Newborn Clinical Network

Practice recommendations, consensus statements and guidelines

• Resources for Health Professionals providing transitional care

• Practice recommendation for the treatment of hypoglycaemia with dextrose gel

• Consensus statement for the screening of Retinopathy of Prematurity

• Consensus statement for the treatment of neonatal encephalopathy

• Practice recommendation for oxygen saturation targets for newborns cared for in neonatal units in New Zealand

• Practice recommendation for Neonatal Subgaleal Haemorrhage

• New Zealand Consensus Statement on the care of mother and baby(ies) at periviable gestations.

• Practice recommendation for the bundle of neonatal care at 23-24 weeks gestation

• Practice recommendations for skin care of neonates < 28 weeks gestation

• LISA-MIST practice recommendation

• Practice recommendations for weight loss, dehydration and hypernatraemic dehydration in the neonate

• Red reflex screening assessment in newborns and infants

• Practice recommendations for 2 year follow-up of infants at high risk of developmental disability plus developmental pathway flowchart.

Purpose of the network

The Newborn Clinical Network was established in 2013 with the aim to provide clinical leadership in the development and maintenance of a sustainable nation-wide, clinical service for newborns as close to home as is practicable. Given the size and range of newborn services, we are interested in particular in advocating for the provision of equitable high quality newborn care in New Zealand.

We have medical and nursing leaders from across New Zealand from both the large (Level 3) and smaller (Level 2) centres. The lead regional level 3 units have always supported their level 2 units and we wish to add to that with national practice recommendations as decided by the network group. Consensus statements with organisations such as NZ College of Midwives (NZCOM) and Ophthalmology and monitoring and auditing of services to inform continuous quality improvement have been undertaken so far. Our workforce and unit capacity issues are discussed with the Ministry of Health and we link with the NZ Neonatal Nurses Aoteroa and the Australian and New Zealand Neonatal Network (ANZNN) on education and quality improvement activities.

Work groups

• Acuity tool for neonatal admissions. Standardising definitions for level of care provided in  Level 3 / intensive care and level 2 / special care does not address the group of high dependency babies that fit between these two groups. Once level of care is agreed alongside an acuity tool we will recommend  that the service specifications be updated with the MOH.

• Use of Oral dextrose gel for newborn hypoglycaemia.  A guideline for the use of gel has now been completed.

• Oxygen saturation targets for preterm newborns who need supplemental oxygen.  Standardisation of saturation targets and alarm limits for preterm and term neonates can be found in the practice recommendations for oxygen saturation targets for newborns cared for in neonatal units, New Zealand.

• Retinopathy screening - standard of care. These have been developed in association with the Paediatric Ophthalmology Group. As ex very preterm infants often move back to level 2 units a standard approach is planned.

• Nursing Workforce -A  clinical nurse specialist role in level 2 units is supported and work involves network members and Neonatal Nurse leaders to enhance the delivery of care.

• Guideline for Cooling in Hypoxic Ischaemic Encephalopathy. This is a recommendation of the 8th PMMRC annual report. The chair of the Neonatal Encephalopathy working group is also on the newborn network and will lead this guideline.

• Measurement of oxygen saturations with the newborn examination. This guideline is in development and will improve early detection of congenital heart disease as well as babies with mild respiratory difficulties in the first 24 hours. Work is in progress.