Neonatal

  • An 18 cot unit divided into four nurseries catering for babies who need intensive care, high dependency or special care.

  • Address: Tunbridge Wells Hospital,

What we do

When you first arrive in the Neonatal Unit it can be quite daunting.

There is a lot of equipment, noises, alarms, lights and many people. Our priority is you and your baby and we adopt a holistic approach: family-based care involving parents in all aspects of care planning and care giving. 

The equipment is there to keep your baby warm, monitored, and to support breathing where needed. We will discuss your baby’s needs with you, and explain how the equipment is helping when you arrive and throughout your baby’s stay.

The Unit has four nursery areas, and depending on how premature or unwell your baby is, they will be in one of these areas. During your baby’s stay they may be moved into a different nursery depending on their progress.

Intensive Care

The intensive care nursery is often where premature and sick babies are admitted. There are three intensive care cots and your baby will be looked after by our very experienced nurses and doctors specially trained in delivering neonatal care. This area is always prepared and we can quickly monitor and assess your baby’s needs.

High Dependency

We have two high dependency rooms with eight cot spaces. Your baby will be admitted into high dependency if they are stable but still need close monitoring and still need support with their breathing.

Isolation 

The isolation nursery is for babies admitted from other hospitals, to make sure there is no risk of cross infection to babies already in the unit.

We will take a swab from your baby on admission and when the swabs show no sign of infection, the babies will be transferred to another appropriate nursery.

Special Care

Special Care has eight cots. Babies not needing intensive care or high dependency will be in a special care cot. They may be admitted for only a short time of observation and return to their mums on the post natal ward, or they may be long term babies who are progressing well and preparing for discharge home.

We have a team of specially trained nursery nurses who will help you prepare to go home with your baby.

Admission

All babies will be assessed by the nursing and medical staff when they arrive. We will look at their breathing, heart rate, blood pressure, oxygen level and temperature. There may be some other assessments/investigations, like blood tests, and we will explain them all to you.

Neonatal care in other hospitals

Sometimes, your baby may need to move to another neonatal unit or hospital for specialist care. 

This may be because your baby needs more specialist care, or your baby has improved and can be transferred to a unit nearer your home.

If this is needed, we will involve you and give you all the information you need about the care your baby may require, and information about the unit they are moving to.

This transfer will usually be carried out by a specialist neonatal transport team who will go with your baby in the ambulance. We aim to keep all babies within our south east coast network where possible.

Get in touch

The Neonatal Unit is an 18 cot unit divided into four nurseries catering for babies who need intensive care, high dependency or special care.

It is in the green zone, level 2 in Women’s and Children’s at Tunbridge Wells Hospital.

  • Matron: Lou Mair
  • Ward manager: Charlotte Taylor
  • Telephone number: 01892 633359

Our team

Nurses

We will allocate a trained neonatal nurse to your baby for every shift and they will introduce themselves. Their name will be written on the whiteboard outside the special care nursery. The neonatal nurses are supported by nursery nurses who may also be allocated to care for your baby, but who work under the guidance of a trained nurse.

The unit also has two advanced clinical practitioners (ACP) who work alongside the doctors in our unit.

We also support and clinically supervise student midwives and child branch student nurses during their training.

Consultants

We have seven consultants and one of them is allocated to the ward on a weekly basis.

Doctors

There is a paediatric registrar and resident doctor allocated to the ward every day.

You and your baby

It is quite normal to feel anxious, nervous and afraid to touch your baby but we will help you touch and hold your baby safely.

You can quietly talk to them, hold their foot or hand, or just place your hand on them. When your baby’s condition allows, you will be able to have cuddles using skin-to-skin contact, also known as  kangaroo care.

When you feel confident you can begin to take part in the daily care of your baby, changing their nappy and giving them a top and tail wash. When your baby can regulate their temperature you will, with support, be able to bath your baby.

Please personalise your baby’s space with pictures or photographs, nappies, cotton wool, baby clothes, blankets and a soft toy. Essential baby items, such as nappies and cotton wool, are available to purchase from the pharmacy.

Feeding your baby 

The benefits of breastfeeding for mother and baby are well-documented and our breastfeeding policy is in line with the UNICEF  Baby Friendly Initiative and our aim is to give you the information and support you need to breastfeed successfully.

Colostrum is the name given to milk produced in the early days of lactation which contains nutrients and protective factors. Babies receive protection against infection from their very first feed of colostrum.

Any baby born too early or ill faces special challenges, so it is important to breastfeed or to feed with expressed breast milk. Babies who are premature or ill are more prone to infection so they need the protective properties of breast milk.

Preterm breast milk contains more immunoglobulins which coat and protects the gut wall. Breast milk is better absorbed and digested than infant formula and this is important for a preterm baby whose gut is immature.

