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A SCBU image you could use in your project?

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Information on neonatal unit at the John Radcliffe Hospital 

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Information on neonatal unit at the John Radcliffe Hospital 

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Who runs the unit, how it operates and so on.

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Oxford Newborn Care Unit - Children's Services

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Oxford Newborn Care Unit at the Oxford University Hospitals.

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All the different types of IVs a SCBU may use.

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All the different types of incubator a SCBU may need.

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All the different types of ventilator that a SCBU may use.

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Explaining what the equipment is for.

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As the parent of a premature baby, over the coming days, weeks and possibly months you are likely to spend a lot of time in the baby unit (also called the neonatal unit). This will probably feel very strange at first, but as you become more familiar with the way the unit works and what all the equipment does (see below), you will find it less daunting.

Your baby may need to be moved between units depending on what level of care (see below) they need at a given point in time.

How the baby unit works

Every neonatal unit has its own set routine. Parents are usually allowed to visit their babies almost 24 hours a day, although there may be short periods when you are asked to leave - for example, during shift handover times. There may also be set quiet times when visitors are asked to be very quiet, to give the babies time to sleep. They may also keep the lids on incubators or swaddle babies to help them rest.

Levels of care

Special care baby unit (SCBU)

Also called the special care baby unit (SCBU, pronounced 'skaboo') or special care unit (SCU), these provide the most simple level of care for babies in their local area and stabilise a baby's condition before transferring them to another unit or provide emergency care if necessary. They may also provide some high-dependency services. They receive babies from other units once they are well enough to be cared for there.

Local neonatal unit (LNU)

Local neonatal units (LNUs) provide special care for babies in their local area, except for those who are very unwell and need complex or longer-term intensive care. The majority of babies over 27 weeks of gestation will usually receive their full care, including short periods of intensive care, within their LNU.

Neonatal intensive care units (NICU)

These specialist units have the facilities to care for critically ill premature babies. Babies will be transferred here from around the country to access the specialised expertise that they offer. They provide the whole range of medical neonatal care for their local population, along with additional care for babies and their families referred from the neonatal network.

Hygiene in baby units

The babies in these units are very vulnerable to infection, so you will be asked to wash your hands every time you enter the unit, and if you have a cough or cold you will be asked not to come in.

Is there somewhere I can take a break?

Most units will have a parents' room where you can doze, catch up with emails, watch TV or even just read a book. Some provide a playroom too, for older siblings.

Can I stay overnight with my premature baby

Some units offer overnight accommodation for parents, which might be a private room or just a reclining chair in a common room. Others will provide contact details of local accommodation where you can stay, such as through the Ronald McDonald House Charities website.

Some baby units have a family room where parents are encouraged to 'room in' with their baby for a few nights before taking them home, to help you all adjust to family life outside the unit.

What does all the equipment in the baby unit do?

The hums, beeps and flashing lights of equipment in the baby unit (whether it is a neonatal unit, special care baby unit (SCBU) or neonatal care intensive care unit) can seem daunting at first, but you will soon become familiar with the machines

Your premature baby will be supported by a lot of different devices. Most of them are involved in helping them breathe, receive nutrients and stay warm.

(1) Incubator

A see-through box on wheels which keeps your baby warm. It may be open, with an overhead heater or heated mattress, or closed, with a lid, to keep the air around your baby warm and humid.

(2) Overhead heater

A heater for an open incubator to make sure your baby's temperature is correct.

(3) Monitors

These check your baby's breathing rate, heart rate, blood pressure, temperature, and the amount of oxygen, carbon dioxide and acidity in his blood. They also alert staff if your baby has apnoea, in which the baby stops breathing for more than 10-20 seconds. This is quite common in premature babies.

(4) Ambient oxygen analyser

This small appliance sits inside the incubator to make sure there is enough oxygen in the air.

