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RWH : Neonatal Services |
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RWH : Neonatal Services |
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Outpatient Services
Inpatient Services
The Intensive and Special Care Nurseries are the largest in Victoria with a cot capacity of 58. This comprises 17 intensive care cots and 41 special care cots. Care is provided for neonates and their families in a multidisciplinary environment, with integrated services from medical and nursing personnel, social workers, physiotherapists, psychiatrists, biomedical engineering, chaplaincy services, radiography and pathology departments. All staff are highly committed to the provision of quality care within a family centred approach. In addition, the Department is a major training unit for both nursing and medical staff who wish to pursue further training and skill acquisition in this highly specialised field. Postnatal Wards and Delivery Suites
Premature Infants' Follow-up ProgramStaff at the Royal Women's Hospital have been interested in the outcome throughout childhood for tiny and very premature babies since the 1960s. Most of these children have been born at the Royal Women's Hospital, but some have been born elsewhere in Victoria. We have been assessing how these children grow and develop, how their lungs, eyes and ears work, their general health, how they are progressing at school, and how they and their families are adjusting to changing circumstances as they grow older. These children have been assessed at 2 years of age, then every 3 years until the age of 14 years. The assessments have been very detailed, often taking up to a whole day for older children. The assessments are independent of any other follow-up care relevant to a particular child. The families and doctors involved receive a detailed written report after each assessment. Because the assessments have been so extensive, they have been expensive to run, albeit at no cost to the families concerned. Consequently, only small, selected groups of children have been able to be followed in this detailed way. These groups have comprised children of birthweight up to either 1000g or 1500g born in the 1960s (1966-1970), the 1970s (1977-1979), the 1980s (1980-1982, 1985-1987), and now the 1990s (1991-1992). Currently we plan to assess children who are enrolled in several trials designed to improve the long-term outcome for preterm children. We would like to assess other groups of children in the future. Most children who were very tiny or premature grow and develop normally throughout childhood, suffering the usual childhood complaints at much the same rate as children who were not tiny or premature. They do, however, have a slightly higher chance of problems with their vision, hearing, thinking, walking and talking, for reasons that we do not fully understand. However, as we understand better how to care for these babies in the nursery, their long-term outcome has improved substantially over the years. The follow-up team at the Royal Women's Hospital was initially led by Dr W H Kitchen who retired in 1991. The current team comprises paediatricians, psychologists, and a nurse coordinator. In addition, the Royal Women's Hospital team collaborates with experts in various fields from the Royal Children's Hospital, the Mercy Hospital for Women and Monash Medical Centre. The follow-up team at the Royal Women's Hospital can be contacted on 9344-2089 (24 hours, or through the Royal Women's Hospital Switchboard (9344 2000), and ask for either Kate Callanan, nurse coordinator, or Professor Lex Doyle. Ultrasound ImagingDiagnostic ultrasound services are provided on-site in the Neonatal Intensive Care Unit and the Special Care Nurseries and cover the following applications:
A routine cranial ultrasound examination protocol is in place for infants less than 32 weeks gestation and/or less than 1500g birth-weight, the group of infants at greatest risk for intracranial haemorrhage and infarction. As part of this protocol, interrogation of the anterior cerebral artery with pulsed Doppler is done routinely as we have shown that this is a sensitive screening test for haemodynamically significant PDA. A Resistance Index of 0.85 or above is an indication for echocardiography. Echocardiography is a frequent requirement in the Nurseries in the diagnosis of congenital cardiac malformations, evaluation of PDA, pulmonary hypertension and ventricular dysfunction. Ultrasound-guided interventions are available for bladder aspiration, cyst aspiration, drainage of effusions, placement of arterial and venous catheters and tissue biopsy. An on-going commitment is the training of Paediatric Fellows in neonatal diagnostic ultrasound, which can prepare them for the qualification of DDU over a two-year period. The neonatal ultrasound service is conducted by Dr Rex Betheras (telephone 9344 2477). Protocols and Reference MaterialsJoint medical and nursing protocols are maintained. Departmental protocols may be made available upon application. Reference materials have been developed for use in the department and may be made available upon application.
Current Research Projects
Post Graduate Training OpportunitiesPost Graduate Diploma in Advanced Nursing (Neonatal Intensive Care)
Advanced Standing: Nurses who have completed a post basic Neonatal Intensive Nursing Course in a formally recognised Hospital program and who otherwise meet the entry requirements may seek advanced standing in the postgraduate subjects, exempting them from 50% of the workload. Post Graduate Certificate in Neonatal CareThis qualification is also available with students having the same entry
requirements as above and the same employment requirements as for the
specialist subjects. Neonatal Fellowship TrainingFellowship in Neonatology at the Royal Women's Hospital (RWH) offers a balance between clinical exposure to neonatal intensive and special care in a supervisory capacity, participation in follow-up and a significant time allocation dedicated to research. Allocation of DutiesFellows are allocated to clinical duties for two periods out of five - one in intensive care and one in special care, delivery suites and postnatal wards. During clinical rotations, fellows will be part of a team, consisting of Hospital Medical Officers (HMOs), Fellows and Consultant staff. Fellows will be responsible for HMO supervision and in turn will operate under the guidance of the attending consultant neonatologist. During their special care/delivery suite/postnatal ward rotation fellows will be seconded to outpatient clinics (one fellow per clinic per week). Three periods out of five are allocated to research and training. Participation in night and weekend rosters continues during these "off-service" weeks. Out of Hours Clinical RosterAll Fellows participate in providing a 24 hour supervision for the HMO Junior staff. Every Fellow is rostered for clinical supervisory duties in-house twenty-one weekend day or nighttime shifts per year and six nights per month.