Mothers of tiny or ill babies often comment how helpless they feel in those early days but providing breast milk means you are choosing to give your baby a unique and ultimate nutrition.

When your baby is admitted to the unit it is not always possible to breastfeed initially. This might be because your baby is too premature to suck and swallow, or your baby is unwell and can't tolerate feeding.

This doesn't mean you can't feed eventually, and we will support you with expressing colostrum and breast milk until feeding can be established. If you do not plan to breastfeed, but would like to express breast milk during your baby’s stay, we will support you.

Expressing room

Our expressing room has pumps, sterilisation tanks and equipment. You are also welcome to express next to the cot, which can help with your milk supply. It is also important to express at home, and you should aim to express every 3 to 4 hours (8 times a day). This enhances milk supply in the long term, especially if your baby is very premature and you could be expressing for several months.

Milk kitchen

This is a designated area for the preparation and storage of milk. Expressed milk should be expressed into a sterile bottle, the bottle should be labelled with the baby’s name, the date and time expressed. The milk can be put into the fridge or the freezer depending on your baby’s requirements. Refrigerated milk lasts 48 hours, and milk can be kept in the freezer for three months. Defrosted milk should be used within 24 hours.

Tube feeding

Many babies are too premature or unwell to breast or bottle feed but can tolerate milk feeds. A small tube will be passed via the nose or the mouth into the stomach and secured by tape on their face.

Tube feeding begins slowly and is tailored to the baby. The milk is measured carefully and given via a syringe, either hourly or every 2, 3 or 4 hours. Feeding is reviewed daily depending on your baby's weight and how they are tolerating the amount of milk.

Breast feeding

We support your choice to breast feed. It is not always possible to totally breastfeed initially, but there are many ways to initiate it. Regular (every 3 to 4 hours) expressing milk, kangaroo care, and placing your baby at your breast even if they are not sucking will help stimulate your milk supply.

As your baby matures or recovers they will become more interested in sucking, and we will help you with this. There will come a time when your baby starts to demand breastfeeding and we will discuss you coming in more frequently and perhaps staying the night. Until that time, get plenty of rest and eat well to keep an optimal milk supply.

Bottle feeding

If you plan to bottle feed, this can start when your baby is mature or well enough to start sucking. Premature babies start to co-ordinate their sucking, swallowing and breathing at around 34 weeks.

We have  smaller teats for premature babies, and when your baby starts bottle feeding it may only be for one feed in 24 hours and only a few drops of milk. We will guide you through bottle feeding your baby, with tips on positioning and how to recognise when your baby is tired or needs winding.

Intravenous infusions

All babies need a certain amount of fluid each day, along with salts, sugar and vitamins. Many of the babies in the unit are too premature or unwell initially to breast, bottle or tube feed and may need to be fed intravenously. This is done using a fine plastic tube (cannula) into a vein – usually the hand or foot. A special infusion pump controls the amount of fluid given.

Visiting

Cots in the unit

When your baby arrives, we will assess your their needs, which includes which type of cot your baby would be best nursed in.

Incubators keep your baby warm and let us have a full view of your baby. Incubators have temperature and humidity settings, which can be adjusted to meet your baby's needs. Access to the incubators is via portholes on the side, stopping the incubator temperature from varying and stops your baby getting cold. You are encouraged to touch and attend to your baby needs through these, and talk to your baby. Some premature babies may be in an incubator for a number of weeks, and we will help you get used to nursing your baby in a closed incubator.

Babytherms are large cots used when your baby is too big for an incubator but needs more room for observation than a traditional cot. The babytherms have an overhead heater and a heated mattress to keep your baby warm.

Traditional baby cots are similar to those in the maternity unit. Some babies will be nursed in cots from admission, others will progress into a cot when they are ready. This is an exciting step for many parents who have nursed their babies in incubators for weeks or months. Sometimes when your baby moves from incubator to cot they need a hot mattress to help maintain their temperature. This mattress can be adjusted to your baby’s needs.

Hygiene

Premature and sick babies are especially vulnerable to infections, and we plan our care to minimise this risk. It is essential all staff, parents and visitors follow important measures to prevent infections.

Hand hygiene is one of the most important measures you can take to prevent infection. 

Everyone entering the Unit is asked to wash their hands thoroughly and remove outdoor clothing. On all cots there is an alcohol hand rub to be used before after handling babies. There are cleaning wipes on the walls to wipe down the cot space, for example following a nappy change.

All babies have their own personal items in the cot, such as cotton wool, scissors, tape and changing bowls to minimise cross infection.

If you or your family feel unwell, have a cold, sore throat, flu, tummy bug or any other bugs/viruses, please ask us whether it is appropriate to visit safely.

