to do. The doctors and nurses will guide and support you in this decision. Your cultural practices and beliefs will be respected by the medical team. 

**What if we “want everything to be done”?**    
Sometimes when doctors talk about stopping life support treatment, parents feel that they want “everything to be done”. It is natural to feel this way. 
The doctors and nurses will do everything they can to help your baby. But some treatments are not helpful. It is really important to avoid treatments that might actually harm your baby.  

**Can I talk about my cultural and religious beliefs about life support?**    
Yes; we respect your beliefs and religious practices. The doctors and nurses will support you and your whānau (family) to make the best decision for your baby. If you need a whānau hui (family meeting) to discuss cultural aspects of life support treatment, please talk to your baby’s doctor or nurse, and a room can be arrange for your hui. 

**What is “quality of life”?**   
Kaitiakitanga: “Quality of life” is a measure of the balance of good things and bad things in someone’s life. For example, comfort, happiness or satisfaction balanced against pain, discomfort, frustration or sadness. Quality of  life will be assessed differently by different people, families and communities.  

**Should “quality of life” be considered when deciding treatment for babies?**   
Mana Tūpuna/ Whakapapa: Quality of life is not the only thing to consider when making treatment decisions for babies, but it is important to think about the impact of treatment on a child’s quality of life. All medical treatment has risks and benefits. Sometimes treatment can do more harm than good.  


Facing difficult decisions

### Nutrition research by the University of Auckland in collaboration with MidCentral DHB

The DIAMOND study is looking at different ways of providing nutritional support to preterm babies learning how to breastfeed and the effect this has on the way they grow, the amount of fat in their bodies and their brain development. 

DIAMOND is for babies born between 32 and 36 weeks' gestation, whose mothers plan to breastfeed, who have an IV line in place and live in the area of MidCentral DHB.

The different types of nutritional support provided to babies in DIAMOND are not experimental and are commonly used in this group of babies; we are trying to find out which one is the best. 




DIAMOND Study

### From all the feedback we have received from parents, we have found out that parents love to read other people's stories. To know that you are not the only one to experience your baby's stay in the Neonatal Unit has shown to be really helpful. 

If you are willing to share your story with other parents, please email your story plus one or two photos to: 

<Babble@midcentraldhb.govt.nz>

We keep the right to edit and/or shorten your story.


Stories

## There is a lot of equipment in the Neonatal Unit, including incubators, monitors, lines for intravenous medication and devices to give your baby breathing support.  

This can look quite overwhelming, but it will seem less scary when you understand how they can help your baby.  

Here we discuss some of the equipment you will see in the Neonatal Unit.


Equipment

### Neonatal units take care of sick term babies (born at or over 37 weeks gestation) and premature infants (born less than 37 weeks gestation)


Neonatal Unit

Babble News

## Depending on why your baby is in the Neonatal Unit they may need some medications to help them. Here is a quick summary of some of the most common medications we use.

Medication

### Depending on the situation at birth and after birth, different health care professionals can be involved in the follow-up of your baby.

- __Midwife/LMC:__ If you get discharged home within the first 4-6 weeks of your baby being born, your LMC will continue to follow you and your baby up at home and monitor progress until your baby is 6 weeks old. 
- __Well Child Provider:__ If your baby is more than 28 days old your Well Child provider will follow you up and make sure your baby is growing well and meeting developmental milestones. They will continue to follow up at different stages until your child reaches their before school check at 5 years of age. 
- __Paediatrician:__ Depending on how premature your baby was or if they have specific medical needs that will be followed up. You may have an outpatient appointment with your baby's consultant several weeks after discharge. These appointment times will be sent out in the mail. 
- __Homecare team:__ Homecare is a follow-up service provided for premature babies born at less than 33 weeks gestation or other infants needing further follow up and medical input. If required, you will meet the team prior to discharge. Once you are home, they will contact you and arrange a good time to come to do a home visit. They will assess how your baby is progressing.
- __General Practitioner (GP):__ There is no set follow up date to go to your GP, however you will need to call and book your baby's first check and immunisations at 6 weeks of age.
- __Visiting Neurodevelopmental Therapist (VNT):__ Visits by a VNT are for babies born at less than 30 weeks gestation. 
- __Respiratory Nurse:__ Will only be involved when your baby is going home on oxygen. 


Follow-up by health care professionals

### There may be times where your baby 'cluster feeds'. This is when your baby wants to feed a lot more frequently or almost continuously over a period of a few hours.

If you are breastfeeding your baby it is normal for your newborn baby to feed 6-12 times every 24 hours. 

Cluster feeding can happen at any time of the day, however typically babies will cluster feed in the evening, this is also the time of day when breasts may feel softer but breastmilk content is higher in fat. 

Cluster feeding can make you tired. Try to rest during the day while baby is asleep to prepare for this time and if you are feeling overwhelmed allow your partner or a family member to hold and comfort your baby so you can have a short break. Your baby will not be able to smell milk and may calm down during this time, so when you restart feeding they may settle better at the breast. 

It is important for the mother to eat and drink well during this time to support a good milk supply.



Cluster feeding

### This is the most commonly asked question. The date of discharge depends on a number of things we will discuss below.

It's only natural that parents will want to bring their baby home as soon as they can, but many premature and/or unwell babies need to stay in hospital for a while.  We never keep a baby on the neonatal unit for longer than necessary and always aim to get them home as soon as possible (or back to their mother if she is still in hospital). 

It is difficult to predict the amount of time a baby will need to spend on the unit before being ready to go home.  The length of stay will depend on how early they were born, their birth weight and the severity of any medical complications/conditions.

The decision on when a baby is ready to leave NNU and go home will depend on a number of things. However, as a general rule for preterm babies: they may be ready to go home at about the time of the baby's original due date. 

Before a baby does go home from the NNU, the doctors and nurses will want to be sure that the baby is generally well and is:

- __Feeding well__, either breastfeeding, bottle feeding or a combination of both. 
- __Gaining weight__ on demand feeding - Ideally your baby will gain 20-30 gr per day. 
- __Keeping warm on their own__ in a cot.  A temperature of at least 36.6 degrees is needed without excessive layers of clothing or blankets. 
- __Breathing on their own__, even if your baby still needs oxygen at home.




When will my baby go home?

### Shortly after your baby is admitted to the Neonatal Unit (NNU) he or she will establish a kind of 'routine' based around his or her feeding times.  

When a baby is fed every 2 or 3 hours, his or hers 'cares' times will be approximately every 6 hours. It is done every 6 hours to maximise the time of undisturbed sleep so your baby's growth and brain development are optimised.  'Cares' is when nappies and other hygiene cares such as a daily wash or, where applicable a bath, are carried out. Nursing staff will cluster all cares and any other procedures, for example blood tests at the same time whenever possible, so that your baby does not get disturbed too often. 

This is also the time when your baby, depending on age and stage, can get up for Kangaroo Cuddles and/or feeds when appropriate.  You as parents will be encouraged to become involved in these times and do the cares and be taught how to do these things. The timing of these can be discussed with you so that you can be in the NNU as much as possible to do them. 

Each day of the week (including weekends), there are Doctors' rounds. Your baby's consultant is likely to see your baby at least once per week, if not more, depending on baby's condition. On the other days the senior house officers or registrars working in NNU will see your baby and review progress. There are also Doctors working 24/7 who are available to see your baby should the nursing staff have any concerns or your if baby's condition changes.

Over the 24 hour period there are 3 changeovers of nursing staff. Morning staff work from 7am until 3.30pm, afternoon staff work from 2.45pm until 11.15pm and the night staff work from 10.45pm until 7am.  A nurse on each of these shifts will be assigned to care for your baby.  It will be your Key Nurse, where possible, if she is on shift.  


Daily routine

Mark and I found out we were going to have a baby a month before our wedding in April 2007.  We were absolutely overjoyed as we have been together for 6 years and were planning to start our family straight after our wedding.  On our wedding day Mark announced to everyone during his speech that that I was 10 weeks pregnant!  Everyone was surprised and so happy for us!  After we arrived home from our honeymoon I had my 12 week scan appointment which Mark and I were so excited about.

For some reason I knew I was having twins and when I asked the lady who was performing the ultrasound to check for two babies she said, indeed there were two heartbeats.  She then went out of the room for a few moments and came back with the doctor who scanned me for a long time before he spoke.   Something was wrong with twin number two.  Twin one looked normal but we would need to be seen by a specialist in a weeks’ time as this was a very complicated pregnancy.  From there we went home, shocked, bewildered that we were having twins, worried they wouldn’t survive.  I hoped and prayed that our two babies would be fine and they would survive against all odds.  We went to a scan the following week with the specialist gynecologist at the hospital.  The outlook was not good, we had a very rare type of twin to twin transfusion and there is no known reason for why it happens, it just does.  There was absolutely no hope for twin number 2 but twin number 1 may survive depending on several things, the main one being premature labour.  The outlook was grim, I was only 13 or so weeks and had to get to 28 weeks preferably.

On the 13th of August 2007 at 24 weeks gestation I woke in the middle of the night to contractions.  We went straight to hospital where I was examined and then within an hour my husband and I were in a helicopter being flown to Wellington.  I was given a series of drugs to try to stop my contractions and steroids to help the baby’s lungs in case they were born.

