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 16/ISSUE 4, JULY 2020

Supporting doctors to deliver paediatric palliative care on neonatal units: the development of a curriculum

Newly qualified neonatologists are required to confidently deliver excellence in communication, decision making and end of life care for neonates with palliative care needs. This study assesses perceived confidence of neonatal subspecialty trainees in delivering palliative care and reports the development of a regionally applicable curriculum to structure training, governance and palliative care team integration into neonatal units across Wales. This study is the first to generate a palliative care curriculum based on learning needs analysis specifically for neonatologists.