NMH

NMH | 2024 42 Neonatology fetal anomalies. Our care of a baby does not end when the baby is discharged from the hospital as many of our babies return to clinic for follow-up or are referred for assessment by their GP or Public Health Nurse. Last year, in 2024, we admitted 1,240 babies to the NICU. On average, 1 in every 6 babies delivered in this hospital is admitted to us even if only for a brief period of time. Many first- time parents are surprised to hear how high that figure is and are often not prepared for the fact that they may be separated from their baby for several hours. For the past number of years, we have made every effort to keep our admission rates for term infants (those infants born ≥37 weeks' gestation) as low as possible. We do this by auditing the reasons why babies are admitted and by looking at alternative ways to provide care that minimise the chances of mothers and babies being separated. In 2020, we introduced changes to how hypoglycaemia (low blood glucose) was managed in the newborn period. By doing so, our staff, supported by our nursing and midwifery colleagues on the postnatal wards, reduced the admissions for hypoglycaemia from 306 babies in 2019, 189 babies in 2020, 109 babies in 2021, 81 babies in 2022, 70 babies in 2023, and 43 babies in 2024. We will continue to make incremental changes year on year guided by feedback received from families who have used our services. A core value in our Department is the concept of family-centred care, not just for those babies who spend long periods of time in our NICU, but also for those babies who may only be with us for a few days. As the clinicians caring for babies, we believe our role is to support families to provide as much of the direct care that their babies need as possible. Family Integrated Care (FICare) is a model of care developed initially in North America which aims to involve families in an integral way in the care of their babies while in NICU. FICare integrates families as partners in the NICU care team, and provides a structure that supports the implementation of family-centred care. In 2023, we introduced further FICare initiatives. We began by instituting a number of changes in the NICU to align more closely with a FICare model. For example, we have rolled out regular FICare group meetings for parents (mother's group, father's group and joint group sessions) to encourage mutual parental emotional and psychological support and to give parents a forum to feedback to us on where we could improve our NICU service. This initiative has been predominantly led by NMH neonatal nursing staff and I would like to thank all those involved in making these meetings a success. We are also working on FICare cot cards for parents and nurses to fill in with the aim of increasing parental involvement in the day-to-day activities of their NICU baby. Also, during the ward rounds, parents are now encouraged to be at their baby's cotside to contribute to the ward round discussion and parents at a neighbouring cotside are offered noise cancelling headphones to promote confidentiality between patients. Ideally, mothers (and partners) should be accommodated in beds beside their sick babies. Obviously, the infrastructural constraints of our hospital in its current location are the main reason why this cannot be achieved. This hospital was not built with modern neonatal intensive care in mind. This is another reason why this Department, along with the rest of the hospital, is fully supportive of our co-location to the St Vincent's University Hospital campus. In a newly-built modern hospital, one that is specifically designed with mothers and babies in mind, mothers and partners will be able to room-in with their babies day and night. Our NICU is one of four designated tertiary care NICUs in this country that provides specialised care to the most premature of infants, many of whom are referred to us while still in-utero (i.e. when the mother is still pregnant) from locations all around the country. Last year, in 2024, we looked after 113 Very Low Birth Weight Infants (babies born ≤29 weeks and/or ≤1500g). These infants are extremely vulnerable and often spend several weeks in hospital frequently not being discharged home before their due date. There have been major advances in neonatal intensive care medicine over the past 50 years and survival across all gestational ages is increasing. We now have reported survivors of infants born at 23 weeks' gestation. In our hospital, where healthy babies are born at a rate of about one every hour, it can be hard to fathom that just a few feet away, in our NICU on the first floor, a tiny baby weighing less than 1lb may be attached to a life-support machine, receiving high level intensive care. The probability of a baby surviving at 23 weeks is still quite low but some of these tiny babies can, and do, survive. Unfortunately, many will face ongoing challenges, particularly as they get older, in terms of their long-term neurodevelopmental outcome. As greater numbers of these tiny fragile babies survive, research has shown us that optimising babies' early neurosensory experiences, and social environment, impacts on their long- term neurodevelopmental outcome. By providing individualised, neuroprotective care to each baby, by gentle containment, minimising stress and pain, safeguarding sleep and optimising nutrition, it has been shown that babies have better long- term physical, cognitive and emotional outcomes. Such developmental care principles underpin all of our care practices in the NICU. Our multidisciplinary team (MDT) which includes Psychology (Marie Slevin), Physiotherapy (Jo Egan and her team), Dietetics (Roberta McCarthy and her team), Speech and Language Therapy (Zelda Greene), Neonatal Occupational Therapy (Aoife Tonge) and Medical Social Work complement the advanced medical and nursing care we provide, advising parents and staff alike on positioning, feeding and social interactions. We continue to benchmark our neonatal

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