Upon arrival in Wellington I was monitored for several hours and once the contractions had finally subsided I was sent off to the maternity ward.  That same evening while I was lying in the hospital bed I felt a huge contraction.  I woke my husband who was lying on a stretcher beside me and told him to call the nurse while I went to the bathroom.  While I was standing in the bathroom all of a sudden my waters broke and I felt a rush of liquid and then another push and Jaycob dropped into my hands crying ever so weakly.  He was little and pink and so perfect!  I was so shocked!  I called for help several times and my husband leapt from his stretcher and saw me standing in the corridor with a tiny baby between my legs and I was talking to him saying “It’s ok Jaycob, you’ll be ok darling, hang on baby” then suddenly the nurses arrived and cut the cord and whisked Jaycob away.

Twenty minutes later and back in my bed I gave birth to our beautiful second born son Gabriel who was stillborn which we sadly had expected.   The nurses took Gabriel away and bought him back to us in a basket with a wee blanket over him.  He was pink and tiny, his eyes tightly fused and his fingers and toes not quite developed but he was beautiful to us.  We held him and cuddled him and the nurse took his footprints for us.  Meanwhile Jaycob was rushed to the neonatal intensive care unit and my husband and I spent time with our precious angel Gabriel.  We were in complete shock and I don’t think it sunk in for quite a few days.

And so Jaycobs fight for survival began with incredible highs and lows.  An emotional journey that hit us hard as every parent knows who has a premature baby and a still born baby.  Jaycob weighed in at 675gms, 1 pound 6 ounces.  Jaycob stayed in the intensive care unit for 8 weeks and was ventilated for over 4 of those weeks before finally advancing to the midline CPAP with high levels of oxygen.  He was incredibly sick for many weeks with skin infections, jaundice, anemia, chronic lung disease, a PDA, inguinal hernias, the list goes on.  We stayed across the road at Ronald McDonald House for the 3 months we were in Wellington and I stayed beside Jaycobs incubator from dawn to dusk every day singing to him and praying he would be ok.  We are so grateful to all our friends and family who visited and helped us out during such a traumatic time.  Jaycob was resuscitated several times and he took a long time to gain weight but eventually he did and we were transferred home to Palmerston North Hospital where Jaycob stayed for a further 2.5 months in the Neonatal Unit.

The whole time while Jaycob was in hospital I expressed my breast milk as the nurses assured me this would help build his immunity.  So I expressed religiously with the hope that one day I might be able to breast feed him although I was told that I may not be able to because he may not latch on.  In the meantime he had my breast milk through an oral gastric tube and then later through a nasal gastric tube.  I finally got to breast feed him when he was 4 months old although it wasn’t easy as he had his OG tube in his mouth and neopuff oxygen through nasal prongs up his nose.  Still, we persevered and a month later he was fully breastfeeding at 5 months old.  This was such a precious time for us as he had had so many artificial and negative experiences due to his early arrival so it was wonderful to be able to give him comfort and to be close to him.  During these early months in hospital we had kangaroo cuddles as often as we could for as long as possible each day but there were many days when he just wasn’t stable enough to come out of the incubator.

Jaycob came home from hospital on the 14th of January 2008  just over 5 months old and remained on oxygen until July.  For his first birthday on the 13th of August, we had a remembrance ceremony for Gabriel at our chapel.  All our family and close friends came to support us, it was truly beautiful.  We released helium balloons after the service but Jaycob didn’t want to let his go and held on tightly.  Daddy had to eventually let it go for him.  It was a very precious moment, one I will always cherish.  Each year on the boys birthday we have a celebration for Jaycob with a cake and we also release a helium balloon in remembrance of his precious little brother Gabriel.

Jaycob started walking at 18 months (14 months corrected) and started babbling and saying a few words, however his speech was delayed for a long time.  His feeding has always been an issue and he has been slow to gain weight however he is now on the growth chart.  He also developed ROP (retinopathy of prematurity) in his left eye and has very little vision in it and so this has slowed his development down.

Jaycob had many hospital admissions in his early years for things associated mainly with his chronic lung disease and asthma.  I was told by his Doctor that his lungs would eventually repair and grow new tissue, which they have and we haven’t had any trips to the hospital since he was about 4 years old.  Physically he is a good weight and height now although because of his oral aversions feeding has been a huge obstacle for him.

Jaycob is now almost 9 years old.  He is very bright in many ways especially with his reading and computer knowledge.  He was diagnosed with autism and an intellectual disability when he was 4 years old and has a teacher aide who helps him each day at school.  His development has been very delayed including fine motor skills and gross motor coordination but he has overcome so many challenges and now runs cross country and loves to swim.   He now talks very well, writes (hilarious) stories, goes to the toilet himself, eats and drinks without assistance (most of the time) and he loves to play with his younger brothers.  He certainly still has some hurdles to overcome but as far as we are concerned he is our miracle child and we just feel so blessed to have him in our life and are so incredibly proud of him.

Jaycob has three younger brothers, all were born full term and 9lb plus.

![Jaycob2](asset://6a7dcd80-bb2b-11e6-9a2d-7f534fd1df46)



Jaycob and Gabriel

### The Neonatal Unit offers 'rooming in', where parents can join their baby in one of our parent craft rooms.  

The purpose of rooming in is to be more involved with feeding, bathing and nappy changing with the knowledge that hospital staff are nearby to provide support if it's needed. It may also be necessary to learn about medications and handling medical equipment if your baby has breathing or feeding problems.  Ideally you will have moved into one of our parent craft rooms and have “taken over” full care of your baby for at least 2-3 days before discharge.


Rooming in

### There are a couple of options for accommodation.

Parents qualify for paid accommodation if they live over 100 kms from the hospital.  The parents currently in the Neonatal Unit (NNU) who live furthest away are prioritised for accommodation.  If you qualify for accommodation (and want it) and your baby is likely to be an inpatient in the NNU for longer than one week, one parent will be offered a boarder bed in one of the five rooms on floor 2 next to the maternity ward. 

If you don’t qualify for accommodation (live in Palmerston North, Feilding, Ashhurst or Linton) and your baby is likely to be an inpatient for longer than one week, you will be required to stay at home overnight .  However, you can visit your baby throughout the day and evening as often and as long as you would like.

If your baby is breast or bottle feeding on demand and is close to discharge (a few days), both parents can be offered a parent craft room for overnight stay.  The parent craft rooms are situated in the foyer of the NNU and have access to toilet / shower.  Each room has a single bed and a chair that folds out into a single bed. Fresh bedding and linen (towels etc) are also provided. 

Patients who have an address within Whanganui DHB (Whanganui, Taihape, Waiouru and some Bulls addresses) will have motel accommodation paid for by Whanganui DHB, until their baby is well enough to transfer to Whanganui Hospital.


Accommodation

### We will give you some numbers and addresses for support services.

__In emergency situations:__

- Ambulance/Fire/Police: [111](111)
- Plunketline: [0800 933 922](tel:0800933922)
- Healthline: [0800 611 116](tel:0800611116)
- Women's Refuge: [0800 733 843](tel:0800733843)
- National Poisons Centre: [0800 764 766](tel:0800764766)

__Community Breastfeeding support:__

- Your LMC. They should always be your first point of call for any feeding questions while you are under their care

Community Birth Services
Multiple clinic locations in MidCentral Region
022 LATCHON / 022 5282466
www.communitybirthservices.org.nz
Referrals can be made via website or phone call. Clinic appointments available with qualified Lactation Consultants or our Breastfeeding Peer Counsellor’s

Whangai Ora Milk Bank (WOMB), Support with providing Pasteurised Donor Human Milk. *criteria applies
Ground floor of Te Papaioea Birth Centre, 117 Ruahine Street, Palmerston North. 
Contact Jacquie on 0272669547 or Info@whangaiora.org.nz 

Milk Café– Drop in support/coffee group with a Lactation consultant present.Every Wednesday 10am-12noon. Search Milk Café—Te Papaioea Birthing Centre Te Papaioea Birthing Centre, 
117 Ruahine Street, Palmerston North. See Facebook for further information
  
La Leche League Palmerston North
We offer: Trained Breastfeeding Leaders, Mother to Mother support. Monthly daytime and evening meetings. Telephone help at anytime, free lending library and a range of leaflets on a wide range of breastfeeding topic.
Contact Lily– 0221910568 (speaks Mandarin), 
Lynlee—0211751454, Natasha—0273800115


__Other Community Support:__

Local Iwi and Māori Providers and Pasifika services in Midcentral District:

Pasifika Health Service
Website: wwww.thinkhauora.nz
Phone: (06) 354 9107
Address:200 Broadway Avenue
Palmerston North
Our Pasifika nurses, community support workers and lifestyle coaches offer a wide range of services including support with pregnancy, breastfeeding and women’s health.

Te Tihi
Website: www.tetihi.org.nz
Email: info@tetihi.org.nz
Phone: (06) 560 3401 
Address:200 Broadway Avenue, Palmerston North
Te Tihi is an Alliance of nine Iwi, Hapū, and Māori organisations who work collectively to deliver whānau-centred services based on the Te Ara Whānau Ora process. 

Mokopuna Ora 
Engaging whānau in the health and well-being of māmā & pēpi 
Weaving together Māori culture and pregnancy and parenting information and education to engage whānau in the health and wellbeing of māmā and pēpi. 
Find them on Facebook , Website: https://mokopunaora.nz/

Rangitāne o Tamaki nui-ā-Rua 
Offer a comprehensive range of services including health and social services (including well child and women's health)
Phone: 06 374 6860 
Email: info@rangitane.co.nz 
Website: https://www.rangitane.co.nz/

Well Child/Tamariki Ora Providers 

-Best Care (Whakapai Hauora) Charitable Trust
-He Puna Hauora Incorporated
-Raukawa Whānau Ora 
-Te Wakahuia O Manawatu Trust
-Whānau Āwhina Plunket 

__Information from Ministry of Health__

The website of Ministry of Health has also very helpful information. See link below.



