In 2001 the Department of Health commissioned an expert group to review neonatal services.
The resulting 'Strategy for Improvement' proposed the reorganisation of neonatal care into managed clinical networks so that units in each network would provide virtually all the care required by mothers and babies without the need for long-distance transfers. This followed evidence from other countries that networked models of intensive neonatal care produced the best outcomes for babies. Networks would align with maternity/obstetric care. Each network would have a supervisory structure and within each clinical network one clinician would have a co-ordinating advisory role.
Since then major changes to the organisation of the NHS have taken place and we are now in the era of NHS England with Clinical Commissioning, Clinical Senates, Operational Delivery Networks (ODNs) etc, and many of us in the clinical situation find it very difficult to keep up to date!
As well as the 15 Neonatal Networks in England - www.bapm.org/networks_info - we now need to understand the ODNs that are organised around the Clinical Senates and more information on these can be found at https://www.england.nhs.uk/ourwork/part-rel/odn/
The Neonatal Taskforce was set up in 2008, chaired by Sir Bruce Keogh, NHS Medical Director with a membership from a broad cross section of the NHS neonatal community supported by Dept of Health colleagues. The Taskforce and its sub-groups developed a Toolkit that was launched in late 2009.
The Toolkit contains four main elements:
- A Commissioning Framework
A resource for commissioners and providers to plan, deliver and quality assure
- Principles for high quality neonatal services
Eight topics that cover the major areas of activity within the neonatal care pathway
supported by evidence, including family centred care, workforce and transfers.
- Appendices/Resources (including)
Sources of data and information
Neonatal nursing career pathway
- CD of examples of tools for local adaptation/use, including
Perinatal clinical dashboard
Nursing workforce calculator
The Toolkit for High Quality Neonatal Services is available to download together with the relevant tools - please click here
Neonatal Critical Care E08
This is one of the NHS Commissioning Service National Care & Clinical Reference Groups. It was set up to cover hospital-based intensive care and associated specialised transport for new born infants with complex needs. More information is available at:
The Neonatal Critical Care Clinical Reference Group (Neonatal CRG) published a Service Specification in 2015 which is available at:
This uses the Neonatal Toolkit mentioned above on which to make recommendations for staffing levels and section 3.2.11 point 3 states:
“All units must have access to Dieticians, Specialist Pharmacy, Physiotherapists, Speech and Language Therapists and Occupational Therapists in line with Toolkit requirements. Allied health professionals must have time within their job plans to provide advice and clinical care to the neonatal unit.”
The NDIG Commissioning document mentioned below makes recommendations on levels of dietetic staffing and has been accepted by the commissioning group as “reasonable” so it is hoped that this level of detail will become part of future national service specifications.
Commissioning a Neonatal Dietetic Service
Following many requests for advice from dietitians, neonatologists and commissioners for support in the establishment of neonatal dietetic services, an evidence based document has been produced by members of NDIG – Neonatal Dietitians Interest Group – a specialist sub-group of the BDA (British Dietetic Association). There has been an increasing interest in this in recent years particularly since the publication of the Neonatal Task Force document in 2009 with its recommendations for dietetic expertise both at unit and Network level. This includes a suggested job specification for a Neonatal Network Dietitian to help ensure the most appropriate use of this resource.
This can be viewed here
The Neonatal Data Analysis Unit (NDAU) was established to improve the quality of operational clinical data captured at the point of clinical care and promote their best use to support neonatal services and facilitate research. The NDAU analyse data for the Royal College of Paediatrics & Child Health National Neonatal Audit Programme (NNAP).
Data is collected electronically by neonatal units around the UK mostly via the Badger.net platform and this is collate and analysed forming a huge database for ongoing neonatal audit and research. Details are available at https://www1.imperial.ac.uk/neonataldataanalysis/
Neonatology on the Web
This is a website developed and maintained by Ray Duncan MD around his interest in neonatology and contains some very interesting information and useful links. There is some amazing historical information. Can be found at www.neonatology.org or www.neonatology.com and links with NICU-NET.
