Posted on

Antibiotics for newborn baby

Antibiotics for newborn baby

Glycemia test being performed on newborn baby

Known risk of an infection

If you received antibiotics in labour only because of the known risk of GBS infection, this will be stopped at the time of the birth. For 12-24 hours after the birth, your team will monitor you and the baby for anything concerning, including signs of infection. The monitoring aims to identify early warning symptoms and signs. For the baby, this will include overall assessment and regular measurement of heart rate, respiratory rate, colour, temperature and feeding. The baby will stay with their mothers on the postnatal ward.

Signs of a possible infection

At birth, a baby doctor will review your baby’s risk of infection based on factors including your own signs infection, the course of your labour and an assessment of your baby. Your baby will be observed closely and have regular measurement of heart rate, respiratory rate, colour, temperature and feeding for at least 12 hours. Depending on the risk of infection, your baby may need to have some blood tests to look for infection and be started on antibiotics. In this case, the neonatal doctors will put a tiny cannula in your baby’s hand or foot so that they can take some blood to test and give the antibiotics directly into a vein (intravenous). If antibiotics are required, your baby will receive these twice a day through the cannula and the ward staff will continue to monitor your baby closely as before. Your baby can stay with you on the postnatal ward during this time. Should there be further concerns your baby may need to be admitted to the neonatal unit to enable close monitoring, further tests and necessary treatment. You’ll be able to visit your baby in the neonatal unit.

Why does my baby need antibiotics?

Antibiotics are started in babies assessed as being at significantly increased risk of infection. This is because infection in babies can be very serious if left untreated and even if your baby looks very well, they can become sick very quickly. The good news is that antibiotics can help keep your baby well. The antibiotics must be given directly into their blood stream as babies are not able to absorb sufficient amount of antibiotics from their gut. You will be able to breastfeed your baby and the ward staff will support your feeding choices. We want you to know that there are normally no side effects or allergic reactions with use of antibiotics in newborn babies. If you are unsure why your baby needs antibiotics, please ask the medical team to explain this to you. Whilst you will have to be careful with the cannula when holding your baby, you will be able to do skin-to-skin and breast feed your baby.

What tests will my baby have?

If your baby requires investigation for infection, a number of blood tests will be performed, including:
  • 1) CRP (C-reactive protein), which is produced by our bodies in response to an infection or inflammation. A high CRP can indicate the presence of an infection in the body.
  • 2) Blood cultures to identify if any bacteria are growing in the blood. This result may be available within 36-48 hours of the test.
After 18-24 hours from birth, the CRP test will usually be repeated by collecting a small amount of blood from a heel prick. If at any stage your baby’s health or any of the results are a concern, they may need more tests like a chest x-ray and/or a lumbar puncture to work out the site of infection and will require a longer course of antibiotics. The neonatal doctors will discuss this with you.

How long will my baby need antibiotics?

The length of time your baby needs antibiotics will depend on how your baby is doing and what the results show. If your baby remains well, the CRP is not high and the blood cultures do not grow any bacteria, the antibiotics can usually be stopped after 36-48 hours. A longer course of antibiotics may be indicated should there be any concerns.

When can we go home?

At the time of birth, it is difficult to know when you and your baby will be able to go home. After 36-48 hours, the doctors will have a better idea of the duration of treatment required. Your team will continue to review you and your baby on the ward daily until they feel sure that you are both well enough to go home. On discharge from the hospital, you will receive written information about the medical treatment delivered on the ward. You can share this with your community midwife and health visitor. Your GP will be sent this information.

Guidance for next pregnancy if you or your baby was identified as having GBS

If you become pregnant again, please inform the maternity care team looking after you that about the positive GBS result, so that they can offer antibiotics in labour to reduce the risk of early onset GBS infection in the baby.

What should I do if I have worries?