Whom to contact for help?

### It is normal for newborns to be unsettled at times and crying is their way of communicating with you. 

__Here is some advice on how to settle a crying baby:__

- __Hunger:__ Make sure they have had a good feed and check whether they are still showing feeding cues. If they are, offer the baby another feed.
- __Wind:__ Your baby may have wind. Try to wind them, so they may then be more comfortable and settle. 
- __Uncomfortable:__ They may have a wet or dirty nappy, if so change their nappy and this may help them to settle. 
- __Overtired or overstimulated:__ Your baby may need to be comforted- wrap them in a blanket to help them feel secure. Cuddle them, hold them close to your chest, so they can hear your heartbeat. Talk or sing to your baby to help comfort them. If they are still unsettled a walk or ride may help to soothe them. 

Sometimes you  __may not find a reason__ for why your baby is crying which can be frustrating/distressing. Remember it is ok to ask for help. Use your support networks, family or friends. If you are feeling frustrated or distressed get a family member/friend who you trust to take your baby. If not, you can gently place you baby down in a safe place, walk away and take a break. Allow yourself time to calm down and then pick you baby up. They are likely to be more calm if you have allowed yourself time to calm down. 

If you think your baby's __cry has changed and is a lot more high pitched__ than usual, they may be unwell so please refer to signs of illness and seek medical advice.



Crying

### Once your baby is ready to go home, the staff at the Neonatal Unit will discuss caring for your baby at home to ensure you are prepared.  

Some important things to consider are:

- If your baby is going home on medication: Do you know how often to give it and how to measure out the dose? Do you know how to store it?
- Do you have the name and contact details of your baby’s GP including contacts for out of business hours?
- Do you have the contact details of your midwife or well child provider?
- Do you have a telephone number for the homecare team (if appropriate)?
- If you are breastfeeding, do you know how to express and store breastmilk? Do you know when your baby is hungry? Are you able to independently get your baby attached to the breast? Can you tell when your baby has had enough milk?
- Do you have phone numbers for breastfeeding support?
- If you are bottle feeding, do you know when your baby is hungry?  Do you know how to make up formula and how to sterilise bottles?
- Are you confident in bathing your baby?
- Can you tell when your baby is too warm or too cold?
- If your baby is going home on oxygen, do you feel confident with swapping oxygen bottles and taping on the cannulas?
- Do you have everything prepared at home for your baby?

Other discharge topics that will be discussed include immunisations, safe sleeping, use of natural fibres of clothing/bedding and blankets, having a warm and smoke-free environment, signs of illness and CPR education.


Discharge education

### We will help you to prepare for taking your baby home.


Preparing for discharge

### Having your baby in the Neonatal Unit is often a stressful time because it is not what you were expecting would happen when you, or your partner, were pregnant. 

Having a baby in the Neonatal Unit is a stressful time for families. We recognise that families have lots of other commitments outside the hospital to attend to. However, spending time with your baby is also very important. Getting to know your baby and taking part in their care is an important part of the journey. 

We expect good communication from family to staff and staff to family. Good communication can help reduce some frustrations and make the journey easier. Staff expect to be treated and spoken to in a respectful way. Offensive language is not acceptable in the Neonatal Unit. 

Your baby needs you and your whānau to be present as much as possible. As baby gets ready for home we need you in the Neonatal Unit much more to establish full feeding. 

Please familiarise yourself with the visiting policy and respect this. It is put in place to protect the vulnerable babies from illness (including yours). 

Please respect the privacy of other babies/whānau by not asking them or going into their bed space. We respect your right to post information about your own baby on social media. However, we ask you not to share information about other babies or staff. 


General expectations

There are many reasons why babies need to be admitted to a Neonatal Unit (NNU)

__Term babies are admitted to NNU for a variety of reasons such as:__

- Breathing problems
- Infection
- Low blood sugar
- Being cold
- Jaundice (yellow skin colour) 
- Poor feeding and/or weight loss
- Hypoxia (lack of oxygen during birth process)
- Drug withdrawal (when Mum has been taking prescription or non-prescription drugs which may affect the baby)

__Preterm babies come to the NNU for the following reasons:__

+ Breathing support: babies born before 37 weeks are not always ready to breathe on their own straight after birth
+ Temperature support: premature babies find it difficult to keep warm and often need an incubator
+ Feeding support: premature babies may need an IV drip to administer fluids and calories and/or a feeding tube, until they are mature enough to feed by breast/bottle
+ IV medication: for example antibiotics in case of infection or dextrose for low blood sugar

Reasons for admission

29th December 2016, 2pm I was really scared and nervous when Doctor’s told us that they are going to take my little brother out today, he was only 28week and 4 days old. He was born at 3:25pm weighing 710g only. I was very HAPPY when I first saw him. I got chance to touch my newly born brother on his head before he was flown to Wellington. 

Next day Dad and me took Mum’s milk for him from Palmerston North Hospital. When first time I saw my brother he had all these lines, monitors and he was in an incubator. I thought in my head how much pain he was in. He was on 1ml feed every 8 hours. My mum was now in Wellington after 3 days. 

I bought him first gift, it was a Teddy Bear bigger than him. He was getting better and better everyday. He weighed 1Kg after 1 month. We were so happy and we celebrated.  

10th Feb he was transferred to Palmerston North Hospital. I came to see him on weekend and I was surprised to see him out in the Cot. Soon all his monitors came off. He gave us an another surprise on 10th of March when he got discharged from Hospital one day earlier. I am so happy and excited. He is ready to go home.
                
I am really greatful to Team NICU Wellington Hospital and Team NNU Palmerston North Hospital.

Thanks 
Big sister Annant  

![Adeeb 2](asset://6a7ddb40-bb2b-11e6-9a2f-b374e75777b4)

Adeeb's story (written by his sister)

### Below you can find information about accommodation, expressing room, meals and parking costs etc.


Facilities

### You may face some challenges when you are at home.

When your baby is at home

### We will discuss some things you will need at home for your baby.

Things you will need are:

- Car seat – to take your baby home from the Neonatal Unit and travel safely in
- Bassinette/cot/Pepi-pod – for your baby to have their own, safe place to sleep.
- Nappies/wipes/cream for baby’s bottom
- Clothes and blankets – ideally made from natural fibres.  Woollen hat, booties and cardigan.
- Bottles/formula/breastmilk if bottle feeding, as well as sterilising equipment such as Milton tablets or a microwave steriliser.


Essential baby gear

### There are a couple of options available for food and drinks for parents.

Mothers qualify for meal vouchers if they have been discharged from hospital (as a patient) and they are present in the unit feeding their  baby for several day feeds.

Currently, in the unit we are lucky enough to have baking delivered every few days from the Kind Hearts Movement group.  

There is a lounge for parents of babies in the Neonatal Unit to use which has tea, coffee, milo, milk, hot water, a microwave and TV.


Meals and drinks

### What we do.

Our unit has 17 bed spaces, and we have the resources (staffing) to care for around 14 babies at any one time. We care for babies who are born at or above 28 weeks gestation and who are born weighing 1000g or above (2lb 3oz).

Any baby born less than 28 weeks and / or less than 1000g will be transferred to our tertiary centre, Wellington Neonatal Intensive Care.  Other babies who may require transfer include babies with major heart conditions, who need surgery or babies who are severely unwell needing ongoing ventilation.

Our NNU is the only ward in the hospital that can provide intensive care (ventilation, CPAP, long lines) to babies less than one month of age. Our staff is highly trained.  At any given time, there are a Registrar (Junior Doctor) and 3 – 4 Nurses on site to care for our babies and respond to emergencies. A Paediatric Consultant (Specialist Doctor) is available 24/7. 

NNU Palmerston North

On January 9th 2015, in the early hours of the morning, we were blessed with the unexpected arrival of our little girl Piper Marie Krakosky. She weighed 2lb and was ten weeks early. She was tiny but strong. I remember being wheeled in my bed to meet her for the first time. So many thoughts racing through my mind. There she was, on a RESUS table, covered in plastic with connections everywhere. In that moment all the anticipation, excitement and plans built over the last few months were replaced with fear, worry and anxiety. This was the beginning of our NNU journey. 

Piper stayed in the NNU for eight weeks and we quickly settled into the routine of feeding, turning, medications and Doctors rounds. The constant beeping of machinery a reminder of how she was getting on. In many ways all of this provided a safety blanket where I knew she was safe and cared for. As the hours stretched to days and the days stretched to weeks, Piper grew stronger and progressed through the NNU milestones. This journey often felt like a rollercoaster. There were days, even hours, where I felt so much joy at meeting the smallest milestone. Our first cuddle and breast feed, tolerating milk, and then the day she moved to a cot, to only at times be met with set-backs that could bring me right down again. 

