Neonatal Service

The Canterbury Neonatal Service provides a holistic family/whānau​ oriented model of care. We view the baby/pēpi as being the focus for our planning of care and for this reason, we have incorporated a Developmentally Supportive Care Neonatal Service for all our babies/pēpi​.

The Neonatal Service provides 24-hour care for newborn babies with a variety of special needs. This includes prematurity, surgery, congenital abnormalities and babies who may have been compromised at birth.
Care is provided by a skilled and experienced multi-disciplinary team utilising current evidence based practice.

Neonatal Intensive Care Unit Video

Neonatal Unit Walkthrough from Canterbury District Health Board on Vimeo.

The Canterbury Neonatal Service provides special and intensive care for all babies born in the wider Canterbury region. This region extends to Timaru in the South, Greymouth in the West and Kaikoura in the North (approximately 20000 square kilometres).           

In addition all newborn babies requiring surgery in the South Island, which is approximately 50,000 square kilometres (excluding the Nelson region), will be cared for within this service. If a baby requires cardiac surgery then once stabilised, the baby will be transferred to New Zealand’s/Aotearoa’s only Paediatric Cardiac Surgery Unit, which is in Auckland.

In view of the large geographical area that this service is responsible for, a highly skilled Neonatal retrieval team is available 24 hours to transport babies to and from our tertiary referral centre in Christchurch/Ōtautahi. However when emergencies occur in a home setting the ambulance is called first. In 2009, approximately 100 transports by helicopter, fixed wing aircraft, or ambulance.

The Neonatal Service currently provides 10 intensive care cots and 28 Level 2 cots, a total of 38. In 2010, 830 newborn babies/pēpi were admitted to the Neonatal Service. The gestational age varied from less than 26 weeks to 42 weeks. The smallest baby admitted weighed less than 500g.​

BF.JPGWe recognise that breastfeeding is an integral part of the care that our babies/pēpi receive and this is both facilitated and encouraged in accordance with the World Health Organisation (WHO) and United Nations International Children’s Emergency Fund (UNICEF) joint statement in 1989. This is supported by the BFHI.

The Service has a strong Nursing and Medical research philosophy. At any time there are numerous consented studies or reviews in progress.  To facilitate this process there are Neonatal Research Nurses employed to assist in the management of some of the Neon​atal studies. More information on current studies in progress is provided here.

The care that we provide, is guided by the Code of Health and Disability Services Consumer’s Rights and The Treaty of Waitangi/ Te Tiriti o​​ Waitangi.  Please see our Service ​Philosophy.

The Canterbury Neonatal Service prides itself on its multi-disciplinary approach and teamwork when caring for the babies/pēpi​ and family/whānau​ of Canterbury/Waitaha. We are constantly sustaining and improving the type of care that we provide for our community/takiwhā​​​. Central to this is our reflective practice and our desire to base as much of our model of care as possible, on current evidence based practice.

Our philosophy as health care providers is to

Consistently provide, as a team, quality holistic care with respect for family/whānau, encompassing the concepts of Te Whare Tapa Whā (The four cornerstones of health), Te Taha Wairua (Spiritual), Te Taha Tinana (Physical), Te Taha Whānau (Family), Te Taha Hinengaro (Emotional and psychological) in accordance with Te Tiriti o Waitangi (The Treaty of Waitangi) and the Code of Health and Disability Services Consumers Rights (1994).

Create and maintain an environment, conducive to the provision of developmentally supportive care, which will maximise the baby’s/pēpi’s outcome and potential for a dignified and independent life.
Promote and foster healthy interpersonal relationships, between nga mātua/parents, extended family/whānau and baby/pēpi.

Ensure the multi-disciplinary team advocates for the baby/pēpi and their family/whānau in all aspects of care including complaints.

Encourage open and effective communication between all staff and family/whānau in a supportive caring environment, providing interpretation when required, without discrimination.

Ensure appropriate preparation for discharge and ongoing needs. These needs will be established in consultation with the family/whānau and multi-disciplinary team members.
Recognise the necessity, of maintaining high levels of care and skill within the Neonatal Service, based on evidence based practice, current teaching and research.​

Neonatal Services, Christchurch Women’s Hospital

ACNM: Associate Clinical Nurse Manager

Provides clinical coordination and professional leadership, support, guidance and coaching to nursing staff of the neonatal service on a shift by shift basis ensuring the provision of safe, effective quality care.

Clinical Director

Provides leadership for the service in conjunction with the Nurse Manager. The CD is responsible for co-ordinating the team providing the medical management of the babies in our service, and represents the service nationally and internationally.