Ongoing maternity care is provided by community midwife, who are local to where you will be based after discharge from the hospital. The community midwife will make contact with you within 24-48 hours of being at home. They will support you and your baby’s care. Should you have any urgent concerns regarding the health of you or your baby, please seek medical advice from your GP, NHS 111, 999 or attend your local Accident and Emergency department. For baby, these concerns may include baby showing abnormal behavior (for example, inconsolable crying or listlessness), being unusually floppy, has an abnormal temperature unexplained by environmental factors (lower than 36 or higher than 38 Degree centigrade), abnormal breathing (rapid breathing, difficulty in breathing or grunting) or change in skin colour (for example baby becomes very pale, blue/grey or dark yellow) or has developed new difficulties with feeding.
Posted on

Helping your premature baby to develop

Helping your premature baby to develop

Premature baby in an incubator Having a premature baby is the beginning of a long and emotional journey towards going home. It can be a very stressful time for your whole family. A premature baby’s development happens in the same order as it would have happened in your womb. When your baby reaches certain health, growth and development milestones, you’ll be able to take them. All babies are different, and their behaviour and development are different too. In premature babies, the differences have to do with how premature they were when they were born. Below are some changes that you can expect and watch out for in your premature baby and what you can do to help their development.

23 to 27 weeks gestation
Weeks of gestation/Cues What you can do to help
23 weeks: Eyes are closed. Little movement. Ask your baby’s nurse to show you how you can touch your baby. Familiarise yourself with the BLISS family handbook.
24 weeks: Your baby’s skin is very thin and transparent. Talk quietly to your baby as they can hear you.
25 weeks: Your baby’s body is lean with no fat. His/hers arms and legs are limp. Your baby doesn’t yet have good muscle tone. Ask your baby’s nurse about how to hold and position your baby. Leave a small piece of cloth that smells of you with your baby.
26 weeks: Your baby’s eyes will start to open but they can’t focus yet. Your baby will sleep a lot. The breath triggering part of your baby’s brain hasn’t fully developed yet, so pauses between breaths are common. Keep the lights as dim as possible. Shield your baby’s eyes from bright light to enable your baby to try and open their eyes.
27 weeks: Your baby may startle at loud noises. Avoid sudden noises. Remember positioning.

28 to 32 weeks gestation
Weeks of gestation/Cues What you can do to help
28 weeks: Your baby’s movements may be jerky and jittery. Their hand grasp and sucking reflexes appear but these will be weak. Ask the nurse about skin to skin contact (kangaroo mother care). Let your baby gently hold your finger. Your baby may take a non-nutritive tool.
29 weeks: The ability to hear and smell will allow your baby to recognise you. Talk softly to your baby when you visit. You may like to read short stories, nursery rhymes or sing to your baby.
30 weeks: Your baby has periods of alertness and sleep Your baby may recognise your face now. Try to observe the periods of alertness in your baby, to allow them to look at you and interact
31 weeks: Your baby may be able to keep his/hers eyes open wide for a time. Move your face back and forth slowly and your baby may follow you and your eyes.
32 weeks: Your baby will be more interested in sucking and may appear to suck the feeding tube. Offer a non-nutritive feed with tube feeds. Speak to your baby’s nurse about cup feeds if appropriate.

33 to 37 weeks gestation
Weeks of gestation/Cues What you can do to help
33 weeks: There are clear sleep and awake cycles. Your baby will be moving around in the cot and incubator a lot. Provide a calm environment around feeding time to enable your baby to focus on sucking, swallowing and breathing.
34 weeks: Your baby may be sucking on hands and non-nutritive tools. Offer the breast, or start using your own bottles and teats. Hold your baby still rather than rocking them to enable them to gradually become accustomed to position changes.
35 weeks: Your baby may wake up when hungry, may cry with a wet or dirty nappy. Allow your baby to gaze at your face. Talk or sing in a soft voice whilst your baby is in light sleep.
36 weeks: Your baby may have a more consistent sleep/wake cycle. Your baby may want to be held and cuddled more. Parents’ voices, smells and faces are very important.
37 weeks: Your baby should be gaining more weight and has fuller cheeks. Spend as much time as you can with your baby. If you haven’t talked about or arranged an overnight stay, this is a good time to book it. Ask the team about resuscitation training.

37 weeks onwards

As long as your baby is well, now is the time to start building on what you and your baby have been doing from 35 weeks. Your baby should be gaining weight well, maintaining their temperature in an open cot and breast or bottle feeding.
  • Take short walks with your baby and try short periods of time with your baby in a bouncy chair.
  • Use more interactive and visually stimulating toys.
  • Talk to the neonatal team about structuring your baby’s day i.e. day/night/bath time/playtime.
  • Make sure your home is ready for discharge.
  • Make sure the baby’s Red Book (Personal Child Health Record Book) is completed before discharge from hospital.
Posted on

Mouth (oral) thrush

Mouth (oral) thrush

Close up of baby's open mouth showing white patches of thrush Oral thrush is a common fungal infection in the mouth. It can be easily and quickly treated if it doesn’t clear up on its own.