However, Piper and the team worked hard and our day came where they let us go home. The thing we had worked so hard for was finally here. This was a bitter sweet moment where we were finally a family, but we were on our own. All the things we had protecting and helping us had gone. It took time for me to gather trust in our ability to look after her and keep her safe. As the weeks grew into months, I did trust. I saw Piper grow in personality and size. Everyday we are amazed at how far Piper has come. Her dad and I will always remember the precious beginning as we watch her play, oblivious to all that happened. We see that even though the starting point was harder than others the journey is still our own. We realise in life some of the most precious achievements we have are the ones we worked the hardest for.

Tania and Joel Krakosky

![Piper-2](asset://6a7ce4f6-bb2b-11e6-9a09-073658df776c)

Piper's NNU journey

### We will discuss below the daily routine you can expect when your baby is admitted in the Neonatal Unit. Also, we will discuss some general expectations.

What to expect

### When you get discharged home you will receive follow up from one or multiple health teams/members. This section will provide information on follow up and other support groups that are available.

__If your baby has been hurt or is seriously unwell call 111.__


Discharge follow up 

### A number of things need to happen on the day of discharge.

Your baby will have a final medical ‘discharge check’ before going home or to the maternity ward. Any final blood tests or other tests will most likely be carried out before discharge (if applicable).

If you go straight home from the Neonatal Unit (NNU), you will need to bring your car seat/capsule on discharge day.  The staff will check it fits your baby safely since your baby will need to leave the NNU in their car seat. Car seats do have an expiry date and part of the checks staff do is to see that the carseat is still valid and safe. We recommend you check this prior to bringing your seat in. 



On the day of discharge

### While your baby is in NNU he or she will be provided with essentials such as nappies, bed linen and clothing (including woollens when baby needs them).  

However, when your baby is ready to be dressed in clothing you may want to bring his or her own clothing to dress them in.  


Nappies and clothes

A short period of fetal distress resulted in our beautiful baby boy being born via emergency c-section on New Years Eve 2015. We were 28 weeks and 4 days through what was a perfect pregnancy. He weighed just over 1Kg, 2.9lb. He was tiny, but he was perfect. He was initially intubated and given surfactant but then put onto C-PAP for a few days followed by oxygen for another couple of days. 

We struggled through the first week, trying to understand what had happened, learning the ins and outs of the neonatal unit, and not to forget- expressing. We weren’t allowed to hold our tiny baby until day six. This was the most beautiful experience I have ever had. The bond I had dreamt of while I was pregnant happened as soon as his skin touched mine. He was really my baby and I was his mum. From then on we had weeks with three steps forward and two steps back, we had ongoing tests and checks, and slowly one by one all of the lines in his hands and feet came out. We spent this time getting to know and fall in love with our baby. 

Day 60, 37 weeks “gestation” saw us packing up all our gear and leaving all we had known as parents. We were going home with our little man finally! 

I got asked, and still get asked a lot if I felt robbed of the rest of my pregnancy and a normal child birth (whatever that is!). But I didn’t, and I don’t. I consider myself incredibly lucky to have my little boy and to have witnessed his strength and determination to get through what was a very challenging start to life. We got to see him grow bigger and stronger every day. 

During this journey we were lucky to have such professional and friendly staff looking after our family. We will never be able to convey how much we appreciated their support. They have such a passion for little people and taught us so much about being the best parents we could be, as well as making us feel like family within the unit

I am so proud of our positivity and unwavering love during a very testing time. But mostly I will forever be in awe of my wee man and how he taught us how precious family is.

![Story 4-2](asset://bea62dc4-e2b0-11e6-b69d-bb8065a08dae)

- Alexandra Atkins

Baby Atkins

### Sometimes, babies are discharged while still needing oxygen or tube feeding. 

If you are going home with low flow oxygen or tube feeding, then you will have close follow up and contact with the homecare team.  You will also be seen by a nurse who specialises in oxygen therapy and then seen at home by the homecare team, to have saturations monitored etc.  

The homecare team will liaise with your baby's consultant to monitor your baby’s progress and help plan when changes to the flow rate, or trials without oxygen or tube feeding can be made. You will be given contact numbers for the homecare team on discharge from NNU.


More complex needs

### Parking costs
For those parents who are not accommodated on site and are travelling to and from home, one parent can have complimentary parking. Please hand over your parking ticket to one of the staff members who will be able to validate your ticket.



Parking

### We will provide you with a lot of information you might need before you go home, or when you are already at home.


Going home

## Having a new baby in your life means a lot of changes. New parents often worry about keeping their baby safe. This section has some guides on ways to protect your baby and to give them the best start in life. 

Keeping Babies Safe 

## Having a baby born early and admitted to a Neonatal Unit can be a scary and isolating experience for parents. 

This section will help you prepare you for some of the things you may see and hear, and to help you better understand your baby's needs at their stage of development.

Gestational expectations

## During your baby’s stay in the Neonatal Unit he/she may require a number of checks and tests.

Some are routine national tests like the Newborn Metabolic Screening, and others are used to guide your baby’s treatment. Here we discuss some of the tests that you might come across.


Routine checks & tests

## There are many ways in which your baby may be fed during his or her time in hospital.  The best and most complete food for your baby is breastmilk. 
Sometimes it may not always be possible for your baby to be fed by breastmilk alone. Intravenous (IV) nutrition, tube feeding, and use of fortifiers or supplements may be needed to complement breastfeeding or use of expressed breast milk.

If you choose not to breastfeed, after being fully informed about breastfeeding, this decision will also be supported. 

Feeding my baby

### Preterm babies often develop 'anaemia of prematurity' which means a low level of haemoglobin. This is the part of the red blood cell that carries oxygen in the blood. 

Preterm babies are less able to make new red blood cells to keep pace with their growth. They may also be low in iron which is needed to make red cells. These factors contribute to a low haemoglobin level or anaemia. 

Treatment of anaemia includes the administration of an iron supplement, usually given once a day before one of your baby's feeds. Occasionally, when the haemoglobin level is very low (checked by a blood test) a blood transfusion is required. If this is the case, the reasons, risks and benefits will be fully discussed with you and you will be asked to sign a consent form. 

Anaemia

### The Newborn Metabolic Screening is also known as the “heel prick” or “Guthrie” test. 

This test is routinely performed after 48 hours in all babies in New Zealand. It checks for a range of metabolic disorders such as cystic fibrosis and phenylkenonuria (PKU).

Informed consent is obtained from parents prior to doing the test. It involves taking blood from your baby’s heel and dotting it onto a testing card. The card is sent to the screening unit in Auckland and your Lead Maternity Carer or Neonatal Unit is notified of the result.

If your baby’s birthweight was less than 1.5 kg he/she will have 2 metabolic screening tests: one at 48 hours and one at 2 weeks. If your baby’s birthweight was less 1 kg they will have one more test at 4 weeks of age.

More information is available from the [National Screening Unit](https://www.nsu.govt.nz/pregnancy-newborn-screening/newborn-metabolic-screening-programme-heel-prick-test). 


Newborn Metabolic Screening

### We will give you some general advice on what to check and do if your baby becomes unwell.

__These are some signs/symptoms of illness in babies:__

- Feeding: Your baby may not be feeding as well, drinking less fluids or they may have vomiting and diarrhoea
- Fever/Temperature instability: Your baby may feel too hot or too cold (normal temperature for well baby is 36.5- 37.5 ℃)
- Breathing: Your baby may be breathing faster than usual, they may be struggling to breathe or their breathing may be wheezy or more noisy than usual
- General: Your baby may be lethargic, meaning they may not be waking/responding as much to what is going on in the environment. Your baby's cry may change and become more high pitched.
- Output: Your baby may not have as many wet or dirty nappies
- Colour change: this may include your baby being pale, mottled, cyanosed (blueish colouring) around the lips or they may develop a rash.


__In case of emergencies, call 111__

It is crucial to learn CPR to be prepared for emergencies.

If you are worried your child is unwell you should contact your midwife, GP or take them to the emergency department. 
For further, less urgent information and advice, you can use the plunket helpline (Plunketline 0800 933 922). 
Ministry of Health website has also very useful information. See link below.




When your baby becomes unwell

### If we suspect baby has an infection we will start antibiotics immediately.

Unlike in adults, we do not wait for the infection to be obvious as babies can become unwell very quickly. These are given through an IV cannula. If the infection is not confirmed the  antibiotics may be stopped after 36 to 48 hours.  

Antibiotics

### A preterm baby's brain is still developing and is vulnerable to injury.
The blood vessels in the brain are thin and fragile and can rupture and leak into the brain causing an intraventricular haemorrhage (IVH). Risk factors include being born less than 32 weeks’ gestation, low birth weight, and being exposed to stress before, during or after birth. 

A head ultrasound will be performed in babies considered to be at risk. If the IVH is small,  in most cases the brain bleed will heal over time without consequences. If the brain bleed is more severe there can be long term problems with development.

Intraventricular haemorrhage (IVH)

**Neonatal Unit**    
Babies born between 28 and 32 weeks’ gestation will be nursed in the Intensive Care section of the Neonatal Unit to provide them with the best environment for their development. Your baby will be nursed on a heat table or in an incubator to maintain his or her temperature and will be placed on monitoring to observe such things as heart rate, oxygen saturations and breathing.

**Breathing**        
Because your baby has premature lungs he/she will probably need help with breathing. When a baby makes extra effort at breathing they can tire easily. We will help your baby with breathing by supporting him/her using CPAP or High Flow. These  help to keep the lungs open, reduce the effort of breathing and prevent apnoea. Sometimes babies with more severe breathing problems need the help of a ventilator.

