Showing posts with label premature birth. Show all posts
Showing posts with label premature birth. Show all posts

Thursday, June 5, 2014

Liquid food linked to poisoning of babies was sent to 22 hospitals

A total of 18 babies are thought now to have been affected by a contaminated batch of intravenous fluid. One baby at London's Guy's and St Thomas' hospital has died, another 17 have blood poisoning.
Parenteral nutrition is supposed to deliver a variety of nutrients intravenously when a baby is unable to eat on its own.

Liquid food linked to poisoning of babies was sent to 22 hospitals

Wednesday, September 25, 2013

'Sugar gel' helps premature babies

Dangerously low blood sugar affects about one in 10 babies born too early. Untreated, it can cause permanent harm. A dose of sugar given as a gel rubbed into the inside of the cheek is a cheap and effective way to protect premature babies against brain damage, say researchers from New Zealand. Current treatment typically involves extra feeding and repeated blood tests to measure blood sugar levels. But many babies are admitted to intensive care and given intravenous glucose because their blood sugar remains low - a condition doctors call hypoglycaemia. The study assessed whether treatment with dextrose gel was more effective than feeding alone at reversing hypoglycaemia.
'Sugar gel' helps premature babies - BBC 25 September 2013

Thursday, November 22, 2012

Campaign to Delay Cord Clamping

NCT is encouraging and supporting this campaign - we have supported change in this practice now for more than a decade and have been encouraging researchers to carry out research in the area so the evidence to force a change in practice is there ... it's getting there slowly - we need a big push by everyone to get it to happen. Belinda Phipps

I am a practicing Midwife with 24 years experience. Seven years ago, I truly reflected on my practice with regards to the third stage of labour and the wide spread practice of Immediate Cord Clamping after teachers voiced their concern at the increasing numbers of children with medical or learning problems. I also observed the same in friends and family children.


After extensive searching and confirmation of very worrying statistics, I had an epiphany and realised that this common practice implemented 40-50 years ago was an interruption of a fundamental birth process, which deprived the baby of up to 40% of its intended blood volume, with unknown results and for the most part absolutely unnecessary.
 
On approaching managers and doctors, I was told I had an interesting scientific theory which was not evidence based. I pointed out at that time that Immediate Cord Clamping was not evidence based. I was informed that to change practice I would have to produce evidence.


I wrote to the RCM and asked for immediate national clarification on timing of clamping the umbilical cord. At the time there was little evidence but George Morley from the US was convinced that Immediate Cord Clamping was the cause of irreversible brain damage leading to Autistic Spectrum Disorders. From that time, I immediately started offering all my women informed choice with regards to delaying the clamping and cutting of their babies cord. Over the years I have received a good deal of antipathy.

Over the past 7 years, there has been a growing body of evidence to support the delay in clamping and cutting of the umbilical cord. The World Health Organisation, Unicef, ILCOR, International Confederation of Midwives, FIGO and more recently the Royal College of Midwives have all recommended Delay in Cord Clamping as best practice. Timings vary from 1 to 5 minutes. 

 
NICE are intending to review and publish new guidelines but not until November 2014 and there is no guarantee that they will include Delaying Cord Clamping in the new guidelines.


Many hospital doctors are reluctant to change their guidelines until NICE give the go ahead, whereas other hospitals i.e. Darlington, Liverpool and Worcester have taken the lead and changed their guidelines despite NICE recommendations.


Two years is too long to wait when there is ample evidence to indicate that Immediate Cord Clamping is detrimental to babies. I am part of a national team which includes Consultant Paediatricians, Obstetricians and Neonatologists. Together we developed the basics trolley, a small resuscitaire which enables the umbilical cord to remain intact whilst resuscitation occurs. Much of the evidence shows that compromised and premature babies benefit from delayed cord clamping.