UNICEF Baby Friendly Initiative website
UNICEF Baby Friendly Initiative – this UK website contains a lot of useful information on all aspects of breastfeeding promotion. There is a lot of useful information for health professionals on the website at: http://www.unicef.org.uk/BabyFriendly/Health-Professionals/
ESPGHAN - European Society for Paediatric Gastroenterology,
Hepatology and Nutrition
ESPGHAN publishes position papers on numerous topics including many relating to infant and childhood nutrition including the 2010 guidelines for enteral feeding of preterm infants. These are available to download from: http://www.espghan.org/guidelines/nutrition/. There is also an annual conference and other educational activities available on their website.
National Perinatal Epidemiology Unit (NPEU)
NPEU is a multidisciplinary research team dedicated to improving the care provided to women and their families during pregnancy, childbirth and the postpartum period, as well as the care provided to the newborn. An Extended Neonatal Network has been established across England to ensure the continued successful conduct and completion of large-scale neonatal studies, predominantly randomised controlled trials which address important questions in the provision of neonatal care. Funding for the establishment of the network is provided by the Medicines for Children Research Network. Further information is available at:
Zetoc provides access to the British Libraries Electronic Table of Contents of around 20,000 current journals and 16,000 conference proceedings published per year. It is free to members of the NHS in England and Scotland. It includes an email alerting service so that users can receive notification of relevant new data. It is available at zetoc.mimas.ac.uk. It gives reference titles and has a link to abstracts and sometimes the full article via an Athens username and appropriate subscription.
Gaining and Growing
Gaining and Growing is a website designed to promote discharge growth and development of preterm infants, especially those born weighing <1500g, by providing easy access to up-to-date nutrition and feeding information for community health care professionals in the Pacific North West of America in the hope that assuring adequate nutritional status will improve outcomes and family life for these children. A summary is available at:
http://depts.washington.edu/growing/Brochure.pdf with links to the full website at:http://depts.washington.edu/growing/
Although it has a lot of useful information, it is American so may differ from UK practice. It was last reviewed in 2015.
California Perinatal Quality Care Collaborative
This was an initiative proposed by the California Association of Neonatalologists. CPQCC advocates not only superior patient care but also efficiency in resource allocation and utilisation. Quality improvement activities are aimed at identifying desired outcomes and promoting best practice. Health care providers and academic researchers benefit from the database.
An excellent nutrition toolkit updated in December 2008 is available to download at:
Paediatric Academic Societies (PAS)
PAS holds an annual conference in the US linking the American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. Abstracts of these conferences are available from past conferences at :
http://www.abstracts2view.com/pasall/index.php and just prior to the latest conference at:http://www.abstracts2view.com/pas/index.php
You can search by author, title or category but be prepared to spend some time as there are hundreds of abstracts and you can get very carried away!
First Steps Nutrition Trust
First Steps Nutrition Trust provides nutrition information and resources to support women who may be become pregnant, pregnant women, and parents of children under 5. The Trust offers evidence-based, objective, information that is not sponsored by food manufaturers or retailers and which can be trusted as clear and accuarte. The Trust is a registered charity and all the work produced will be freely available to all. http://www.firststepsnutrition.org/index.html
They produce a wealth of excellent non-biased information on infant feeding, infant formulas, etc. For example – a practical guide to infant formulas and specialised infant formulas in the UK:
Infant milks in the UK: A practical guide for health professionals
Infant & Toddler Forum
The Infant & Toddler Forum brings together a multi-disciplinary team of experts and practitioners from paediatrics, neonatology, health visiting, dietetics and child psychology to share new ideas and to debate the latest thinking in infant and toddler nutrition http://www.infantandtoddlerforum.org
Last updated July 2016
The Forum is supported by an educational grant from the Infant Nutrition division of Danone UK. The views and outputs of the group, however, remain independent of Danone UKand its commercial interests.