How do I know if my baby has thrush?

  • Look out for white spots or patches on your baby’s cheeks, gums and palate. These patches can look like milk spots, but if you rub them there will be a raw area underneath.
  • Your baby may fuss when breastfeeding or might even refuse your breast or bottle.
  • Sometimes babies get nappy rash when they have oral thrush. It might look red or bright pink with small raised spots and you might find standard nappy rash creams aren’t effective in clearing the rash.
  • If you are breastfeeding you may notice that you have thrush on your nipples, making them painful, red and cracked.

What treatment will we receive?

Your GP or Health Visitor may prescribe an antifungal treatment. The type of treatment will depend on the age of your baby. A course of treatment usually takes 7 days. If there is no improvement after a week, ask your GP for further advice.
  • If you have thrush on your breasts, the GP will prescribe medicine for you too.

How can I prevent thrush?

  • Oral thrush will usually become less of a problem as your baby’s immune system develops.
  • Take extra care when sterilising bottles, soothers and other feeding equipment.
  • If you still have thrush, wash your breasts after feeding. Use plain water, pat dry and applied any prescribed treatment to avoid further contamination.
  • To prevent re-infection, make sure you keep separate towels for your hands before and after feeding, and before and after changing your baby’s nappy.
Posted on

Keeping your baby warm after birth

Keeping your baby warm after birth

Baby wearing a sleep suit and a baby beanie hat

Why is this important?

If a baby becomes cold after the birth, the baby can be at risk of developing hypothermia. Hypothermia is a condition where the body temperature drops to a dangerously low level. In a newborn, this occurs when the baby’s temperature drops below 36.5°C. A baby with hypothermia may have problems breathing regularly and maintaining their blood sugar and may result in admission to the Neonatal Intensive Care Unit (NICU) for treatment. Leaving the warmth of the womb at birth, the wet newborn baby comes into a much colder environment and immediately starts to lose heat. Most of this heat loss occurs within the first few minutes after birth and if not kept warm in the first 10-20 minutes, the baby may lose enough heat for their body temperature to fall to a very low level. Some babies are more at risk of getting cold, these include:
  • Preterm babies born at less than 37 weeks’ gestation
  • Babies with low birth weight
  • Babies of mothers who are diabetic
  • Babies who need to be resuscitated at birth
  • Babies where the mother has an infection in labour
However, all babies are susceptible to hypothermia in the first few hours after the birth, so it is important to take simple measures after the birth to keep your baby warm.

What will my maternity team do to ensure that my baby is keep warm?

  • Ensure the temperature of the birth room is at least 24°C
  • Check the air conditioning and fans in the birth room are turned off or facing away from the baby
  • Keep windows closed
  • Turn on heaters if appropriate
  • After the birth, your baby will be dried immediately and a hat will be put on your baby’s head.
If there are additional risk factors, then a hat will be placed on your baby’s head to alert all team members that your baby is more at risk of getting cold. Once your baby is dried, the wet towel used to dry your baby will be removed and replaced with a blanket. During skin to skin contact, your baby will be covered with blankets. You will be encouraged to feed your baby or express your breast milk and give your baby within an hour of birth. Bathing your baby should wait until the baby has adjusted to the environment and maintains its temperature. The baby’s temperature will be checked shortly after the birth to ensure that this is within the normal range.

How can you help your baby?

