The majority of expectant mums enter pregnancy hoping that their baby will be born around the time of its due date, will be well-grown (of average birth weight), healthy, and ready for life outside their mother’s uterus (womb). However, circumstances sometimes mean that all of these expectations get ‘turned on their head’ and the baby arrives early (prematurely) and/or is born smaller than would normally be expected (‘growth restricted’ or ‘small for gestational age’). Should this be the case, your baby is likely to need extra observations to monitor their health and well-being, regular treatments, and additional support with feeding and maintaining their body temperature to keep warm. This doesn’t necessarily mean that your baby will be separated from you to be cared for in a specialist neonatal intensive care unit (NICU), or special care baby unit (SCBU), but where your baby’s care needs mean they need more than routine care, it is likely that you will both be transferred to a smaller transitional care ward/unit, rather than a general postnatal ward.
A transitional care ward enables you and your baby to remain together but with additional support to help you care for your baby and feed them. Whether you choose to breastfeed or not, you will have the support and monitoring from a team of experienced midwives, nursery nurses, advanced neonatal nurse practitioners (ANNP) and paediatricians (baby doctors) 24 hours a day. Compared to larger postnatal wards, transitional care facilities tend to be much smaller in size, usually anything from around five to 15 transitional care cots. These facilities may be located alongside or within a postnatal ward or NICU/SCBU, or may be entirely separate.
Which babies are likely to need transitional care?
Some circumstances can mean that there is an increased likelihood that your baby will require transitional care:
- Babies who are born early (ie, before 37 weeks of pregnancy)
- Babies who are born smaller than would normally be expected (ie, babies weighing less than 2.5kgs)
- Babies whose mums have diabetes
- Babies whose mums are on specific medication that can affect the baby once they’ve been born
- Babies with any condition that affects their ability to maintain their temperature (stay warm) and feed adequately.
What does transitional care involve?
Babies receiving transitional care will need to be monitored regularly. This includes checking your baby’s temperature (under the arm), breathing (ie respiratory rate), heart rate (pulse) and skin colour (eg, good colour, pale, jaundiced etc). All of these observations give an indication of your baby’s health and well-being and are documented in baby’s care records.
Support with feeding
Often, there is a need to make sure that your baby is receiving adequate nutrition; particularly babies that are born early or are small for their gestation, as they tend to feed more slowly and tire quickly. This involves a heel prick to check baby’s blood glucose levels (blood sugar); where this is found to be within the normal range, it usually gives a good indication that your baby is taking sufficient volumes of breast/formula milk. However, where the blood glucose level is low, the doctor will discuss the options available, which often include increasing the frequency of feeds (ie, little and often). However, where babies become overly tired during feeds, staff may recommend giving your baby tube feeds until breast/bottle feeding can be established. This involves passing a very small, soft plastic tube, through which milk can be given, from the baby’s nose or mouth down into their stomach. This means that your baby receives all the nutrition needed without becoming over tired. This way, your baby can conserve energy, which helps him/her to stay warm and maintain healthy glucose levels. If appropriate, you may be able to express your breast milk which can also be given by tube.
Keeping baby warm
Where your baby is still finding it difficult to maintain his/her body temperature (despite wearing a bonnet and warm clothing), it may be recommended that he/she is placed in a heated cot, or an incubator. The latter is also used where babies become jaundiced and need phototherapy (light treatment). Phototherapy is rather like being under a sun bed but without receiving a sun tan. The ultraviolet (UV) light helps to lower the level of jaundice, but in order to do this effectively, the baby needs to be naked so as much of the skin as possible is exposed to the UV light. Nursing the baby in the incubator at your bedside ensures your baby remains warm and safe, and you will still be able to care for your baby and have any support you might need. For more information on this topic, see our feature on ‘Baby Jaundice’.
Protecting baby from infection
Should the paediatrician feel that your baby is showing signs of infection, or may be susceptible to it, they will recommend giving antibiotics. Antibiotics tend to be given intravenously (into your baby’s bloodstream) because they act more quickly this way. This involves inserting a very tiny plastic tube (cannula) into a vein in your baby’s hand or foot, which is then taped down securely to hold it in place. The antibiotics will be given by the staff on the unit. While the cannula might look a bit worrying, this does not mean you cannot still care for your baby; the staff will be able to show you how to change/dress your baby with the cannula in place. Doctors will always err on the side of caution when dealing with babies and young children, and will suggest starting antibiotics sooner rather than later.
N.B. Newborn babies have very immature immune systems, so carers and visitors must always wash their hands with antibacterial gel before entering transitional care wards/units and before handling the baby. If your baby’s visitors have infections, it is safer to delay visiting your baby until they have recovered/are no longer infected or contagious.
Preparing to go home
Transitional care is often used when preparing a baby to go home, particularly those babies born very prematurely who have had a lengthy stay in the NICU/SCBU. A stay on the transitional care ward enables parents to get to know their baby’s care needs and gain confidence in performing specific procedures (eg, giving medication and learning how to give care over a 24 hour period). It is all about looking after both the baby’s and the family’s needs, and ensuring that all the right support is in place!
To summarise, transitional care:
- Prevents you and your baby from being unnecessarily separated
- Reduces the need to admit your baby to NICU/SCBU
- Ensures your baby receives the closer monitoring/treatment required
- Ensures that you and your baby receive the extra care you need within a safe environment
- Supports the establishment of breastfeeding (where this is your chosen method of infant feeding).