Neonatal Follow-up Program

Publication: 01/05/2008  --
Last review: 21/02/2017  
Next review: 21/02/2020  
Standard Operating Procedure
CURRENT 
ID: 1241 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2017  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Leeds Teaching Hospitals’ Neonatal follow-up program

Scope:

This guidance is for newborn infants who received specialist neonatal care and were discharged to a Leeds post code.

Aim:

To provide structure for the follow-up and reporting of health outcomes in line with national and Network standards 1,2

1. NICE quality standards 2010, 2. DoH neonatal toolkit 2009,

Objectives:

  1. Ensure out-patient follow-up of all at-risk newborn infants
  2. Streamline follow-up to general/specialized neonatal clinics
  3. Provide a structured approach to monitoring and referral for neurodevelopment delay
  4. Provide an audit tool

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4 steps to organise follow-up at discharge:

Step-1: identifying which (at risk group1-6) and (clinic code) - figure 1 & table 1
Step-2: complete & fax out-patient referral proforma- Appendix A
Step-3: ensure other follow-up provisions e.g. neonatal outreach, Developmental massage, ROP etc
Step-4: enter follow-up arrangements on BadgerNet and cc letter to follow-up provider, e.g.CDC consultant

Important Notice: Referrals to CDC are only made following discussion and agreement with the responsible CDC consultant paediatrician. The criteria for referral include: (a) genetic/sydnromic condition with known significant developmental delay e.g. children with Down’s syndrome and (b) any child with significant developmental delay/disorder that is confirmed at follow-up. The timing for referral is decided after discussion with the named CDC consultant paediatrician

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At risk groups 1-6: who does need follow-up?

  1. Preterm infants < 30 weeks gestation
  2. Preterm infants 30+1-36+6 weeks gestation with any of the following:
    • <1500 grams birth weight
    • <2nd centile of weight
    • Ventilated for >72 hours
    • Significantly ill during neonatal period
    • High risk for neurodevelopment problem e.g. abnormal head scan
  3. Infants with HIE (cooled or not cooled)
  4. Infants with chronic lung disease (CLD)
  5. Any infant with significant abnormality on brain imaging
  6. Infants with significant or multiple congenital anomalies
  7. Syndromic diagnoses
  8. Infants at risk of neonatal abstinence syndrome (NAS)
  9. Infants at risk of transmitted infections
  10. Other neonatal problem (discussed at discharge planning)

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At risk groups 1-6: where does follow-up occur?

  1. Neonatal clinics:
    1. Neonatal early intervention (NEOEIF) clinic
    2. Neonatal general (NEOGEN) clinic
    3. Neonatal feeding (NEOFCN) clinic
  2. Local Child development centres (CDC)
  3. Other follow-up provision:
    • Neonatal outreach team follow-up
    • Children’s community nursing team follow-up
    • Developmental massage group
    • Leeds Addiction unit (LAU) team
    • ROP follow-up program
    • Neonatal murmur clinic

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Figure-1: follow-up flowchart (How)

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Table 1: Follow-up (where and when)

Gestation

Neonatal course

Time of
follow-up

Clinic Code

Other follow-up

< 30+0 weeks

No complication

-

3 months
post-discharge

NEOEIF
If ≤ 27+0 weeks

OR

NEOGENN
If ≥27+1 and ≤ 30+0 Weeks

Outreach follow-up √

Developmental massage√

Important: all this babies need an appointment at 2 years corrected age. 2 year’s outcome form should be completed on BadgerNet

Complication

CLD on home oxygen or

Other urgent clinical needs

6-8 weeks
post-discharge

≥ 30+0-<37 weeks

No complication

-

No routine clinic follow-up

 

Outreach follow-up√

Complication

Respiratory support >72 hours, abnormal head scan, IUGR, Birth weight <1500 grams, other

6-8 weeks
post-discharge

NEOGENN

Outreach follow-up√

Term
≥37+0

Complication *

HIE
(+ those with significant seizures, stroke, abnormal neurology, abnormal scan, etc)

3 months
post-discharge

NEOEIF

Developmental massage√

Important: all infants with HIE will need an appointment at 2 years corrected age. 2 year’s outcome form should be completed on BadgerNet

Other complications eg; significant NNU admission, multiple congenital anomalies, meningitis, etc.