(5) Intravenous (IV) drip

Your baby can receive fluids, nutrients and medication through this narrow tube and needle. If your baby needs a drip for a long time, the team might insert a catheter (also called a PICC line or long line), which doesn't need to be changed so often.

(6) Feeding pump and tubes

Flexible plastic tubes through which nutrients are passed. They might have one, or all, of the following: a nasogastric tube which goes through your baby's nose, an orogastic tube through their mouth and into their stomach, and a transpyloric tube which goes directly to thier gut.

(7) Power supply

The point from where the power comes to power the other machines. All hospitals have back-up power in case of a power cut.

(8) Ventilator monitor

A monitor on which all the ventilator settings are displayed.

(9) Ventilator

Some babies will be put on a ventilator - a machine that blows air and oxygen through a tube into their nose or throat and into the lungs. A positive pressure ventilator delivers the air mixture in 'breaths' while an oscillatory or high-frequency ventilator delivers it through tiny vibrations.

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Tommy's - The Neonatal Intensive Care Unit (NICU)

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As the parent of a premature baby, over the coming days, weeks and possibly months you are likely to spend a lot of time in the baby unit (also called the neonatal unit). This will probably feel very strange at first, but as you become more familiar with the way the unit works and what all the equipment does (see below), you will find it less daunting.

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Useful for those who are creating a magazine for the new parents.

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What is the neonatal unit?

The neonatal unit provides expert 24/7 hospital care for premature or sick babies.

One baby in nine born in England will spend time on the neonatal unit (Bliss 2015), so it's something that happens to many families.

There are three types of neonatal unit, to suit the needs of different babies:

Neonatal intensive care unit (NICU), for the smallest or most seriously ill babies.

High-dependency care, for babies who do not need to be in the NICU but who still require complex care.

Special care, for babies who were born closer to their due date or who have a less serious illness. If your baby was born very early but is now growing well, or if he is getting better after a serious illness, he may be transferred to special care (BAPM 2011, Bliss 2015).

Why is my baby being moved to another hospital?

If your local hospital does not have the level of neonatal care your baby needs, he may have to stay in a different hospital until he is stronger. Sometimes, babies are transferred because all the cots are full in the local neonatal unit, or because there is a shortage of staff (Bliss 2015).

This is a really difficult situation for parents. If your baby is far away from home and you are struggling to spend time with him, ask your baby's nurse what help is available from the hospital or local charities. The hospital's Patient Advice and Liaison Services (PALS) can give you information.

You can also contact the special care baby charity, Bliss, for advice and support.

Can I stay with my baby in the neonatal unit?

Most neonatal units are open 24 hours a day for parents to visit. Others have more restricted visiting hours.

Your baby's siblings, and other relatives and friends, may also be allowed to visit. Ask one of the nurses about the policy for your baby's unit.

Many hospitals have a place for parents to stay overnight, but, unfortunately, some do not (Bliss 2015).

If you're away from the hospital you can call the neonatal unit any time, day or night. Ask as many questions as you want to, and don't hesitate to talk about any worries or concerns you may have about your baby.

Why does my baby need to be in the neonatal unit?

Premature babies need extra help while their bodies catch up on the growth and development they missed in the womb (uterus). The neonatal unit provides this in several ways.

It's harder for your premature baby to stay warm because he can't regulate his own body temperature yet. A special cot (incubator) can help with this (GOSH 2014, Knobel-Dail 2014).

Some babies who are born early need help with breathing for a while, until their lung development catches up. Babies who are weak or very ill may also need help with breathing (Bliss nd a).

If your baby is too small, too premature or too weak to feed, he might receive fluids and a nutrition mixture through a drip. Or he may need a tube that carries milk into his stomach (Tommy's 2014).

Premature babies also need extra monitoring, treatment and care because they can be more vulnerable to infection and other medical problems. You can read more about these in our article on early challenges for your premature baby.

About half of babies in the neonatal unit were not born prematurely, but need treatment or care because they are ill (Bliss 2015).