Ward rounds

The paediatric consultants change on a weekly basis. The on-call consultant will come to the unit each day at about 9am to discuss and review your baby’s care and treatment. 

All parents are welcome to attend ward rounds (except the Monday morning ward round which is a teaching round), for information on their baby’s care. We will ask you to leave the room while other babies are being discussed to preserve their privacy and maintain confidentiality.

You are welcome to make an appointment to speak to the consultant, we will arrange this for you if you ask the nurse caring for your baby.

You may also be asked to leave the room during nursing handovers to respect the privacy of other babies and families. After the handover we will be able to discuss any aspects of your baby’s care with you.

You will also meet other staff involved with the Unit including ward clerks, cleaners, ophthalmologists (specialist eye doctors), radiographers, pharmacists, dietitians, audiologists, speech and language therapists, midwives health visitors, GP, safeguarding team, social workers, obstetricians and paediatric physiotherapists.

Tests and treatments

Your baby may need routine tests or procedures during his/her time on the Unit and we will not specifically ask for your permission to do these. We are happy for you to ask questions and will discuss the results of any tests with you.

Consent

Some procedures, treatments and research programmes may need your permission, either verbally after discussion with a doctor or using a written consent form. (surgery, hearing screening, PKU blood test , immunisations).

Communication and confidentiality

Your baby’s medical and nursing notes are legal documents and remain the property of the trust. Information about your baby’s condition will only be shared with parents and other relevant health professionals, such as your baby’s GP or health visitor.

Monitoring

After the initial assessment, we will continue to monitor your baby.

The monitors are at the cot space and look like a computer screen. The monitors will make an alarm sound if there is something we need to know about. 

The alarms can be frightening but we always respond to the alarms, but often the alarms sound if the baby wriggles or if one of the probes is dislodged. Monitors help us check on your baby's wellbeing and we will also watch your baby closely for any changes in their colour and condition.

Heart rate and breathing are monitored by placing three soft, sticky electrodes to your baby’s chest and abdomen.

Blood pressure can be monitored using a non-invasive method with a small cuff around the arm or leg (similar to how most adults have their blood pressure taken).

Sometimes babies need more continuous blood pressure monitoring by connecting a blood pressure device to an arterial line inserted by doctors. The line is also helpful because bloods can be taken from it without disturbing your baby.

We'll check your baby's oxygen levels using a small probe, usually on the hands or feet. Theis helps tell whether your baby needs more oxygen or respiratory support.

We also monitor their temperature using probe under the arm. If your baby needs continuous temperature monitoring we'll put a probe on the skin with a small sticky patch to hold it in place.

Help with your baby's breathing

Many babies in the unit need some help with their breathing because of prematurity, infection or birth problems.

This could be for just a few hours or for a number of weeks or months.

There are four ways we help babies with breathing, and we decide how to give this support using clinical observation, x-rays and blood gas analysis.

Ventilators are machines which do the work of breathing for your baby. The doctors put a small tube (an endotracheal tube) in the mouth down into your baby’s wind pipe. This is secured with a ties and a bonnet. The machine rate and air/oxygen level will be set to your baby’s requirements by doctors and monitored closely.

Nasal prong CPAP (continuous positive airway pressure) helps your baby because the effort of breathing for some, especially premature babies, is tiring. CPAP delivers a constant small pressure which helps keep the lungs expanded. Oxygen is delivered through nasal prongs, which are placed in your baby’s nose and secured by ties and a bonnet.

Vapotherm (high flow therapy) is often used when your baby has weaned off ventilation or CPAP. The machine delivers air/oxygen through a cannula in your baby’s nose which is less bulky than CPAP. This makes handling your baby easier, and it’s also more comfortable for your baby. The pressure is gradually weaned down, which can be days or weeks/months depending on your baby.

Nasal prong oxygen is used when your baby does not need pressure support for breathing but does need oxygen. The oxygen is delivered through a cannula in your baby’s nose.

Going home

As your baby’s condition improves, we will start to prepare you and your family to go home.

The Unit has three parent rooms with en-suite facilities and you will be able to stay in the same room as your baby overnight (we call this 'rooming in') and totally care for your baby.

This will give you the opportunity to become familiar with your baby’s behaviour and feeding routine with help at hand if needed.

Before discharge you will also be taught basic resuscitation skills, and given information about ongoing medical needs, medication and outpatient appointments.

You will need to register your baby’s birth.

Your baby must also be registered with your local GP as soon as possible after birth. Your GP and health visitor will be told of your baby’s discharge home.

Please make sure your car is fitted with a car seat before discharge from hospital.

Bliss also have some helpful advice about going home on their website.

The personal child health record is given to parents after the birth of their baby. The book helps you and health professionals keep a record of your child’s growth and development and preventative health care.