6-8 weeks
post-discharge

NEOGENN

-

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Follow-up provision (Where and who)

Neonatal outreach Criteria:
A team of specialist neonatal medical and surgical nurses provides community follow-up of eligible infants till 6-8 weeks of life. Long term nursing input is provided by the children’s community nursing team

  1. Gestation <35 weeks at birth
  2. Weight <2 kg at discharge home
  3. Babies born 35+0-36+6 weeks (discuss with outreach team at discharge planning)
  4. Oxygen dependant babies
  5. NG feeding – short + long term
  6. Complex congenital abnormalities
  7. Neurological complications e.g. seizures, cranial USS abnormalities
  8. Neonatal haematological disorders requiring ongoing monitoring
  9. Palliative care

Developmental massage Criteria
This is a system of early intervention delivered to groups of infants at the child development centre (CDC) at St James’s hospital.

All infants registered with a Leeds GP who are:

  1. less than 30 weeks gestation
  2. less than 1250g birth weight
  3. have identified neuro-developmental concerns (includes congenital cerebral abnormalities, parenchymal lesions, significant fits; significant postural or muscle tone difficulties)
  4. Are oxygen dependent at discharge.

Neonatal Feeding clinic Criteria:
Mostly the criteria for this clinic are the SALT referral criteria:

  1. Infant 37 weeks corrected gestational age and is not progressing well with oral feeds
  2. Infants may be referred at any time if:
    1. There is neurological involvement
    2. There are concerns regarding the safety of the swallow
    3. There are concerns from staff re infant’s feeding skills i.e. where the infant’s feeding patterns give cause for concern even allowing for prematurity
    4. The infant is on long term NG feeds
    5. The infant has undergone surgical intervention and requires TPN +/- tube feeding
  3. Infants with significant growth failure including those with GORD

The timing of first appointment is decided by the feeding clinic team.

Newborn’s with heart murmurs (clinic code NEONPCAR)
All babies with a heart murmur should be assessed by a registrar. If the murmur is still felt to be present then the baby should be referred to paediatric cardiology using the cardiology referral form (appendix 2). Urgent cases should be discussed with the consultant of the week. Cardiologists will then triage these referrals and the majority will be seen in the Neonatal Cardiology Clinic (Code NEONPCAR) by Dr Miall. Please do NOT send referrals direct to Dr Miall.

Patients on NICU with an innocent murmur should be referred as above. Those who have been seen by a paediatric cardiologist on NNU should have follow up under paediatric cardiology as instructed by the cardiology team.

Neonatal Infections clinic:
This includes infants at risk of transmitted infections e.g. HIV, HCV, syphilis.
For timing of the first appointment please refer to specific infection guidelines:
HIV Positive
Hepatitis C Virus in infants of infected mothers
Syphilis (Congenital)

Post-natal ward discharges:
No baby should be referred to any neonatal clinic without prior discussion with outreach sister, senior registrar or consultant. See guideline: Newborn - Full Examination of the Newborn Protocol

Infants with NAS:
These infants are under Leeds Addiction Unit (LAU); however their follow-up is by community paediatrics. Referrals (notification cards) should be made to the Springfield Clinic in Ashley Wing, SJUH under the care of Dr Anna Gregory.
Note; No separate neonatal clinic or infection clinic follow-up is required.
The community paediatric team will follow-up neonatal problems and Hepatitis C and B (first dose of HepB vaccine should be administered prior to discharge). If separate neonatal follow-up is required please inform community paediatrics.

ROP screening follow-up:
This is organised by the ophthalmology team; however it is our duty to confirm follow-up arrangements prior to discharge or transfer of a baby. For discharged babies local follow-up arrangements should be confirmed with the ward clerks. See guideline: Retinopathy of Prematurity

 

Provenance

Record: 1241
Objective:
Clinical condition:

Infants with health or neurodevelopmental risks

Target patient group: All preterm, All sick newborns
Target professional group(s): Secondary Care Doctors
Midwives
Adapted from:

Evidence base

Not supplied

Document history

LHP version 1.0

Related information

Not supplied

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