Neonatal Intensive Care - Consent

Consent

Your baby may require a number of tests or procedures during his/her time on the unit. Many tests (e.g. daily blood tests, chest x-rays and head ultrasound scans) are considered routine for neonatal intensive care and we will not specifically ask your permission to perform these. Other tests and procedures are less routine but are considered very low risk and are usually essential for your baby's care. These include blood transfusions, screening for retinopathy (premature eye disease), and more specialised x-rays and scans (e.g. CT or MRI scans) - we will discuss these procedures with you beforehand unless in an emergency. Other procedures and treatments require you to give your consent (permission), either verbally after discussion with a doctor or in some cases (surgery, hearing screening, immunisations etc) by completing a written consent form after having an opportunity to ask any questions. There may be some rare situations where it is not possible to get your consent in time but you will be informed of such an event as soon as possible. Naturally the doctors and nurses are happy to discuss the results of any test with you and we will endeavour to keep you fully informed at all times.

The following are examples of procedures that are regularly carried out on the Neonatal Intensive Care Unit.

Blood Taking

When babies are unwell samples of blood will be taken to check for infection, anaemia, blood sugar, salt and jaundice levels etc. We always use the smallest amount of blood possible and usually take it through a fine needle inserted into a vein, from a heel prick or from an arterial line. The doctors and nurses will be happy to discuss the reasons for the various tests we do and the results as these become available.

Blood Transfusion

Newborn babies in our care often need to have blood transfusions. This is because the bone marrow which usually makes blood cells doesn't work very well in the first weeks after birth, particularly if the baby is ill or premature. The blood used for transfusion will have been thoroughly tested before it is given to your baby.  We do not give blood unless necessary and will always try to discuss the reasons with you first - unless the transfusion is needed as an emergency to save the baby's life. Sometimes we need to do an 'Exchange Blood Transfusion' - which means that we slowly remove all the baby's blood whilst slowly giving donor blood. This is usually done for dangerously high levels of jaundice. We sometimes just give the part or parts of the blood which the baby is lacking - for example plasma to help improve circulation or blood clotting factors, or platelets where these are very low.

Intravenous Infusions (drips)

All babies need to have a certain amount of fluid each day, along with salts and sugar etc. If this need cannot be met by feeding the baby by mouth or a tube into the stomach we insert a fine plastic tube (cannula) into a vein - usually on the back of the hand or foot or at the elbow. Special infusion pumps control the fluid given, and we monitor the situation by weighing the baby and doing blood tests. We use the same type of cannula to give antibiotics and other drugs. We can also give intravenous feeding (often called TPN - total parenteral nutrition) through a cannula into a vein - this is intended to feed the baby rather than just prevent dehydration, and will be started if the baby cannot be fed by mouth or tube into the stomach for more than a few days. For TPN we often insert a special type of plastic cannula called a 'long line'. These work in just the same way but are much longer and the tip lies in a large vein close to the heart. Although these lines carry some additional risks they can also remain in place much longer which can be a major advantage for the baby.

Arterial Lines

As above but the fine plastic tube (cannula) is inserted into an artery - usually at the wrist, ankle or umbilicus. We use these lines to measure blood pressure and to take blood tests.

Lumbar Puncture

We can take samples of spinal fluid by inserting a fine needle between the back bones in the lower part of the spine. It is uncomfortable for the baby but only for a few minutes. It is only done if essential - generally to check for possible infections surrounding the brain (meningitis). The test results are usually available within 2 to 24 hours allowing us to change the baby's treatment if necessary or to reassure you that all is well.

X-rays

These are usually done on the NICU using a mobile x-ray machine. Most often we x-ray the chest to detect problems with the lungs and heart, or the abdomen to look at the intestines. We also do x-rays to look at the position of the tips of the various tubes we have inserted. The amount of radiation used for these x-rays is as low as possible and we only do x-rays when they are needed to help us look after your baby.

Ultrasound Scans

A mobile ultrasound machine is also in use on the neonatal unit. This is almost identical to the machines used on pregnant mothers to check on the baby's growth and position. We use it to check on the baby's brain - by scanning through the fontanelle (soft spot), to check on the heart and sometimes other organs such as the liver, kidneys and bladder.

Eye Tests

All babies should have a simple eye check by the doctors on the neonatal unit to look for cataracts. The most premature babies will also be seen by a specialist from the eye department usually when they are about 6 weeks old.

This test is a little more complicated - requiring 'drops' to widen the pupils and sometimes an instrument to open the eyelids. It is a very important test because in premature babies the blood vessels at the back of the eye sometimes develop abnormally, and this can interfere with vision (retinopathy). If the specialist finds any retinopathy they will check again until it either settles itself or needs treatment with a special laser.

Hearing Tests

All newborn babies now routinely get a hearing test within the first few days of life. This is also the case for babies admitted to the Neonatal Intensive Care Unit. However, this test may be delayed for a few weeks in the smallest infants. This procedure requires placing small electrodes behind each ear whilst baby is sleeping. Occasionally a hearing test may be arranged following discharge home. An appointment will be sent to you for this test.

Neonatal Screening Test

On baby's 7th day of life, a blood sample is taken and sent to test for four rare illnesses: Phenylketonuria, Hypothyroidism. In the near future it is planned to test for Cystic Fibrosis and Galactosaemia. This test is performed on all newborn babies, whether sick or well. If these illnesses are detected early, they can be treated. Sometimes this test may need to be repeated if baby is not on the full amount of their feed.