Having surgery, getting treatment for an infection or having light therapy for jaundice are some of the reasons that a baby may be in the neonatal unit.

Who will care for my baby in the unit?

On the neonatal unit, a skilled team of people from different professions will care for your baby. Some of the people you may meet include:

Staff and specialist neonatal nurses.

The senior nurse in charge of the unit (unit or ward manager).

Consultant paediatrician or neonatologist, the senior doctor who leads your baby's care.

Specialty paediatricians (also known as staff grade doctors or associate specialists). They are experienced doctors, but not consultants (RCPCH 2016).

Junior doctors in training. Despite the title, some junior doctors are actually very experienced, because their training takes many years.

Other specialist doctors, such as surgeons.

Physiotherapists to help with your baby's development.

Radiographers, who take X-rays and scans.

Dietitians who advise on nutrition.

Pharmacists.

A social worker to help you with family issues, financial worries, and support after you take your baby home (Bliss nd b).

Last but not least, there's you, the parents. You know your baby best and are always his most important carers. The professionals will recognise this and treat you as part of the team. They should encourage you to take an active part in your baby's care, as far as possible (Bliss 2011, NHS England 2015, Scottish Government 2013).

This means everything from changing nappies, feeding and cuddling your baby, through to agreeing your baby's medical treatment plan with his consultant.

What are all those machines and tubes for?

It's scary to see your baby attached to all sorts of tubes and machines. But it's all there to keep him safe. As your baby gets stronger, he will need less of this technology and it will be easier for you to hold him and care for him. Here is some of the equipment you could see in a neonatal unit:

Baby warmers

An incubator is a special cot with a lid that keeps your baby warm and sometimes controls the moisture level (humidity) around him. There may also be an overhead heater to keep your baby at the right temperature (GOSH 2014, Knobel-Dail 2014).

Monitors

Some of the machines you see attached to your baby are monitors that track his condition from minute to minute, and show the results on a screen.

These monitors may be keeping a check on his:

Heart rate

Blood pressure

Breathing

Oxygen levels

Temperature

(Cambridge University Hospitals)
These monitors have alarms, which may go off a lot. The monitor alarms are highly sensitive, and closely track every little change in your baby's body. An alarm going off can give you a scare if you don't know what it means. If you're ever worried or unsure about the monitors, don't hesitate to ask your baby's nurse.
Help with breathing

A ventilator can help your baby's lungs do the work of breathing. The doctor will gently insert a soft tube into your baby's windpipe. Through the tube, the ventilator pushes a mixture of air and oxygen in and out of your baby's lungs (Tommy's 2014).

A CPAP machine (continuous positive airway pressure) is another piece of equipment to help your baby breathe. It gently inflates your baby's lungs and keeps them open. Air goes in through a mask or a tube in your baby's nose (a nasal cannula) (Tommy's 2014).

If your baby just needs extra oxygen, he can have it through a mask, or via prongs that fit straight into his nose. Alternatively, the oxygen he needs may be fed directly into his incubator.

Tubes

Your baby may need to get fluids, medicines or nutrition through a tube into his vein. This vein is inserted with a thin needle. Sometimes the tube is called a venous cannula (the word cannula generally means a thin tube).

This tube may be attached to an infusion pump. It's a machine that makes sure your baby receives the right amount into his vein, at the right speed.

Your baby's doctor may also insert a tube in one of his arteries to test his blood pressure, oxygen and carbon dioxide levels. This may sound worrying, but babies only rarely need this treatment. Doctors obtain samples using this method because it works well and doesn't distress the babies under their care.

A feeding (gastric) tube gives your baby milk straight into his tummy, if he is not able to feed from the breast or bottle. The nurse will gently insert a soft, flexible tube through your baby's mouth or nose and down into his stomach.