As part of a growing global network, I was delighted to be approached by the NCT and I would like to invite you all to join the campaign to lobby the National Institute of Clinical Excellence to change the Current Guidelines which recommend Immediate Cord Clamping (NON evidence based practice, proven to be detrimental to babies and normally performed before baby has breathed) to recommend Delayed Cord Clamping for at least 3-5 minutes, but ideally until the cord stops pulsating.

 
http://www.change.org/petitions/nice-implement-delayed-cord-clamping-immediately?share_id=QmzivsMSYS&utm_campaign=petition_created_email&utm_medium=email&utm_source=guides
 

Amanda Burleigh RGN RM

Thursday, September 20, 2012

Claudia's Birth



by Claire Lloyd

Week 28 of my second pregnancy seemed a good time to take a holiday.  No worries about labour starting, and still small enough that I could enjoy walking and playing with my very active two year old.  We booked a cottage in Yorkshire, planning to stop off at my Mum’s in Lincolnshire on the way back.  We had a great week and were winding down on the night before we had to leave when I realised I couldn’t feel much movement in my womb.  Usually babe kicked like crazy between 8 and 11 in the evening, but that night – nothing.  On the Friday, packing the car and organising my daughter took most of my attention, along with driving to my mum’s.  But that evening I felt the same – no movements.  Now I was getting worried. 

Early on Saturday my husband and I went to A&E at the local district general hospital in North Lincolnshire.  I was taken to be monitored at antenatal assessment, where I could tell by the monitor screen and the midwife’s face that something was not right.  Up to the ward, where more and more people gathered around the bedside – they tried their best to be calm and positive but it was clear they were worried and this situation, for such a small local hospital, was not one they were used to.  Then came the consultant – because it was Easter Saturday, I knew it had to be serious for him to be called.  I was told that the baby had to be delivered as the heart rate trace was dangerously flat, and was given a hefty steroid injection to help boost its little lungs. 

So Claudia Jasmine Lloyd was delivered at 5.20pm by emergency C-section, on 7 April,11 weeks early.  She had bled into my body – a foetal-maternal haemorrhage.  The level of haemoglobin in her blood at birth was 2 (normally I believe 18) and she had lost 2/3 of the blood in her body and her brain and organs may have been starved of blood.  Before the C-section the hospital had contacted the regional neonatal transport team to assist after the birth as the hospital did not have the expertise in neonatal intensive care.  Claudia was to be rushed to the nearest level 3 NICU as soon as she was stabilised – the stabilisation took six hours.  The first time I saw my daughter was at midnight, for five minutes, before she was taken in the ambulance to the other hospital.  Just before then, the ambulance team and the local midwives had asked me and my husband about baptism arrangements if Claudia didn’t make it. 

We were left in shock.  My husband stayed with me for a while on the postnatal ward and then left for my mum’s to get some rest – he wasn’t allowed to stay with me.  I lay awake most of the night, constantly worrying for Claudia and hormones raging to cuddle and feed her, while others’ babies cried around me.  The morning after my op I was presented with a breast pump.  I have to say that expressing milk was the last thing I wanted to do – I tried, failed, cried and slept.

The following day I was transferred to the hospital to be with Claudia, and to continue my recovery.  The first time I saw my precious baby there was in an incubator, on total oxygen.  Her face was completely covered with a mask, hat and wires.  It would be five days before we saw her hair for the first time.  Steve and I were shell-shocked.  








Claudia, 1 day old











The midwives there gave me more realistic advice about hand expressing using a syringe.  I expressed 2ml of milk in total over 8 attempts – but Claudia was not yet on milk feeds, rather on fluid TPN, so the precious colostrum was yet to be given to her. 

Claudia’s day to day condition, amazingly to us, improved quite rapidly.  The breathing support she was on was lowered day by day.  On her tenth day she was out of intensive care status and officially high dependency (still sounds scary but it was a real landmark for us).  She transferred from TPN fluid feeds to my milk – 0.5ml per hour at first but ramped up really quite quickly – and we were soon able to help feed her using a syringe of milk which was administered through a mouth or nose tube.  We also helped with her “cares” – changing her tiny nappy, wiping her mouth and nose.  We weren’t able to pick her up until day three.

We spent as much time by her bedside as possible, while trying to preserve some semblance of normality for our two year old.  For me, this normally meant mornings with Claudia, lunchtime and early afternoon with Beth, and late afternoons/evenings back at the ward, interspersed with eight expressings of milk per day.  When medically appropriate, the hospital encouraged lots of skin to skin contact (kangaroo care – basically slipping baby down our tops) – I spent many a long evening into the small hours with Claudia close to me, as did my husband when childcare permitted.











Kangaroo care with our tiny 3lb baby













The longer term prognosis for Claudia was set out for us.  Due to her haemorrhage, she had been starved of oxygen to the brain.  Ultrasounds had indicated “bright spots” on the brain which could develop into cystic brain damage.  In Claudia’s case this could lead to physical or learning disability, including conditions such as cerebral palsy.  But only time would tell.

