The implications and considerations of redirecting care in a local neonatal unit

This paper explores the case of a very sick infant in a local neonatal unit (LNU) for whom we unfortunately had to redirect care from intensive to palliative. It was decided that it was in the best interests of the baby and the parents to do so in the LNU, rather than transfer him to the tertiary neonatal unit. This article describes the benefits and challenges of redirecting care in the LNU, and how other LNUs can develop tools to empower themselves to confidently provide redirection of care in these unusual cases.

Arameh Aghababaie¹
Paediatric ST3 Doctor
a.aghababaie@nhs.net

Catherine Douch²
Paediatric ST5 Doctor

Yana Belosludtseva³
Neonatal Consultant

¹Homerton Health NHS Foundation Trust, London
²Royal Free London NHS Foundation Trust
³Barts Health NHS Foundation Trust, London

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Keywords

neonatal intensive care; redirection of care; palliative care

Key points

Babies that are born sick or extremely preterm or with severe congenital abnormalities in a LNU are often transferred to a tertiary neonatal unit once stabilised.
These babies have the highest incidence of mortality and, therefore, tertiary neonatal units have more robust experience of redirection of care in neonates.
On occasion, it may not be possible or in the baby’s best interests to transfer to the tertiary unit and it may be appropriate to redirect care from intensive to palliative in the LNU.

Also published in Infant:

VOLUME 15/ISSUE 1, JANUARY 2019

Multidisciplinary antenatal and perinatal palliative care

Perinatal palliative care is a fairly new subspecialty within the areas of paediatric palliative care, neonatology, fetal medicine and obstetrics. Involving parent-centred, non-judgemental shared decision making, it aims to provide high levels of comfort and care for babies and holistic multidisciplinary support for their families. The focus of antenatal and perinatal palliative care should be to support and enable families to spend time with their baby, make informed choices and build memories. Children’s hospices have proved extremely valuable in this area of palliative care.