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
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
  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:

VOLUME 19 ISSUE 4/JULY 2023
Talking about lactation – the importance of shared decision making in antenatal anticipatory care planning
When discussing lactation management as part of an anticipatory care plan, healthcare professionals should impartially discuss the choices available to families without personal judgement or bias to support families to come to their own informed decisions. This article outlines how the Milk Bank at Chester has been working collaboratively with the Forget Me Not Children’s Hospice and loss families to co-develop a leaflet to educate and support families on their lactation choices following an antenatal diagnosis of a life-limiting condition with a shortened life expectancy.

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