**Apnoea**        
It is common for babies born at this gestational age to have pauses in breathing. These are called 'apnoea of prematurity' and are treated with caffeine citrate and respiratory support.

**Feeding**        
Your baby is unlikely to begin full milk feeds straight away and will require additional nutrition via an intravenous line. At this gestation, babies will usually be given Total Parenteral Nutrition (TPN). Your baby may be able to have small amounts of breast milk via a feeding tube, so mums are encouraged to begin 3-hourly expressing soon after birth. 

This is also necessary to stimulate lactation as your baby will not be able to do this for you. Oral gastric tube feeds will be started as soon as possible and intravenous nutrition will be weaned. Your baby can taste and smell, and you may notice him/her 'rooting'. Consider placing a pad freshly scented with mother’s milk in your baby’s bed during tube feeds. 

**Cares**         
Parents are encouraged to be involved in their baby’s cares as soon as possible. You will be supported with taking your baby’s temperature, changing their nappy, general washing and holding tube feeds. Your presence in the unit to support your baby’s cares is important for your his/her healing and wellbeing. 

The care times can be worked around you and your baby’s needs, and the staff will work in partnership with you to ensure you are as involved as much as possible. 

**Skin-to-skin (kangaroo) care**       
This is a protected quiet time for you and your baby and promotes bonding, supports breastfeeding, increases parental confidence in handling a sick baby and enhances growth and development of the baby. As soon as your baby’s condition is stable enough, you will have opportunity for skin-to-skin time.


What can you expect at 28-32 weeks?

**Neonatal Unit**     
Babies born between 33-36 weeks’ gestation will be nursed in level II or level III of neonatal care to provide them with the best environment for their development and individual needs. Your baby will be nursed on a heat table or incubator but may quickly move into an open cot if they are maintaining their temperature. He/she will also be placed on some monitoring to observe his/her heart rate, breathing rate and oxygen saturations.

**Breathing**      
Because your baby has premature lungs he/she will probably need help with breathing. When a baby makes extra effort at breathing they can tire easily. We will help your baby with breathing by supporting him/her using a CPAP or High Flow which will help to keep the lungs open, reduce the effort of breathing and prevent apnoea. 
 
**Apnoea**     
It is common for babies born in this gestational group to have pauses in breathing. These are called “apnoea of prematurity” and are treated with caffeine citrate and respiratory support.

**Feeding**    
Your baby may be able to have milk feeds via a feeding tube if he/she is stable. Mums are encouraged to begin expressing 3 hourly following birth to stimulate lactation. Expressed colostrum can be given to your baby but may need to be mixed with some formula until milk supply is established (normally around day 3). The rhythm of sucking, swallowing and breathing becomes coordinated at this age. He/she will gradually progress to full sucking feeds. 

**Cares**    
Parents are encouraged to be involved in their baby’s cares as soon as possible. You will be supported with taking your baby’s temperature, changing their nappy, general washing, preparing and giving tube feeds. Your presence in the unit to support your baby’s cares is important for your baby’s healing and wellbeing. The care times can be worked around you and your baby’s needs and the staff will work in partnership with you to ensure you are as involved as much as possible. Nursing staff will attend to your baby when he or she shows cues for example crying, wriggling or waking. 

**Skin-to-skin (kangaroo) care**    
This is a protected quiet time for you and your baby and promotes bonding, supports breastfeeding, increases parental confidence in handling a sick baby and enhances growth and development of the baby. Skin-to-skin time can start as soon as your baby’s condition is stable enough.



What can you expect at 33-36 weeks?

**Neonatal Unit**   
Your baby may be nursed in an incubator or on a heat table if he or she is having issues with temperature instability or if otherwise medically indicated. Most stable babies will be nursed in an open cot. He/she may also be placed on some monitoring to observe his/her heart rate, breathing rate and oxygen saturations. 

**Breathing**    
Your baby may be in the unit due to some breathing problems resulting from birth. He or she may not have cleared all the fluid in his or her lungs, may have been exposed to meconium or may have a lung infection. In all these cases he or she may need some respiratory support such as CPAP, High Flow or low flow oxygen depending on how severe the breathing problem is. These will support your baby’s breathing and can provide oxygen to maintain his or her oxygen levels. 

**Feeding**    
If for some reason your baby is unable to feed straight away, mums are encouraged to express soon after birth to stimulate lactation while also providing a supply of colostrum. This can be given to your baby via a feeding tube as soon as he or she is stable. 

**Cares**    
Parents are encouraged to be involved in their baby’s cares as soon as possible. You will be shown how to take your baby’s temperature, change their nappy, general washing and holding. You will be able to attend to these at least 6 hourly or whenever it is required. Nursing staff will attend to your baby when she or he shows cues for example crying, wriggling or waking. Other interventions can happen around care times in order to provide adequate periods of undisturbed sleep for your baby's brain development 

**Skin-to-skin (kangaroo) care**     
This promotes bonding between parents and their baby and supports breastfeeding, increases parental confidence and enhances growth and development of the baby. Parents will be encouraged to have skin-to-skin cuddles as soon as their baby is stable enough.


What can you expect at term?

### An apnoea means stopping breathing for at least 20 seconds. It is very common in premature babies, especially below a gestational age of 34 weeks.  

Apnoea occurs in premature babies because their breathing centre in the brain is not yet fully developed. When a baby stops breathing, his/her heart rate can slow down causing a bradycardia, also known as a brady. During an apnoea, a baby's skin may change colour to a pale bluish colour.

Babies at risk of apnoea will be on a monitor. If an alarm occurs, the nurse will look at the baby and ifthe apnoea continues, the baby will be given gentle stimulation by rubbing the skin. Sometimes babies may require extra support with oxygen. Some babies may only have a few apnoeas a day, while others can have them more frequently. 

Apnoea of prematurity can be treated with a medication called caffeine. As the baby becomes more mature, the apnoeas will decrease and eventually stop. This will happen before they are discharged home.

If a baby starts to have more apnoeas than expected further tests may be required to rule out other problems such as infection.

Apnoea of prematurity

### If your baby is very premature or very sick, he or she may need intravenous (IV) nutrition.

A solution will be given intravenously called Total Parenteral Nutrition (TPN). This solution delivers a combination of protein, carbohydrates, lipids, vitamins and minerals and provides all your baby needs for complete nutrition.

Babies receiving TPN usually require a special kind of IV line. This may be an umbilical venous catheter (UVC), which is inserted into the stump of baby's umbilical cord. This line can be used for up to a week. Your baby may also need another type of IV line called a “PICC line” or “long line” which can stay in for several weeks, if needed.

Expressed breast milk feeds will be introduced gradually as soon as the baby is stable, usually via a feeding tube, and the IV nutrition will be weaned off.  

Intravenous (IV) nutrition

## Breast milk provides the ideal nutrition for your baby. 

Breast milk is even more important for a baby who is born preterm and who faces a higher risk of infection. Breast milk contains nutrients and antibodies that enhance your baby’s health and development.

It is possible to take your preterm baby home fully breastfed. With some perseverance and patience, you can establish and maintain a milk supply and with the help and support of staff your baby can learn to breastfeed successfully!

Breastfeeding

### The best way to get started with breastfeeding when your baby is preterm or unwell is to express your milk.

Expressing is vital to establishing and maintaining a milk supply. Women who do not express may have difficulty breastfeeding their baby when he or she is ready to start feeding. It can be very difficult to bring a milk supply back if expressing has stopped and milk production ceases.

Another important way to promote breastfeeding is being with your baby when he or she is in the Neonatal Unit, especially during the day at 'care' times.  When your baby is alert and showing feeding cues, they should be offered a chance to breastfeed. This will help them to establish effective breastfeeding. 

Your baby can start licking, nuzzling and maybe sucking on an empty breast initially (immediately after expressing) and progress to more effective feeding on a full breast as he or she becomes coordinated with sucking, swallowing and breathing, or recovers from his or her illness.


Getting started

## In this section, we will describe what you can expect when your baby is born with a gestational age of 28-32 weeks and what you can do to support your baby.

28-32 Weeks

### Click here for an [online video](https://www.youtube.com/watch?app=desktop&v=ZsJBnTxRmA0&embeds_referring_euri=https%3A%2F%2Fwww.kidshealth.org.nz%2F&embeds_referring_origin=https%3A%2F%2Fplunket-prod.heyday.net.nz&feature=emb_imp_woyt) about baby resuscitation (CPR)




Basic Life Support

### The Newborn Hearing Screen is a routine test that is recommended for all babies in New Zealand to check if they are able to hear well. 
It is important to detect hearing loss as soon as possible, since treating it early will help baby’s language, learning and social development.

The hearing screeners will meet with you to discuss the test and get your consent. Newborn Hearing Screening is usually done as close to discharge as possible (minimum 36 weeks for preterm babies). 

If your baby misses out on the hearing screen prior to discharge, an outpatient appointment will be organised by the screening team.

More information is available from the [National Screening Unit](https://www.nsu.govt.nz/pregnancy-newborn-screening/universal-newborn-hearing-screening-programme). 

Newborn Hearing Screening

### Hypoxic ischemic encephalopathy (HIE) or “asphyxia” occurs before or during labour and birth when a baby's brain does not get enough blood and oxygen. This can cause injury to the brain.
### 
HIE can be mild to severe. A baby with HIE may be irritable, have reduced level of awareness, abnormal body movements and seizures (fits). Babies with HIE need to be closely monitored, and if the HIE is severe, they will need respiratory support, intravenous (IV) lines, and may need a special treatment called therapeutic cooling. 

