Neonatal care
Neonatal care
Feature
Care Unit ( NICU ) in Swansea , which is a level three neonatal unit providing care for the smallest and sickest babies in South Wales and surrounding areas .
None of the nine neonatal units in Wales currently meet the minimum recommended neonatal AHP staffing ( BAPM 2021 ). However , several key projects looking at the neonatal workforce have been commissioned by the Welsh Government in the past year and work is underway to try and address this ( Maternity and Neonatal Safety Support Programme 2023 ; Neonatal Services ( Intensive Care , High Dependency and Special Care ) Service specification 2023 ).
Alongside the other Welsh neonatal occupational therapists and a parent who had received neonatal occupational therapy when her own child was on the NICU in Singleton , I was invited to the Senedd in May 2023 , to meet with Welsh Government to discuss why neonatal occupational therapy is such a valuable resource .
Singleton NICU has 26 cots , so I must carefully prioritise which babies and families will benefit most from occupational therapy intervention . Family Integrated Care ( Fi Care ) is an evidencebased model that places parents at the heart of their baby ’ s care .
The charity Bliss states this is a model of care that promotes a culture of partnership between parents and staff , enabling and empowering parents to be the primary carer of their own baby .
Singleton NICU was one of the first five neonatal units in the UK , along with Glasgow , Leeds , London and Birmingham , to adopt this model of care and I have played a lead role in the implementation of Fi Care within Singleton .
One of the key aims of Fi Care is to reduce parent-infant separation . Unfortunately , this is unavoidable for some babies . During the pandemic in 2020 , one such case arose when a mother had to have her baby delivered early (‘ Baby T ’), due to a severe COVID-19 infection , resulting in the mother being admitted herself to intensive care for several weeks .
There is a wealth of evidence demonstrating the importance of positive touch and skin to skin care , sometimes referred to as kangaroo care , for babies being cared for in neonatal units ( Charpak et al 2017 ).
Parental separation results in a lack of opportunity for these crucial positive touch experiences for the baby . American neonatal units have for some time used volunteer ‘ cuddlers ’, especially for babies experiencing neonatal abstinence syndrome ( NAS ), where
Above : Adele with the baby in the neonatal unit
mothers may have reduced or no contact with their babies ( Hignell et al 2019 ).
Singleton NICU is situated in the same building as Hafan Y Mor Children ’ s Therapy Centre , where they have a team of children ’ s occupational therapists and technical instructors . Adele Childs is a highly experienced OT technical instructor with over 28 years ’ experience , 21 of which spent working with children .
Adele had experience in working with babies and had shown a great interest in my neonatal role and on her own initiative carried out some reading around neonatal occupational therapy practice .
When the case arose of ‘ Baby T ’, permission was sought from the neonatal matron for Adele to spend time on the neonatal unit , under my supervision , to provide ‘ hand hugs ’ or cuddles for this baby .
This intervention had a hugely positive impact on the baby ; lower heart rate and higher oxygen saturations were both recorded . Feedback from the neonatal nursing team observing the baby indicated that he was more settled whenever he had these positive touch experiences .
I was already aware that there were frequent admissions to the neonatal unit of babies with NAS . These babies demonstrate significant dysregulation , with excessive crying , and demand a great deal of nursing staff time .
Following extensive discussion with the unit matron and children ’ s occupational therapy lead , a plan was made for Adele to provide regular sessions for babies with NAS on the neonatal unit , under my close supervision .
Due to the highly specialist nature of neonatal care , I devised a detailed competency and training
24 OTnews January 2025