As parents, you can help the maternity team in ensuring that your baby is kept warm. There are many things you can do to help:
  • Tell a midwife or support worker if the birth room is not warm enough. This is very important just before and in the hours after the birth.
  • This may mean reminding a midwife or support worker to close windows and turn off the air conditioning/fans, or turn up the heaters.
  • Ensure that during skin-to-skin contact your baby is covered with blankets.
  • Ensure tht your baby keeps the hat on for the first 12 hours; as much as 25% of heat loss will be from the baby’s head if it is not covered.
  • If a hat has been put on your baby’s head then please keep this in place for 12 hours. You can usually then remove the hat and replace it with one of your own baby hats.
  • When dressing your baby for the time, warm the clothes and blankets beforehand. You can do this by placing the baby clothes against your skin or under your clothes.
  • When in the cot, ensure that your baby is adequately covered. Babies usually need one or two more layers of clothing or bedding than adults.
  • Tell a midwife or support worker if you think your baby’s breathing is not normal.
  • If you notice that your baby is breathing very fast for a continuous period (more than 60 breaths per minute), or seems to be struggling to breathe, with nostrils flaring or making noises wih each breath, then please tell a member of your maternity team.
  • Babies use up energy to keep themselves warm, there you will be encouraged to feed your baby regularly and will be supported in doing so. Some babies may need more frequent feeds. However, a well baby will need to have feeds at least every three hours for the first few days of life.

How long should I take these measures for?

If kept warm, once the baby is around six hours old, then will then usually be able to maintain their temperature at a normal level. The observation of your baby’s temperature will continue for at least 12 hours. Some babies that are unwell or vulnerable at the time of birth (for example, a baby with a low birth weight) may need support to keep warm for a longer period of time. If you have any questions, please ask one of the midwives or support workers.
Posted on

Handling your newborn baby

Handling your newborn baby

Close up of baby wrapped securely in a blanket being held in the mother's arms Babies like being held securely and gently. They need to have their heads and necks carefully supported as their neck muscles are not strong enough to hold their head up yet Babies find touch soothing; an upset baby can be comforted by a gentle cuddle or rhythmic rocking in a parent’s arms. It may often help to wrap your baby up securely in a blanket, although it’s very important not to allow your baby to become overheated. Very occasionally babies are accidentally dropped, particularly when a parent falls asleep holding a baby; or when holding the baby they slip, trip or fall. Here are some things you can do to stop your baby being injured:
  • Return your baby to its cot when settled
  • Change your baby’s nappy on a changing mat on the floor
  • Do not leave your baby unattended on a bed, sofa or changing table, even for a second, as they could roll off
  • Always keep bouncing cradles or baby car seats on the floor, rather than on a table or kitchen worktop, as your baby’s wriggling could tip it over the edge
  • Hold on to the handrail when carrying your baby up and down stairs, in case you trip. Make sure the stairs are free of toys and other trip hazards.
  • Watch where you’re putting your feet while carrying your baby. It’s easy to trip over something like a toy.
Handle with care guide on how to keep your baby safe
Posted on

Coronavirus breastfeeding local information

Coronavirus breastfeeding local information

Amid the current pandemic of widespread infection and difficulties in purchasing formula milks, breastfeeding has never been more important for the health and wellbeing of our babies and their mothers. Current understanding is that COVID-19 cannot be passed to your baby via breastmilk. Infection could be spread to the baby in the same way as to anyone in close contact with you. However, the benefits of breastfeeding outweigh any potential risks of transmission of the virus through breastmilk or by being in close contact with your child. Therefore guidance is that breastfeeding babies should stay with their mothers and continue to be breastfed. Practise excellent hand hygiene: washing thoroughly with soap for a minimum of 20 seconds after touching face or surfaces and before handling your baby. If you are symptomatic, then you can consider wearing a mask when handling and feeding baby. We know that breastmilk is likely to be part of baby’s best defence against the virus if they do contract it; and we know that there are currently shortages of alternative milks for baby, so we hope that this information sheet on breastfeeding support will be useful.
Coronavirus and infant feeding
Coronavirus and pregnancy

Lancashire and South Cumbria local support with breastfeeding during COVID-19

If you are considering beginning breastfeeding for the first time, aiming to increase breastmilk supply because of formula shortages, or having breastfeeding complications that you’d like some support with, then we’ve put together some information about how to access support. Face to face breastfeeding peer support groups have been suspended to protect all. Visits from your midwifery and health visiting service will continue to some degree, but may be not be undertaken face to face or be reduced going forward. However, there are many ways to access support and information from a trained peer supporter or lactation consultants within our area and nationwide, during classic ‘working hours’ and also round the clock, which may be of use. These services are available by telephone, via social media groups and in some cases via WhatsApp video call or similar. NB. THESE ARRANGEMENTS COULD CHANGE DAILY ACCORDING TO STAFF AVAILABILITY but we will update the information regularly. We have agreed care pathways across Lancashire and South Cumbria so that if you require more specialist support, those delivering the below services can refer you onto it.