Administrative DutiesAdministrative duties to be shared between the Fellows include:
Annual LeaveEach fellow is entitled to 5 weeks leave per year from 1999. Training in UltrasoundUp to two Fellows per year can be trained in all aspects of neonatal ultrasound. As part of this training these fellows participate in a clinical ultrasound service. Other Fellows will receive exposure to basic training in ultrasound. Training Program
Supervision and EvaluationSupervision Dr Peter Davis is the Neonatal Fellowship Program Supervisor. He can be contacted on extension 2151 during working hours, or at any time through the hospital switchboard. Each trainee will have nominated a Consultant Paediatrician to be their immediate supervisor whilst at the hospital. Associate Professor Lex Doyle is the Postgraduate Training Supervisor. He will allocate supervisors and oversee the training programme. He can be reached on extension 2151 (9.00 a.m. - 5.00 p.m.), or any time through the hospital's switchboard. Evaluation All trainees will be evaluated by Consultant Paediatric Staff, particularly their supervisor and the Director of Paediatrics, as well as Senior Nursing Staff, using pro formas similar to those developed by the Royal Australasian College of Physicians for Advanced Trainees in Paediatrics. These will be discussed with the trainees during and at the completion of their rotation at the Royal Women's Hospital. In turn, the trainees will be asked to evaluate the training programme, with any suggestions for improvement welcomed. It is an expectation that, by the end of a 12 months' Fellowship, at least one minor research project will have been completed (including submission to a scientific meeting or journal), or one major research project will have been designed and be implemented. Research projects that are accepted for presentation at a national meeting will gain the Fellowship trainee financial support to attend the meeting. Funding for international travel for presentation of outstanding research work will be available on a competitive basis. Applications for Fellowship positionsPaediatric trainees interested in joining the Royal Women's Hospital Fellowship program should contact the Neonatal Fellowship Program Supervisor, Dr Peter Davis or the Director of Neonatal Services, Dr Neil Roy. Current fellows are also available to provide additional information regarding the program and life in Melbourne generally. All may be contacted through the RWH switchboard or via email (addresses follow). Telephone and E-mail numbers
Family Support ServicesCase ManagerAll infants admitted into the Intensive and Special Care Nurseries are assigned a Case Manager. A Case Manager is a Neonatal nurse who has experience in both Neonatal Intensive Care and Special Care Nurseries. The Role of the Case Manager includes:
Family Psychiatry ServiceTechnological achievements have greatly advanced the treatment of premature of sick neonates. These break throughs, however, also mean families of babies in special care nurseries have an experience of childbirth which is far from the idealised experience and which itself represents a major life stress or crisis. Recognising that the baby is part of a family, and that there is a reciprocal interaction between the well being of the parents and the well being of the infants, efforts are made at all levels, to sensitively care for and meet the needs of parents. Becoming a mother or father is a challenge with profound psychological implications. This is further complicated by crisis and anxiety over the well being of the baby. Some parents are receptive of psychological interventions at this time which are aimed at preventing subsequent morbidity, such as postnatal depression, post traumatic stress disorder and relationship difficulties within the family. The liaison psychiatrist is available to see parents on referral, to consult with staff of debrief following critical incidents. Social work ServicesA social work service is provided to Neonatal Services Division by 2 part-time Social Workers (Total EFT 1.2). There is an automatic referral of all families whose babies are in NICU to conduct a psycho-social assessment, and to provide a range of services which include emotional support, counselling, practical assistance, advocacy, information provision and linkage with community resources. These services are also provided to families whose babies are in the Special Care Nurseries. The focus here is on country families, those with limited support, families where there are concerns about parenting skills, families where there are issues of violence and abuse and families whose babies have disabilities. Bereavement support and counselling is provided for families after the death of a baby who has been a patient of this unit. Social Workers are involved in parent support and education groups. Social Workers take responsibility for the field education of social work students and are involved with in-service training for students from other disciplines. The social workers, Diane Robinson and Jude Tynan can be contacted at the Social Work Department on 9344-2451 or in the Neonatal Social Work Office on 9344-2415/2969 or by Fax on 9344-2809. Earlybirds AuxiliaryThe Earlybirds Auxiliary Group of the Royal Women's Hospital was formed in mid-1994. We are a group of parents who have had sick and/or premature babies treated in the Neonatal Intensive Care Unit (NICU) and Special Care nurseries on the 9th floor of RWH. We are all so grateful to the hospital and the wonderful nurses for the care we and our babies received, that we decided we would like to give something back in some way. We also felt there was an