Special lights

If your baby has jaundice, he may have treatment with a phototherapy light. Jaundice is common in newborns and it turns the skin yellow. It happens when a substance called bilirubin builds up faster than the baby's body can get rid of it.

Phototherapy helps your baby break down the bilirubin, until he can do it on his own. Your baby may be placed under a phototherapy light that shines above him, or on a blanket that shines the light on his back (NHS 2015).

How can I help my baby while he is in the unit?

All babies need their parents. Your touch, your voice and your presence all help your baby a great deal. The nurses should also encourage you to take care of your baby as much as possible, and help you do this safely and confidently. To find out more about taking care of your baby while he's in hospital, read our articles about:

When can my baby come home?

It's hard to say, because all babies are different. It depends on how your baby's doing. Babies who are smaller and those born sooner tend to stay longer on the unit.

A premature baby who is otherwise well usually stays in the neonatal unit until around the date he was due to be born (Jeffries 2014). If your baby is doing really well, he may even be able to come home sooner than this.

When your baby is almost ready to go home, you may be able to take over his care while he's still in hospital. This is called transitional care, and is a kind of stepping stone between hospital and home. You stay overnight with your baby, with nurses or midwives nearby for help and advice if you need it (BAPM 2011).

Transitional care is not available everywhere but if you do have access to it, it can really build your confidence when you bring your baby home.

Last reviewed: November 2016

Next review: November 2019

References

BAPM. 2011. Categories of care 2011. British Association of Perinatal Medicine. www.bapm.org [Accessed September 2016]

Bliss. 2011. The Bliss baby charter standards. www.bliss.org.uk [Accessed: September 2016]

Bliss. 2015. Hanging in the balance. Bliss baby report 2015. www.bliss.org.uk [Accessed September 2016]

Bliss. nd a. Ventilation. About neonatal care. www.bliss.org.uk [Accessed September 2016]

Bliss. nd b. Who's who on the neonatal unit. www.bliss.org.uk [Accessed September 2016]

Cambridge University Hospitals. nd. Routine monitoring of your baby. www.cuh.org.uk [Accessed September 2016]

GOSH. 2014. Thermoregulation for neonates. Great Ormond Street Hospital. www.gosh.nhs.uk [Accessed September 2016]

Jeffries AL. 2014. Going home: Facilitating discharge of the preterm infant. Canadian Paediatric Society position statement. Paediatr Child Health 19(1):31-36 www.cps.ca [Accessed September 2016]

Knobel-Dail R. 2014. Role of effective thermoregulation in premature neonates. Research and Reports in Neonatology 4:147-156

NHS. 2015. Treating jaundice in newborn babies. Health A-Z. NHS Choices. www.nhs.uk [Accessed September 2016]

RCPCH. 2016. Career information for Staff, Associate Specialist and Specialty (SAS) doctors. Royal College of Paediatrics and Child Health. www.rcpch.ac.uk [Accessed September 2016]

Tommy's. 2014. Feeding your premature baby. Pregnancy information from our midwives. www.tommys.org [Accessed September 2016]

Tommy's. 2014. Breathing support for premature babies. Pregnancy information from our midwives. www.tommys.org [Accessed September 2016]

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The neonatal unit provides expert 24/7 hospital care for premature or sick babies. One baby in nine born in England will spend time on the neonatal unit (Bliss 2015), so it's something that happens to many families.

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You're designing and ideal SCBU - what are the minimum standards?

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How one NHS hospital supports baby's SCBU needs

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How one NHS hospital supports baby's SCBU needs

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Vital information on breathing equipment and milk feeding

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SCBU information - what equipment does a preterm baby need? 

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SCBU information - what equipment does a preterm baby need? 

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PowerPoint used in lesson to explain the different types of equipment needed.

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Information on why some babies need special care

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Special care: ill or premature babies - NHS.UK

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Find out about the special care given to babies born early (prematurely) or those who are sick, jaundiced or born with a disability.

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Resource used in your lesson - Thurs