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Do not separate neonates with common illness from mothers ‘in most cases’

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Many neonates are needlessly separated from their mothers to receive treatment for common health complaints in hospital, according to a new report by health service regulators.

Most treatments for health complaints, such as hypoglycaemia or jaundice, could be better provided in the community or without separating mother or baby, said NHS Improvement today.

“Separating them from their mother causes stress for both mother and baby”

Birte Harlev-Lam

Its report – titled Reducing harm leading to avoidable admission of full- term babies into neonatal units – focuses on newborns, up to the age of 28 days, requiring admission for neonatal care.

The report forms part of the Avoiding Term Admissions into Neonatal Units (ATAIN) programme which looked at the biggest causes of newborns needing to be admitted shortly after birth.

It highlighted that the number of babies admitted to neonatal units increased by 24% between 2011 and 2014.

In addition, there was a further 6% increase in 2015, despite a fall in the overall number of live term births, said the report, which was drawn up with input from the Royal College of Midwives.

It concluded that, while some term admissions were entirely appropriate – for example, for a congenital abnormality – a large number of cases care could be managed without needing to separate mother and infant.

“Mothers and babies should never be separated unless this is absolutely necessary”

Cathy Warwick

The four biggest causes of newborns needing admission to a neonatal unit shortly after birth are hypoglycaemia, jaundice, respiratory conditions, and asphyxia (hypoxic-ischaemic encephalopathy).

But the report authors said that 20-30% of all term babies admitted to neonatal units for the first three problems did not receive any intervention that could not have been provided in a setting that kept mother and baby together, either in hospital or in the community.

For example, 23% of admissions for respiratory problems stayed for up to 48 hours and needed special care only, with 10% not needing oxygen at all.

Most babies admitted for jaundice required phototherapy only and could be more appropriately managed in a transitional care setting, said the report.

Similarly, among babies admitted for hypoglycaemia, 30% of admissions occurred before they were four hours old − a period of physiological transition in glucose metabolism.

The report added that 44% were admitted directly from the delivery suite, and admission blood glucose concentration was above the operational threshold in a quarter of these admissions, suggesting little or no postnatal ward interventions.

This conclusion was supported by the finding that nearly 75% of babies admitted for hypoglycaemia within an hour of birth did not need intravenous glucose infusion, it said.

Meanwhile, the report noted that avoiding admission also meant mothers and babies were given more opportunity for skin-to-skin contact, viewed as a vital part of bond forming and supporting baby health and development.

NHS Improvement

No need to admit neonates for common conditions

Birte Harlev-Lam

Birte Harlev-Lam, clinical director, maternity and children at NHS Improvement, said: “As a midwife, I know how important it is for mums and their babies to spend those very special few hours after birth together. This time is vital for a baby’s health and development.

“When a baby needs additional care shortly after birth, separating them from their mother causes stress for both mother and baby which can also impact on a baby’s ability to breastfeed or regulate its temperature,” she said.

“NHS staff in maternity units work hard to provide new mums with safe, quality and compassionate care, but we want to make sure that they are supported to provide additional care without needing to separate mother and baby if it’s avoidable,” she added.

Professor Cathy Warwick, chief executive of the RCM, said: “We must reduce unnecessary admissions to neonatal intensive care unit and readmissions to hospital. Mothers and babies should never be separated unless this is absolutely necessary.

Professor Cathy Warwick

Professor Cathy Warwick

Cathy Warwick

“This is a very welcome report,” she said. “It is critical if we are to ensure safe high quality care that the findings of this report are implemented.

“However, like other safety initiatives it needs time, education and resources to ensure the changes it indicates are embedded fully and have the impact we hope for,” said Professor Warwick.

“This includes having the right staff with the right skills on our postnatal wards and in the community to provide the safest and best possible care,” she added.

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Readers' comments (1)

  • Many of the babies who are admitted to neonatal units could be cared for on the post natal wards if the midwives were not so busy, and if they were not becoming deskilled with neonatal care, due to the reliance on specialist neonatal staff to deal with anything but the absolute 'norm'. Some hospitals have 'virtual' or 'peripheral' transitional care where the baby stays with mother on the post natal ward but is monitored up to four times a day by neonatal staff. However what often happens is that the midwives take little or no part in the care so effectively the baby is only seen six hourly, or even less. The only answer is to have more midwives to enable them to do the job they are trained for, caring for mothers from conception through delivery and caring for mother and baby up until discharge to the care of the health visiting team.

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