The hospital was very keen to have us transferred closer to home, so it was on day 14 when, at three hours notice, we were transferred.  Claudia travelled in the ANTS (Anglian Neonatal Transport Service) ambulance, and Steve, Beth and I followed down the A1 with a car full of holiday packing and two freezer bags of expressed milk.









Beth got a “ride” in the neonatal ambulance!















We got to the hospital on Friday evening and were introduced to Claudia’s new home, cot space 9 in the special care baby unit (SCBU), where she would be for the next six weeks.  It was to be quiet for us in that space – this hospital had a restricted visiting policy in place, which meant that Beth couldn’t visit her little sister at all.  Adult visits were less restricted than in our previous hospital, however, so grandma got to have her first cuddle with Claudia.  Again, we all spent many a day and late night with Claudia, sitting by her cot, giving her kangaroo care, changing, washing, feeding.

I stayed at the hospital in hostel accommodation for five out of the six weeks, as I wanted to be close to Claudia and spend as much time with her as possible, but also because I could not drive after the c-section.  I wanted to see my other daughter Beth every day too; this involved two taxis, a train journey and around £45 a day when my husband or mum couldn’t ferry me around.  The hostel rooms and flats were distinctly ordinary.  Communal spaces like the kitchens were not particularly clean, and cleaning and sterilising breast pump parts was a particular challenge.  One week, the flat had no working toilet as it overflowed into the flat’s corridor. 

Feeding Claudia, as for any premature baby, was to be a challenge.  I expressed my milk for her 6-8 times a day for eight weeks.  Most of her feeds were via naso gastric tube with some trials at breastfeeding from week 32.  The expressing was soul destroying but in the expressing room in the Neonatal Unit, I did at least get to talk with other mums and share experiences.  I made some pretty good friends in that tiny room.  A couple of the mums had babies born at 23 or 24 weeks.  If you thought 29 weeks was scary…just imagine.

I had always wanted to breastfeed and was determined to increase the BFs as soon as I could.  I often had to “top up” her feeds according to what I thought she took but she was soon feeding two or three times a day from me.  However, breast feeds coincided with increased episodes of sleep apnoea (halting breathing with monitors beeping and nurses rushing over to help) so I started to get a bit of a complex about breast feeding which took a while to shake.

We started to see the light at the end of the tunnel at week 36.  Her weight gain improved, having been poor at first, and apnoea incidents became far less common.  We were transferred into the transition ward and after five days, Steve and I ‘roomed in’ with Claudia with arm’s length support from the nurses.







Home time – leaving SCBU, June 2012










We were discharged in early June, and coming home engendered a mixture of delight and fear.  Having had a baby already, we thought we knew what to expect, but every child is unique, and our darling, fragile, prem baby was very different to care for from our first beautiful girl.  It was like learning to care for a newborn all over again.  Claudia liked being held and worn, and would not sleep by herself for a good eight weeks, even in a pram or car seat.  We got through the early days though, with the love and support of friends and family and lots of (non-alcoholic) beer and ice cream.

When at home, we were under the care of the neonatal community team until Claudia’s feeding tube came out.  I expected to be able to increase the breastfeeds and decrease the tubes as Claudia had more energy.  However, as soon as she came home Claudia seemed to ‘forget’ how to feed from me.  This was mortifying – I cried through many an attempted feed before I gave her a bottle of my expressed milk and saw her gulp it down.  We thought at first that we might have to feed her this way permanently but with advice and support we re-established feeding at around three weeks adjusted, and Claudia is now fully breastfed.  Apparently if babies don’t feed well from mums at birth there is a ‘window’ between four and eight weeks where they get the feel for it again.  I would recommend that anyone who has problems feeding their babies at birth tries again at this stage.

Claudia’s journey is really only just beginning.  We won’t know whether she will have any disabilities until later on in her life.  We need to be particularly watchful coming up to her developmental milestones such as walking and crawling.  So far, she has smiled, kicked, batted and held her head up as we might expect, but her MRI scan indicated, as we feared, cysts on her brain which may cause long term problems.  We are being supported medically by our local hospital, but all we can do is care, love, hope and pray from here.







 Claudia August 2012

Related Posts Plugin for WordPress, Blogger...