Clinical Nurse Specialist (Advanced Neonatal Practice) CNS (ANP)

Clinical Nurse specialist (advanced neonatal practice); CNS(ANP) are senior nurses who have many years experience and have done speciality training to work on the medical team. They rotate around different areas of the Neonatal service with the registrars covering different areas of neonatal, postnatal, delivery suite and retrievals. They are responsible for the day to day medical management of your infants and will discuss any concerns with the Neonatal consultant on duty.

Dietitian

The Neonatal Dietitian is here to make sure your baby receives the best nutrition and she will be monitoring the growth and nutritional intake of your baby. She is on the morning ward rounds to look at growth charts, to discuss and implement feeding changes. If you have questions regarding what nutrition your baby is receiving or your babies growth then ask your nurse to contact her and she can come and discuss this with you. She is also able to provide advice for breastfeeding mothers on their own nutrition as this can be an issue for many busy parents. She is available Monday to Friday.

Discharge facilitator

The role of the discharge facilitator is to assist in the preparation of families transitioning to home. In particular, families who are discharging with ongoing medical needs such as home oxygen and tube feeding. Discharge facilitators are part of a multi-disciplinary team caring for the family and liaise closely with the Neonatal Outreach Nurses. Contact details are 364 ​​4244 or pager numbers 5291 / 5487.

Enrolled Nurse

Provides quality nursing care, support and education to babies and their parents within the special care/level 2 environment of the Neonatal Service.

Hearing Screening Team

Hearing screening is offered to all babies admitted to NICU as part of the national Universal Newborn Hearing Screening and Early Intervention Programme. At some point during a baby’s NICU journey, parents/caregivers are given written information about the programme. We have a team of four NICU nurses who complete screening of the babies admitted to NICU. As a baby nears discharge home (usually after 36 weeks), parents/caregivers will be approached by one of the nurses on the hearing screening team to see if they would be interested in having their baby screened. This is a good opportunity for parents/caregivers to ask any questions they may have about the screening. Hearing screening is a simple process, and parents/caregivers are given the results from the screen straight away.

Hospital Aide

To facilitate appropriate cleaning and setting up of equipment to support the Clinical Team in the care of the neonate and to ensure adequate stock levels are maintained.
Infection Control and Prevention Nurse Specialist
The Clinical Nurse Specialist in Infection Prevention and Control (IP&C) is an information/advisory resource who has specialist education in this field of nursing. This specialist nurse can provide education and support in relation to any IP&C issues both to parents and staff in neonatal unit e.g. infectious disease and how we control these in the unit. In addition, there are printed resources available which may also be useful for parents.

Karitane Nurse

Provides a strong parent craft model of nursing care to babies and their parents within the special care/level 2 environment, this includes consistent and current advice on areas such as lactation and discharge preparation.

Māori Health Worker

Kia ora koutou. Ko Kathy Simmons toku ingoa, ko Ngati Kahungunu ki Wairoa toku Iwi. Kaiawhina Whaea me nga Pēpi. I am part of the multidisciplinary team and my role is to tautoko (support) and awhi (help) parents on their journey in NICU and provide a culturally safe environment.

Medical Technicians

Clinical Engineering takes care of the medical equipment and systems. This includes advice on the purchase, operation and the maintenance of medical equipment. The development of medical equipment systems to meet the clinical requirements is also included.

Milk Room Aide

To facilitate the appropriate making of milk feeds and milk additives for infants within the Neonatal Services.

Neonatal Nurse Manager

The nurse manager coordinates nursing and the support team across neonatal inpatient and outreach services, facilitating and promoting excellence in patient care.

Neonatal Outreach Nurses

A team of neonatal nurses who follow up a selection of babies from the neonatal unit after discharge to provide support and advice.

Paediatricians

Consultant Neonatal Paediatricians: the paediatricians are responsible for the overall medical management of your baby. We have six neonatal consultants who rotate through service in the neonatal unit. You will see a lot more of the consultant who is “on service” for that week. If you would like to speak to your consultant please indicate to your nurse or the ACNM on duty. They will also follow your baby up after discharge if indicated.

Pharmacist

A Clinical Pharmacist visits the Neonatal Unit each morning (Monday – Friday). The visit will usually include attending the ward round and providing medication dosing advice to the medical team and to any parents who may have medication related queries about their infant’s care. As part of the ward visit the pharmacist will also check medication charts to ensure that all prescriptions have been written correctly and that the medicines can be given in a safe and timely manner.

