What is neonatal care?
Neonatal units in hospitals specialise in the care of babies born early, born with a low weight or who are born at full term but have a medical condition that requires specialised treatment.
The babies that often spend the most time on the unit are there because they were born some weeks or months before their due date, and they can often be very small. Full term babies may also require treatment if they have medical or surgical conditions, or if they had a traumatic birth.
There are three different categories of neonatal care within the NHS (NHS and Department of Health, 2009, p. 10):
- Intensive care (IC) is care provided for babies with the most complex problems who require constant supervision and monitoring and, usually, mechanical ventilation. Due to the possibility of acute deterioration, a doctor must always be available. Extremely premature babies all require intensive care and monitoring over the first weeks, but the range of intensive care work extends to babies born at any gestation.
- High dependency care (HDC) involves care for babies who need continuous monitoring, for example those who weigh less than 1,000g (2lbs 3oz), or are receiving help with their breathing via continuous positive airway pressure (CPAP) or intravenous feeding, but who do not fulfil any of the requirements for intensive care.
- Special care (SC) is provided for all other babies who could not reasonably be looked after at home by their mother. Babies receiving special care may need to have their breathing and heart rate monitored, be fed through a tube, supplied with extra oxygen or treated for jaundice; this category also includes babies who are recovering from more specialist treatment before they can be discharged.
Babies may also receive transitional care. This is where the mother stays in hospital to care for her baby with some support from hospital staff.
The following table comes from the 2014 NDAU (Neonatal Data Analysis Unit) report, and shows the total number of days’ of care provided in each category in England, Scotland and Wales (NDAU, 2015, p.13).
*3.2 percent of babies included in the data are not categorised in any of the three levels above.
The different categories of neonatal care are provided at three types of unit (NHS and Department of Health, 2009, p. 10)
- Neonatal intensive care units (NICUs) provide the whole range of neonatal care for their local population, as well as care for babies and their families referred from the neonatal network. Many NICUs in England are co-located with neonatal surgery services and other specialised services.
- Local neonatal units (LNUs) provide neonatal care for their own catchment population, except for the sickest babies. They provide all categories of neonatal care, but they transfer babies who require complex or longer-term intensive care to a NICU, as they are not staffed to provide longer-term intensive care. The majority of babies born over 27 weeks gestation will usually receive their full care, including short periods of intensive care, within their LNU. Some networks have agreed variations on this policy, due to local requirements. Some LNUs provide high dependency care and short periods of intensive care for their network population. LNUs may receive transfers from other neonatal services in the network, if these fall within their agreed work pattern.
- Special care baby units (SCBUs) provide special care for their own local population. Depending on arrangements within their neonatal network, they may also provide some high dependency services. In addition, SCBUs provide a stabilisation facility for babies who need to be transferred to a neonatal intensive care unit (NICU) for intensive or high dependency care, and they also receive transfers from other network units for continuing special care
These neonatal units are organised into neonatal Operational Delivery Networks, which are responsible for co-ordinating the care of babies in their area to ensure that babies receive the care that they need, as close to home as possible.
How many babies are admitted to neonatal care?
Every year, over 90,000 babies are admitted to neonatal care in the UK because they have either been born prematurely, or full term but sick.
England, Scotland and Wales
Below is a table showing the percentage of babies admitted in 2014 in England, Scotland and Wales and what gestation they were born at (NDAU, 2015, p 4).
Twins and multiples have a much higher chance of being born prematurely. According to the report, in 2014 11.5 per cent of babies admitted for neonatal care in England, Scotland and Wales were from a multiple pregnancy (NDAU, 2015, p. 10), despite only 1.6 per cent of all live births in England, Wales and Scotland being multiple births (ONS, 2013, p.1 and ISD, 2013, data table 5).
Data for Northern Ireland is collected separately from England, Scotland and Wales.
According to their public health agency, NICORE, approximately 1,800 babies a year are born needing specialist care and will be admitted to a neonatal unit (NICORE, 2015, p. 4).
NDAU. (2015). NDAU 2014 report. Retrieved from: https://www1.imperial.ac.uk/resources/98E6A2BD-03B3-4D5D-89B8-A7DEC031537D/ndau2014reportv1.2.pdf
NHS, Department of Health. (2009). Toolkit for High Quality Neonatal Services. Retrieved from: https://www.nepho.org.uk/uploads/doc/vid_8769_Toolkit%20for%20high-quality%20Neonatal%20services.pdf
NICORE. (2015). Neonatal care in Northern Ireland, 2012. Retrieved from: http://www.qub.ac.uk/schools/SchoolofNursingandMidwifery/Research/FileStore/Filetoupload,515887,en.pdf
ONS. (2013). Births in England and Wales by Characteristics of Birth 2, 2012. Retrieved from: http://www.ons.gov.uk/ons/dcp171778_338077.pdf
ISD, (2014). Births in Scottish Hospitals: Year ending March 2013. Retrieved from: http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Publications/data-tables.asp