Therapeutic cooling is where the baby's temperature is kept between 33-34 degrees to help the healing process and reduce the brain injury. Babies requiring cooling need to be cared for in a tertiary hospital. 

HIE may affect a baby's development but outcomes can be difficult to predict. A brain MRI scan may be performed to help assess the extent of any injury. Babies with HIE will have continued follow-up care by a doctor.

Hypoxic Ischemic Encephalopathy (HIE)

## Babies’ brains and the blood vessels in the brain are very vulnerable. Depending on what happened during pregnancy, labour and after birth different types of brain injuries can occur.

Brain injuries

### It is common for parents to feel they lack control of the situation when their baby is sick. Remember you and your family are the most important people in your baby’s life.

The unborn baby lives in a warm, fluid-filled environment being gently rocked with relatively well defined boundaries. There are no bright lights, loud noises, people touching or painful procedures. This section offers an overview of how you can support your baby’s development in the stressful neonatal environment. During care, watch how your baby moves and acts, to know times when he/she appears secure and calm and times when your baby appears to need rest.

**Touching and holding**      
At this gestation your baby’s skin is sensitive to touch. Begin talking to your baby quietly then add touch slowly. Touch your baby using continuous gentle pressure on his or her upper legs, upper body or head. Avoid stroking, rubbing or poking your baby as this will over stimulate and stress him/her. 

When holding or moving your baby, swaddle him or her in a blanket and keep his/her arms and legs close to the body. Hold baby still, rather than rocking as your baby cannot tolerate rocking motion at this age/gestation. Any handling or repositioning should be done with slow gentle movements and without sudden changes. You will be guided in this by the nurses. 

**Non-nutritive sucking**      
This is the sucking that your baby does when there is no milk to swallow e.g. the beginning of a breastfeed (before let down) or when sucking on his/her fingers. All babies (especially premature babies) have a developmental need to suck. Sucking on a pacifier or gloved finger during tube feeds helps to link the association between sucking and a full stomach. It also improves oral muscle tone and coordination.

**Sleeping**     
At this gestation, it is difficult to tell when your baby is awake or asleep. His/her sleep patterns become more obvious the older he/she gets. Your baby may show brief alert states and deep sleep usually increases around 30 weeks.  When your baby is sleeping, try not to wake him/her as they need long periods of undisturbed sleep for their brain development. Assess your baby’s readiness for interaction, and if necessary wake slowly by placing your hands gently around him/her and talk softly.
 
**Positioning**     
At this gestation  your baby’s movements are jerky and he/she will try to stretch his/her arms and legs. Good positioning and boundaries around your baby’s body will help ensure your baby is comfortable and will promote their growth.

**Looking, listening and smelling**     
At this gestation, your baby may have a low tolerance for stimulation. Your baby’s eyes will open for short periods of time but he/she cannot focus yet. Avoid bright lights in your baby’s eyes. Prepare your baby before touch by talking softly first. He/she may begin to try to listen to soft sounds and sometimes may become quiet and still and look at you when hearing your voice. Be aware of noise levels surrounding the cot. At this age your baby can taste and smell and you may notice him/her 'rooting'. 

Consider placing a pad freshly scented with mother’s milk in your baby’s bed during tube feeds. Skin to skin care during tube feeds may help increase a mother’s milk supply. Keep strong odours, such as hand sanitiser and perfumes, away from incubators.



Developmentally supportive care at 28-32 weeks

### It is common for parents to feel they lack control of the situation when their baby is sick. Remember you and your family are the most important people in your baby’s life.

The unborn baby lives in a warm, fluid-filled environment being gently rocked with relatively well-defined boundaries. There are no bright lights, loud noises, people touching or painful procedures. This section offers an overview of how you can support your baby’s development in the stressful neonatal environment. During care, watch how your baby moves and acts to know times when he/she appears secure and calm and times when your baby appears to need rest.

**Touching and holding**   
Babies at this gestation show increasing tolerance for touch. Prepare your baby for touch with a soft voice. When touching your baby, do not stroke, rub or poke but rather provide a continuous gentle pressure to his/her legs, upper body or head. When holding or moving your baby, swaddle him or her in a blanket and keep his/her arms and legs close to his/her body. Hold the baby still, rather than rocking as your baby cannot tolerate rocking motion at this age/gestation. When holding your baby while he/she is in a light sleep, talk or sing to him/her in a soft voice.

**Non-nutritive sucking**   
This is the sucking that your baby does when there is no milk to swallow, e.g., the beginning of a breastfeed (before the letdown) or when sucking on their fingers or a pacifier.  All babies (especially premature babies) have a developmental need to suck. Non-nutritive sucking on a pacifier or gloved finger during tube feeds helps to link the association between sucking and a full stomach. It also improves oral muscle tone and coordination.

**Sleeping/positioning**   
When your baby is sleeping, try not to wake him/her as you touch and hold him/her but if necessary rouse your baby slowly by placing hands around him/her and speak softly. Avoid noise and light in your baby’s bed space and support periods of rest so your baby may conserve energy. When sleeping your baby should have boundaries around his/her body to support arms and legs. Repositioning should be done using gentle movements and without sudden changes. Your baby may start to spend time sleeping on his/her back. This is to help to prepare your baby for safe sleep when it is developmentally appropriate, and they transition into a cot. 

**Looking, listening and smelling**   
Your baby can tolerate a variety of sounds, so you are able to interact while he/she is awake. Try to develop a pattern of care e.g. feeding, nappy change, interaction and then sleep. Provide darkness at night so he/she can become used to a day night cycle and shield his/her eyes from bright lights during procedures. Provide short periods of soft rhythmical sounds such as singing softly when he/she is awake. Avoid loud sounds around your baby’s bed space.


Developmentally supportive care at 33-36 weeks

### It is not uncommon for you, the family, to feel separated and left out of the care of your newborn baby. Remember you are the most important people in your baby’s life.

The unborn baby lives in a warm, fluid-filled environment being gently rocked with relatively well defined boundaries. There are no bright lights, loud noises, people touching or painful procedures. This section offers an overview of how you can support your baby’s development in our stressful world. During care, watch how your baby moves and acts to know times when he/she appears secure and calm and times when your baby appears to need rest.

**Touching and holding**  
Your baby’s skin has matured but continues to be sensitive. You can touch your baby in a variety of ways including gentle steady pressure, rhythmic stroking or patting.

**Sleeping/positioning**     
Your baby should sleep lying on his or her back and have an emerging sleep pattern of being more awake during the day and asleep more at night. Parents should vary the position of their baby’s head from side to side to avoid head preference. Swaddling below shoulder height offers security with arms tucked close to his or her body as well as enabling hand to mouth contact.  

**Looking, listening and smelling**    
Your baby may show longer periods of being awake, alert and interactive. He or she will be able to see items 20-30 cm away, showing particular interest in faces. He or she will enjoy you talking or singing to them. Develop a regular pattern of care for your baby, e.g., feeding, nappy change, interaction and sleep.


Developmentally supportive care at term age

### Bronchopulmonary dysplasia (BPD) is a term given to preterm babies that have more severe and persisting respiratory problems in the Neonatal Unit. 

It is also known as chronic lung disease (CLD). These babies require ongoing oxygen or respiratory support close to or after their due date. 

It is due to abnormal development of lung tissue after birth and scarring and stiffening of the lung. This means the lung tissue will not work as well as it should. . The more preterm a baby is, the higher their risk of BPD, since their lungs are more immature. Other factors such as infections and use of a ventilator increase the risk of a baby having BPD. 

Most babies with BPD will recover over time, and the lung continues to grow and repair throughout childhood. However, babies with BPD have increased risk of respiratory infections during early childhood and asthma in later childhood. A small number of babies with BPD may need to go home on oxygen. 

Bronchopulmonary dysplasia (BPD)

### Tube feeding means giving your baby milk through a tube that goes to their stomach either through the nose (naso-gastric tube) or the mouth (oro-gastric tube). 

Your baby might have tube feeding when he/she is not able to drink. This can be because your baby is too sick and doesn’t have the energy to drink. Babies born preterm are usually not alert enough and do not have the sucking strength nor the coordination (suck-swallow-breathe) to drink for themselves initially.  

Tube feeding will be gradually “weaned” off as your baby establishes sucking feeds. Sometimes babies will go home with tube feeding, but if this is required, neonatal staff and the Home Care team will give you all the support, information and training you need.

Tube feeding

### A breastfeeding code or score is an assessment tool to help assess milk transfer at the breast. 

The Neonatal Unit staff will use this tool and teach you how to assess baby when he/she is learning to breastfeed. Initially, your baby's breastfeeding progress may be inconsistent, depending on his/her awake/alert patterns. The code or score will help in determining whether your baby needs any additional milk via an alternative route.

See the Neonatal Unit page for your local code or score. 

Breastfeeding Score

### There are certain ways your baby will show you that he or she is hungry and interested in sucking. 

In a preterm baby the period of alertness, when the baby shows feeding cues, can be brief and baby may go back to sleep quickly.

**Early baby feeding cues:**  

* Licking or smacking lips. 
* Opening and closing mouth. 
* Sucking on lips, tongue or on hands and fingers.
  