Nearer to the time of discharge home, if your infant will need medicines to be continued at home, the pharmacist will help to ensure that this can happen as easily as possible. In some cases there may be discharge medicines that need to be dispensed from the hospital pharmacy, rather than your local community pharmacy after discharge and the Neonatal Clinical Pharmacist and Discharge Facilitator will be able to advise you if this is the case. During your infant’s stay in the NICU please do ask the pharmacist if you have any questions about medication that you think they may be able to help with.

Physiotherapist

Physiotherapists assess infants for their development, head shape, range of movement and muscle strength, meet with parents for specific handling and positioning sessions and discuss developmental play ideas and liaises with the community therapists if infants have ongoing needs. Physiotherapists also run a developmental playgroup for preterm infants to ensure achievement of developmental milestones in the first year of life.

Radiologists

We are a team of five Radiologists (located at Christchurch Women’s Hospital and Christchurch Public Hospital) who specialises in Neonatal and Obstetric Radiology. We assess and diagnose neonatal abnormalities on several different forms of imaging. This most commonly includes neonatal Xrays and ultrasound but may also include CT, MRI and Xray fluoroscopy. We use a state of the art system called PACS which displays the images electronically and allows rapid communication of the results with the Neonatologists. We also present the cases for discussion at a weekly multidisciplinary Xray meeting with the Paediatric surgeons and Neonatologists.

Registrars

Neonatal registrar: registrars are paediatricians in training (with several years practice as doctors already). They rotate around different areas of the Neonatal service with the CNS (ANP) covering different areas of neonatal, postnatal, delivery suite and retrievals. They are responsible for the day to day medical management of your infants and will discuss any concerns with the Neonatal consultant on duty.

Registered Nurse

Provides a high level of clinical nursing care for neonates within the neonatal service and their families.

Safety and Quality Unit

The Women’s and Children’s Safety and Quality Unit (SQU) is responsible for overseeing the quality and safety of the services we offer and providing guidance, tools and advice to clinical/operational staff and managers. We are continuously monitoring the quality of care users of our services receive and looking for ways that collectively we can improve this.

Social Work Team

There are three Social Workers in NICU, Nicci, Fleur and Mary-Anne providing 80 hours of support each week. We assist with practical and emotional issues that may arise. Our goal is to work alongside families to help reduce stress in order that parents can attach and experience the most positive start possible with their baby/babies. We can refer onto agencies when support is required following discharge.

NICU Social Worker work with families providing emotional and practical support. We understand the complexity of the issues in the NICU. Our role is to walk beside families through the NICU journey to help reduce stress in the unit and at home.

Speech Language Therapy

There is a Speech Language Therapy service available to all babies admitted to the NICU. We offer a Monday to Friday service, and there are currently three therapists on the unit. Speech Language Therapists assess your baby’s sucking and feeding skills, and will create individual feeding plans to help with his or her sucking and feeding. For those babies that are bottle fed, we may recommend specialist teats.

We also work in conjunction with the infant feeding specialist, the physiotherapist and the medical team to give advice around feeding positions and routines. We usually see babies born early, those with syndromes, cleft palate or any baby having difficulty feeding. Babies can have feeding difficulties for a variety of reasons, so our involvement may be for a short or long time. For those babies that are on the NICU for a long time, we also give advice about early communication development. Outpatient follow-up is also available once your baby has gone home.

​The Christchurch Women’s Neonatal Transport Team covers retrievals of newborn, premature and/or sick babies from Kaikoura to the West Coast and down to Timaru, as not all hospitals have the resources to care for preterm or sick babies. The team also covers the retrieval of babies requiring surgical intervention from Nelson to Invercargill and take them to Christchurch Women’s Hospital, which is the only hospital that provides surgical services to neonates in the South Island.

​​​​​The transport team may also collect preterm or sick babies from other hospitals around New Zealand if the retrieval team from the referring hospital is unable to do the transport. The transport team will also transfer babies back to their home hospitals once they are well enough and are almost ready for discharge home.

The goal of the Neonatal Emergency Transport Team is to provide the same quality of specialised care to newborn, premature and/or sick babies as they would receive within the Neonatal Intensive Care Unit environment to reduce morbidity and mortality. The team is on call 24 hours a day, 7 days a week.
The transport team consists of a dedicated team of specially trained Registered Nurses/Midwives, Clinical Nurse Specialist/Advanced Nurse Practitioner and a Neonatal Registrar.
The babies are transported by Road Ambulance (St John) or by Fixed Wing Aircraft (New Zealand Flying Doctors) or Helicopter (Garden City Helicopter).