Families and Babies Lancashire (covering North, Central, East and West Lancashire)

Staffed by peer supporters. Tel: 01254 722929 (9.30am – 2.30pm, 7 days a week) FAB Lancs Breastfeeding Support

Blackpool and Fylde Coast Breastfeeding Support

Staffed by peer supporters and lactation consultants. Fylde Coast Breastfeeding Support

South Cumbria Breastfeeding Support

Staffed by peer supporter/lactation consultant. ann@cumbriabreastfeeding.org.uk South Cumbria Breastfeeding Support SCBS In it Together (new group)

Barnoldswick, Burnley and Colne BFFs

Staffed by peer supporters. Barnoldswick Group Burnley Group Colne Group

Blackburn with Darwen

Staffed by infant feeding support workers and volunteer peers supporters. Tel: 01282 803266 (Voicemail facility – please leave name, contact number and support question and we will respond with two working days.)

Blackburn with Darwen’s Breast Intentions

Staffed by volunteer peer supporters. Breast intentions (BwD infant feeding support)

East Lancs NCT Feeding Support

Staffed by peer supporters. branch.eastlancashire@NCT.org.uk Burnley Bumps and Babies

National support

National Breastfeeding Helpline

Tel: 0300 100 0212 (9.30am – 9.30pm, 7 days a week) National Breastfeeding Helpline

The Breastfeeding Network Drugs in Breastmilk

A service for information on medications or medical conditions and breastfeeding – factsheets written by pharmacist Dr Wendy Jones (MBE). Breastfeeding network drugs fact sheets

La Leche League Helpline

Tel: 0345 120 2918 La Leche League Helpline

NCT Helpline

Tel: 0300 330 0700

Lactation Consultants of Great Britain

An interactive map enables you to find expert and experienced International Board Certified Lactation Consultant (IBCLC) support. Many of our colleagues are using videocalls, email and phone support as a priority during the present COVID-19 situation. (NB Private IBCLC support may incur a fee.) Find an IBCLC

Online support

Breastfeeding Twins and Triplets UK

Breastfeeding Twins and Triplets UK

Breastfeeding With CMPA and Other Food Allergies

Breastfeeding With CMPA and Other Food Allergies Support Group UK

Breastfeeding Yummy Mummies

Evidence based information and support, administration by a team of qualified breastfeeding peer supporters, health visitors, midwives and IBCLC. Breastfeeding Yummy Mummies

Support in other languages

Breastfeeding support in other languages

Information sources for health professionals

UK Drugs in Lactation Advisory Service (UKDILAS)

Information around medications whilst breastfeeding
Posted on

Smoking in the home

Smoking in the home

Close up of baby's hand clasping adult forefinger It may be tempting to start smoking again after the birth of your baby. However, second-hand smoke can still cause great harm to you, your family, and especially your new-born baby. Studies show that smoking during and after pregnancy can put your baby at risk of Sudden Infant Death Syndrome (SIDS). Here are some benefits of keeping your home smoke-free:
  • babies and children from smoke-free homes are less likely to get illnesses such as asthma and meningitis.
  • children that grow up in smoke-free homes are less likely to become smokers themselves.
  • you are less likely to experience accidents caused by smoking, such as fire and injuries.

Support

You are much more likely to quit for good with the help of a trained stop smoking advisor. Your midwife or GP can refer you to local smoking cessation services or you can self-refer via the NHS Smoking Helpline on 0300 123 1044. The type of stop smoking support you receive will depend on where you live and your personal preferences. Stop smoking services usually offer:
  • Weekly support either face-to-face, over the phone or online
  • Free medication or medication on prescription to help you stop smoking
All nicotine replacement therapies are safe to use during breastfeeding.

E-cigarettes

Although not risk free, e-cigarettes carry a small fraction of the risk of smoking. If using an e-cigarette or ‘vaping’ helps you stay smoke free, it is far safer for you and your baby than continuing to smoke. If you want to use an e-cigarette, you can still get free expert help from a specialist stop smoking advisor.
Portal: Smoking in the home after your baby is born
Smoking and breastfeeding Smoke-free homes Safer sleep