urgent need for a support group for parents going through the trauma of having a sick baby in hospital. There are an average of 50 babies treated on the 9th floor each month. If we, because we have been through it already, can help make even one family's journey through NICU and Special Care easier then we feel we will have achieved what we set out to do. What do we do?There are two distinct areas within our group - firstly, offering support to parents who are currently going through similar experiences to those we have been through with a sick baby being treated in the 9th floor NICU and Special Care nurseries. This is a very traumatic time for parents especially if this is their first child. We offer support by making ourselves available to speak to parents regarding any worries that they may have. We also invite parents to attend our monthly meetings so that they can see our babies who have "graduated" from the NICU and Special Care nurseries and are now flourishing. This is a wonderful way to let parents know there IS hope and that their baby is receiving the best possible care in the best possible hospital. Secondly, we help raise much needed funds which go towards purchasing the many expensive pieces of life-saving equipment required by the NICU and Special Care nurseries. Anyone who has had a baby treated on the 9th floor can tell you that the number of machines, monitors, drips and alarms used in the treatment of their baby was incredible. When you consider that the hospital has room for 15 NICU patients and 50-60 Special Care patients, that adds up to a huge amount of expensive equipment, and all of which needs regular servicing or replacing. Our current goal is to provide each bed on the 9th floor with is own "oximeter". These cost approximately $2000 each so we have a lot or work to do to reach our goal. We feel it is a very worthwhile goal, and with help, we will achieve it. How can you help?The most effective way in which you can help is by making a donation to the Earlybirds Auxiliary either by way of a cash donation (all donations over $2 are tax deductible) or goods which we can raffle or sell on one of our stalls. Another way to help is to promote awareness of the Earlybirds Auxiliary amongst your workmates, family and friends - The more people who know about our group, the closer we will come to achieving our goals. One more way to be involved is to receive our free monthly newsletter so that you can be up-to-date with our fundraising programme. If you feel you may be able to help us in anyway or you would like to receive our newsletter, please contact Rae Desmond (Divisional Secretary) on 9344-2335. Thank you for taking the time to read about "Earlybirds Auxiliary". Parent Education SessionsAll sessions are held in the Quiet Room
Neonatal Hospital in the Home (HITH)The Neonatal Hospital in the Home (HITH) commenced in November 1997, initially as a pilot study. Purpose/Aim of Neonatal HITHIt is a service offered to allow babies to continue hospital care in their own home with their parents, supported by regular nurse visits and under medical supervision. Most importantly this service facilitates the earlier transfer of the neonate to the home environment. It also enables the reduction in costs caused by long term hospital stays. To be eligible, the infant and family must meet the following HITH criteria before transfer:
The types of infants who fit the criteria are;
Two neonatal HITH nurses are employed to provide the seven day/week service of home visits. Their hours are 0800-1600 hours. Infants involved in HITH are not discharged home and remain the responsibility of the RWH. Parents have access to 24 hour medical and nursing backup and support should any problems arise at home. Other Divisional ActivitiesLevel 2 Neonatal Nursing CourseThe Intensive and Special Care Nurseries offer a 12 week course to employees
of Level 2 nurseries within Victoria to further develop clinical skills in
caring for babies of a higher dependency. Although the focus of this course is
for non-ventilated neonates, some time is spent in the Neonatal Intensive Care
Unit to allow attendance at high risk deliveries and development of skills in
stabilization of these babies while awaiting transfer. The 1998 course was conducted jointly with The Mercy Hospital For Women, with the theoretical program shared between the two hospitals. Double the usual number of students participated with half gaining clinical experience at the RWH and half at the MHW. NETS Continuing Education ProgramThis program is conducted in conjunction with the NETS Education Department
and the Level 3 units at Monash Medical Centre, Mercy Hospital for Women, the
Royal Children's Hospital and The Royal Women's Hospital. The aim is to provide
an update for nursing staff from Level 1 and 2 hospitals within Victoria. It is
offered 3 times a year and the education provided at The Royal Women's Hospital
includes stabilization of the newborn prior to transfer, management of the
infant with respiratory distress and care of the newborn of a chemically
dependent mother. A tour of the Intensive and Special Care Nurseries is
conducted so the staff are aware of the care provided after transfer. Neonatal Resuscitation ProgramA theoretical and practical program is provided each year for all nursing
staff employed by the hospital. This is coordinated for the Intensive and
Special Care Nurseries by the Clinical Facilitator to ensure all staff maintain
competency in this necessary skill. Research/Audit NurseA part-time research/audit nurse is employed as part of the departmental establishment. Duties include:
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