**Active baby feeding cues:**   

* ‘Rooting’ is a reflex where baby automatically turns his/her or face towards a stimulus and opens their mouth to make sucking motions. When a baby is having skin to skin or someone is holding them close to their chest they may display the rooting reflex. 
* Wriggling or squirming around a lot.

**Late baby hunger cues:**  

* Moving head frantically from side to side.  
* Crying. 




Feeding cues

## In this section, we will describe what you can expect when your baby is born with a gestational age of 33-36 weeks and what you can do to support your baby.

33-36 Weeks

### Preterm babies often have episodes where they stop breathing called apnoeas. Caffeine is a stimulant of the nervous system and is used to treat apnoea. 

It can be given intravenously or orally. It helps to regulate the baby’s breathing. Caffeine is safe in the long term and treatment of apnoea with caffeine may improve long-term motor function. 

Apnoea is more common in babies born at less than 34 weeks’ gestation and very common in babies less than 28 weeks’ gestation. 


Caffeine

### We promote the immunisation of all babies. 

It is the parents' or caregivers' decision whether their child is immunised. We will seek your consent before immunising your baby and ask if you wish to be present during the vaccination.

**When will my baby be immunised?**
The first immunisations occur 6 weeks from birth, regardless of the baby’s gestation at birth. For example a baby born at 34 weeks' gestation will be immunised at 6 weeks of age, and they will only be 40 weeks' corrected gestational age at this time.

**Who will immunise my baby?**
A staff member who is specially trained will immunise your baby and will arrange a time with you. 

**What immunisations will my baby get?**
The three immunisations babies receive at 6 weeks and 3 months are:

- Rotavirus (Rotarix ®), an oral vaccine. 
- Diphtheria/Tetanus/Pertussis/Polio/Hepatitis B/Haemophilus influenzae type b (Infanrix hexa), an injection into the thigh.
- Pneumococcal (Synflorix or PREVENAR 13®), an injection into the thigh.

[Click here](https://www.health.govt.nz/your-health/healthy-living/immunisation/immunise-your-children) for more information about immunisation in New Zealand.



Immunisation

### In some situations, your baby may need screening blood tests.

In babies who are at risk of having a low blood sugar (e.g., preterm babies, small and large babies, babies of mothers with diabetes), blood sugars are checked frequently during the first few days after birth.

If your baby is born at 32 weeks or less, blood tests will be checked approximately every fortnight. However, if your baby becomes unwell this will be done more frequently. These routine blood tests check that your baby is progressing well and is not developing conditions such as anaemia of prematurity. 


Routine bloods

## Here you will find out about some of the ways your baby may receive nutrition before he or she learns to breastfeed or bottle feed.


Other feeding methods

### In some situations, babies will receive hospital formula milk.

Depending on the reason for your baby's admission and the availability of expressed breastmilk (EBM), or based on your decision not to breastfeed, your baby may require formula milk. 

As well as standard formula, we have a special type of formula for preterm and small babies (usually for babies less than 2.0 kg).  

Informed consent is always gained from parents before formula is given to babies. The reasons for using formula should be explained to you. 

Some babies with medical conditions may require a specialised formula. If your baby needs this kind of formula it will be discussed with you.

The formulas we use are 'ready to feed', meaning they are pre-mixed and ready to give to your baby. Formulas can be given by cup, bottle or feeding tube. 

If your baby is going home on formula, we may ask you to bring in a tin of formula powder so we know that he/she will tolerate it before going home. Staff will instruct you on the safe preparation of formula and sterilisation of feeding equipment. 

[Click Here](https://www.healthed.govt.nz/resource/feeding-your-baby-infant-formula) for more information on preparing baby formula.


Hospital formula

## Breathing problems are the most common reason for babies to be admitted to the neonatal unit.  

A baby with breathing difficulties can show signs of:

- Breathing fast, above 60 breaths per minute
- Noisy breathing / make a grunting noise when they breathe out
- Flaring nostrils (open wider when they breathe in to help more air to enter)
- Chest will work harder and movements will be deeper (recessions)
- Low oxygen levels
- Shallow breathing
- Change in skin colour, can be pale/bluish
- Apnoea  

Some of the common breathing problems in babies are described below.

Breathing problems

### Meconium aspiration means that the baby has inhaled meconium into the lungs. 

Meconium is the name used for a baby's first poo, and it is black in colour and is thick and sticky. During labour, if a baby becomes stressed they may pass their meconium before or during birth. If they do, they may breathe some into their lungs and it can irritate and block the airways. If this occurs, the baby will have breathing difficulties and be at risk for lung infection. Meconium aspiration usually occurs in term babies.

A baby with meconium aspiration will need blood tests, and a chest X-ray. 
Breathing difficulties are treated with respiratory support. Intravenous antibiotics will usually be started until infection is ruled out. Some babies with meconium aspiration need treatment for pulmonary hypertension.

Meconium aspiration

### Expressing milk for your baby will become a very important aspect of his or her care and your day. 

Expressing will be required for your preterm or unwell term baby, and the milk expressed will be used for tube feeding or top ups if your baby is unable to suck at the breast. Even if you had not planned to breastfeed or breastfeed long term, you may want to consider expressing while your baby is in the Neonatal Unit, so your baby can have the benefits of the expressed breast milk.

To gain a milk supply it is important to begin expressing milk as early as possible following the birth, at least within 6 hours. This will help stimulate your milk supply and increase long term milk production.

**Important facts:**
The amount of milk expressed will vary in quantity and appearance over a day.
Don’t compare the volumes of milk you express to what other mothers achieve. You are unique and every baby has a different requirement.
Keep expressing even if the volume is low. It may remain low for several weeks, but it will usually increase when your baby starts to breastfeed.

**To help stimulate and increase your milk supply:**
Use of warmth and breast massage prior to expressing.
Express frequently, especially at night.
Express a minimum of 7 and up to 10 times in a 24-hour period for 10-20 minutes. Be guided by a lactation consultant for your individual needs.
Express next to your baby’s incubator or cot as much as possible.
Have skin-to-skin cuddles daily with baby.
Put your baby to the breast as soon as your baby’s condition allows.
Perform breast massage.
Have an expressing plan that works for you. Staff will work with you to develop this plan.

It is very common with long term expressing for there to be a drop off in supply around 4-6 weeks. By continuing with regular expressing or increasing expressing frequency this usually improves. If not, please discuss with neonatal staff, your midwife, lactation consultant or GP.  



Expressing breast milk

## In this section, we will describe what you can expect when your baby is born with a gestational age of 37 weeks and over, and what you can do to support your baby.

Term Infants

### This is a sugar gel, used to treat low blood sugars (hypoglycaemia) in babies. 

The inside of baby’s cheek is dried and the gel is rubbed in.

Dextrose gel 

### During pregnancy, and with a new baby, it can be a very stressful time for you and your family. We know family violence can escalate during times of stress and women are at greater risk following the birth of a baby.

In the Neonatal Unit we talk about family violence and screen all women as part of the violence intervention programme. We do so because we know the risks and we want the best outcome for you, your baby and your family.

In New Zealand reports of family violence are on the rise.

**Here are some of the facts:**

- Almost half of all homicides in New Zealand are committed by a person identified as family to the victim.
- In 2014 New Zealand police responded to a family violence related matter on average every 5 and a half minutes.
- 76% of family violence incidents go unreported to police.
- 1 in 3 women experience sexual and/or physical violence from a partner in their lifetime.
- Being exposed to violence (as victims or witnesses) negatively affects children.

Violence in the family is not limited to just physical. Abuse can be emotional, sexual, financial, psychological or in the form of neglect. Using any form of violence to hurt or control someone is unacceptable.

Men are at risk too. We focus on women as they statistically have a higher risk of being victims of family violence. However, men can be victims as well.

If you want to know more please talk to any one of our staff members or click on the links below:

- [Women's Refuge](https://womensrefuge.org.nz/)
- [It's Not OK Campaign](http://areyouok.org.nz/)
- [Shine - Making NZ Homes Violence Free](http://www.2shine.org.nz/)



Family violence 

### If your baby is suspected to have an infection, they may have an “infection workup” or “septic screen”. 

This helps to detect the source of infection and can include blood samples, chest x-ray, urine sample, nasal swabs and spinal tap. The spinal tap involves passing a small needle in your baby’s lower back to collect fluid from the spine, which is then tested for meningitis. This will give an indication of what kind of infection is present and how it should be treated. Neonatal staff will discuss the results of the infection workup with you and treatment options.  


Infection workup

### This is an iron supplement used for treatment and prevention of anaemia. 

Most preterm babies will go home on iron. It is given by mouth or naso-gastric tube. 


Ferrous sulphate 

### Pneumonia is an infection of the lungs, also known as a chest infection. 

Babies can come into contact with an infection during pregnancy, at birth or a short time after birth. Group B Streptococcus (GBS) is the most common cause in babies. Sometimes the cause is unknown. A baby with pneumonia will show signs of breathing difficulties. A chest x-ray, blood test and blood culture will be done to confirm or rule out pneumonia. 

Sometimes a baby with pneumonia will need oxygen and support with their breathing. Antibiotics will be started and usually continued for at least 5 days.


Pneumonia

### Breastmilk is an excellent and complete food for most babies. However, very preterm or very small babies need extra calories and protein to support their high growth rate.

**Human Milk Fortifier (HMF).** HMF is a supplement powder which can be added to your expressed breastmilk (EBM). HMF is made from powdered milk. 