The Neonatal Transport Team does between 60-80 emergency retrievals a year and 40 transfers of babies back to their home hospital. About half of the transports are by ambulance and half by fixed wing and only a few by helicopter.

The Neonatal Service provides a multidisciplinary team approach to breastfeeding and infant feeding.

Infant Feeding Specialist (Clinical Nurse Specialist)

The Clinical Nurse Specialist supports staff and families in breastfeeding education and clinical matters. To contact: Pager 8363.

Associate Clinical Nurse Manager – Breastfeeding Initiative

Monitors Breastfeeding Initiative standards around the 10 steps to successful breastfeeding, the non-breastfeeding mother, the International Code of Marketing and subsequent resolution, and the Treaty of Waitangi.

Feeding Team

Clinical expertise in breastfeeding and supports colleagues in clinical breast feeding skills
Neurodevelopmental Physiotherapist

Assesses complex babies for neurodevelopmental issues related to feeding, sucking amd swallowing.

Speech Language Therapist

Assesses the suck and swallow of complex babies and implements a programme with staff and parents involved.

Discharge Planner

A nurse who works with complex babies and plays an important role in setting up specifically targeted programmes and recourses for discharge into the community e.g. teaching home feeding via pump.

Information on Breastfeeding

  • Ministry of health/breastfeeding
  • Information for the professional and parents
  • NICE Guidelines. Quality standards for a donor breastmilk bank.
    guidance.nice.org.uk
  • King Edward Memorial Hospital: PREM Bank. This Donor Milk Service is based in Perth, Australia, and provides insight into a functioning donor breastmilk bank.
    canterbury breastfeeding network – local & international breastfeeding news, information and research

Baby Friendly Hospital Initiative

The Neonatal Service supports the Baby Friendly Initiative and recognises the 10 Steps to Successful Breastfeeding . For information about the Ten Steps and the Baby Friendly Hospital Initiative see .babyfriendly.org.nz

The following outlines your Baby Friendly Hospital education requirements:

  • Medical Staff – 2 hours’ education over the last 2 years
  • Nursing Staff – 21 hours – comprising 17 hrs of education + 1 hr Breast Feeding for Māori
  • Women over a 5 year period and 3 hrs Clinical Breastfeeding education over the last 2 years.
  • Ancillary Staff – 3 hrs education over 3 years
  • All new staff need to have initial education within 6 months of starting.​

Level 3 (Intensive Care)

Our Level 3 or intensive care area provides care for babies/pēpi ​who need help with breathing (ventilator or CPAP) or who have complex needs including needing surgery. In addition, any baby that requires intensive observation will be cared for within this environment.

The service utilises Continuous Positive Airway Pressure (CPAP) and various forms of ventilation (High Frequency and Nitric Oxide, Volume and SIMV-Synchronised Intermittent Mandatory Ventilation) in supporting babies who are experiencing breathing difficulties or who require support post surgery.

Utilising the extended multi-disciplinary team, these babies are cared for in a physical environment that enables us to closely monitor all of their activity. Extremely sick or unwell babies are usually cared for by one Nurse who is able to solely focus on the baby’s/pēpi’s and family’s/whānau​’s needs.
Within our entire neonatal environment the parents are a valued member of the team. Staff will assist in any way possible to minimise separation and encourage contact. This often involves changing nappies, taking temperatures and kangaroo care. The parents’ role is highly valued.

Level 2 (Special Care)

The Level 2 or special care area provides support and care for babies/pēpi​ who are able to breath for themselves but may still have special needs that require input from our multi-disciplinary team. These babies may require oxygen therapy, intravenous therapy, antibiotics, who are of a low birth weight, or are unable to keep warm or feed well.
This area doesn’t appear as “High Tech” as intensive care and encourages the family/whānau to participate more freely in the care of their baby/pēpi. In this situation, one Nurse will care for up to five babies.

Babies often progress into room 6 where their care is focused more on the “well” baby who perhaps still remains a little small and who is beginning to establish oral feeding. The physical surroundings of this nursery, allows and encourages families/whānau​ to achieve a high level of participation in the care of their baby/pēpi. Nurses in this level impart Parentcraft skills that will be of enormous value when the babies are discharged into their home environment.

Parent rooms are available when the baby/pēpi​​ ​ is close to discharge. We aim for all parents to room in with their baby/pēpi​​ for at least one night prior to discharge to enable parents to feel more confident on discharge. Meals are provided for parents living in.

Page last updated: 12 December 2018

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