Infant Journal
for neonatal and paediatric healthcare professionals

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

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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neonatal intensive care; redirection of care; palliative care
Key points
  1. 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.
  2. These babies have the highest incidence of mortality and, therefore, tertiary neonatal units have more robust experience of redirection of care in neonates.
  3. 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:

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.