**Probiotics.** Depending on the gestational age of your baby, probiotics may also be given mixed with EBM. Probiotics are the healthy bacteria (bugs) that normally live in our gut. In preterm babies, they help to improve feed tolerance and prevent a severe disease of the gut called necrotising enterocolitis.


Fortifiers and probiotics

### At this gestational age your baby will not do much breastfeeding, but there are some vital things you can do.

Your baby will initially receive nutrition via an intravenous (IV) line, then progress to feeds via a feeding tube. Usually babies commence tube feeding 2 hourly then progress to 3-hourly feeds as tolerated. 

During this time your baby may enjoy skin-to-skin contact time at the breast. As he/she shows more interest in feeding, neonatal staff will guide you with positioning and latching your baby on the breast. This usually happens around 33-34 weeks.  

Neonatal staff will help you to assess your baby’s developing feeding skills.


Breastfeeding 23-31 weeks 

### An unborn baby is surrounded by nice warm fluid during pregnancy, but at birth their body has to adapt to a sudden change in temperature. 

Babies are not able to shiver and keep warm like adults and have difficulty bringing their temperature up on their own if they get cold. If a baby is exposed to cold stress their body has to use more energy and they may develop low blood sugar and increased oxygen requirement. **A normal temperature is between 36.6-37.5.**

Babies who are preterm, small or unwell are at risk of low temperature and temperature instability. Preterm babies born before 34 weeks need to be nursed in a warm environment such as an incubator or heat table. Once they reach 34 to 35 weeks they may be able to maintain their temperature in a normal cot. The amount of heat provided will be gradually weaned until they are able to maintain their own termperature.

In the Neonatal Unit babies’ temperatures are monitored closely. Babies that have any sudden low or high temperatures will likely be tested for infection.

Cold babies 

### Babies require a lot of care and attention. As a parent it is important to know your limits and know how to keep yourself and your baby safe if things start to get too much. 

Every year in New Zealand babies are severely injured or killed from being shaken. When a baby is shaken, the rapid movement causes the brain to move hitting the skull and causing damage. The brain swells and is further damaged leading to irreversible injury or even death. 

**Six key messages:** 

- Crying is how babies communicate. It's normal to sometimes feel frustrated when your baby cries and you cannot calm him/her. Make a plan to deal with these feelings in a safe way for you and your baby.
- It’s OK to walk away. Ensure your baby is safe, not sick or hurt and doesn’t need anything (like a feed or nappy change). Then put them in a safe place and take a few minutes away from them to gather your thoughts. 
- Never, ever shake a baby. It only takes a moment to lose control and do irreversible damage.
- Never leave your baby with someone who you can’t trust to keep their cool. 
- Share this information with anyone who cares for your baby or anyone who you think would benefit from this knowledge. 

**If you suspect your baby has been hurt, seek help, dial 111.** Do what is best for your baby.

Watch the [Power to Protect](https://www.youtube.com/watch?v=bM2yc3oRu8g) video on YouTube.


Never shake a baby 

### Jaundice (yellow colour of the skin and eyes) is very common in both preterm and term babies. 
Jaundice is due to excess bilirubin from breakdown of blood cells. It can be measured in the blood.

If your baby looks jaundiced, a bilirubin test is recommended to measure the level of the jaundice. Blood is collected by pricking your baby's heel or inserting a needle into a vein. The result determines whether treatment by phototherapy is required. Ongoing monitoring may be necessary.


Bilirubin 

### Hypoglycaemia occurs when the level of glucose (sugar) in the blood is too low. 

A normal blood sugar level for a newborn baby is 2.6 mmol/L or above. A baby with hypoglycaemia often does not show any signs, but might be sleepy and too tired to feed, have tremors, be floppy, or develop breathing difficulties. 

Glucose provides the brain with energy to help it function, and it is very important that it is maintained at normal levels. If low levels are not treated, permanent brain injury may occur..
Babies at risk of low blood sugar require regular screening blood tests until the blood sugar is stable,  Usually treatment consists of extra feeds, dextrose gel in the mouth, or IV dextrose. 

**Babies who are at risk include:**  

- Babies born from mothers who had diabetes during pregnancy
- Preterm babies
- Low birth weight babies or very large babies
- Babies that are unwell/sick
- Babies with breathing problems 


Hypoglycaemia

### A pneumothorax is when air leaks from the lungs into the space between the lungs and chest wall. 

In babies, it can occur spontaneously or may be associated with resuscitation, meconium aspiration, respiratory distress syndrome, infections and CPAP or ventilation. Preterm babies are more at risk for a pneumothorax because their lungs are more fragile and can rupture easily. The pneumothorax is diagnosed on a chest x-ray.  Small air leaks do not cause significant problems and will heal on their own but may require extra oxygen. If the air leak is large it may compress the lung and cause breathing difficulties.  

Large air leaks may need drainage by needle aspiration or a chest drain. The drain will stay in as long as required, usually a couple of days.  A baby with a chest drain will have regular medication for pain.

Pneumothorax

### If a baby is establishing breastfeeding, bottles will usually be avoided. 

If a baby needs top ups and does not have a feeding tube, then a small cup may be used to feed the baby. This is only a temporary measure. 

Bottle feeding may sometimes be suggested to help establish sucking feeds. The reasons for introducing a bottle will be fully discussed with you before this happens, including the possible risks and difficulties when offering a bottle to a preterm baby learning to breastfeed. Parent consent will be sought before a bottle is introduced.

Cups and bottles

### At this gestational age your baby will not do much breastfeeding initially but will soon learn and there are some vital things you can do.

Your baby may initially receive nutrition via an intravenous (IV) line, then progress feeds via a feeding tube. Your baby may commence tube feeding 2 hourly then progress to 3-hourly feeds as tolerated. 

At this time your baby may enjoy time nuzzling and licking at the breast during kangaroo cuddles. As he/she shows more interest in feeding, neonatal staff will guide you with positioning and latching your baby on the breast. 

It is recommended that you initially express prior to breastfeeding, as a baby of this gestation is still developing his/her suck, swallow and breathing skills and may not yet cope with the flow of your milk. As your baby becomes coordinated with the suck, swallow and breathing skills, he/she will cope with a faster flow.

Breastfeeding 32-34 weeks

### This is a sugar solution.

It is used to provide necessary fluid and sugar through an IV cannula until your baby is able to feed adequately. It is also used for treatment of low blood sugars (hypoglycaemia).


IV Dextrose

### “Face up, Face clear, Smoke Free”

In the Neonatal Unit, many babies sleep in different positions depending on their needs. For example, preterm babies can be placed on their sides or tummy at times. This is done for developmental reasons and is only safe in the Neonatal Unit because the babies are fully monitored. When a baby is ready to go home safe sleep principles are essential.

**SUDI – Sudden Unexplained Death in Infancy**
New Zealand has the highest rate of SUDI in the western world with 60-70 babies dying each year. One of the ways New Zealand is trying to reduce this problem is ensuring every sleep is a safe sleep. 

**There are six key principles for safe sleep:**

- **Face up:** Baby should always be placed on their back in their own safe sleeping space (bassinet, cot, Pepi-pod or wahakura) for every sleep
- **Face clear:** Baby’s face should be clear of blankets, toys etc. 
- **Smokefree:** Babies are safest when they are not exposed to smoke especially in the house or car. Having a smoke free household is safest for your baby
- **Breastfed:** Breastfeeding your baby is a protective factor for SUDI and helps to keep them safe. 
- **Close to parent:** Babies are safest when close to their parent or caregiver. It is recommended for babies to sleep in their own safe sleep space in the same room as their parent/caregiver for the first 6 months of life.
- **Handle gently:** Babies need to be handled gently at all times.

**Unsafe sleep practices**  
Sleeping your baby in unsafe places increases their risk of injury and SUDI. 

- Car seats are essential for protecting your baby but are not designed for sleeping. When you arrive at your destination, take baby out of their seat and lie them in a safe sleeping space.
- Pillows are not safe to use with babies. Even propping a baby up on a pillow can put them at risk. When your baby sleeps they need to be lying on a flat firm mattress.
- Bed Sharing or co-sleeping can put your baby at increased risk of death especially if they have added risk factors. These include: being small, exposed to smoke or the parents being under the influence of drugs or alcohol.

**Pepi-Pod**  
A Pepi-Pod is like a wahakura. It’s a safe sleeping space, especially made for babies, that can be used safely in bed with the parents. These are available to buy online. Some people may be eligible for one from their healthcare provider (e.g., Midwife, Neonatal Unit etc).

For more information from the Ministry of Health visit [Safe Sleep](https://www.health.govt.nz/your-health/pregnancy-and-kids/first-year/helpful-advice-during-first-year/safe-sleep). 

Safe sleep

### X-rays may be needed to guide management of your baby, e.g., if he/she is having breathing problems or a line is inserted. 

This is done by the x-ray team in the hospital who bring a portable x-ray machine into the Neonatal Unit. Your baby may be repositioned to give the team a clear x-ray picture. You will be asked to move away from the x-ray machine to make sure you are not exposed to unnecessary radiation, although the dose for your baby is extremely small.

X-ray

### Probiotics are healthy gut bacteria and are used to reduce the risk of necrotising enterocolitis (NEC).

Probiotics are given to the babies who are the most at risk of NEC, usually those born at less than 34 weeks’ gestation or with birthweight less than 1500 g. Criteria for probiotics may vary depending on local risks. 

Probiotics are given in a small amount of milk or water by mouth or naso-gastric tube.

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