What can I expect when my baby is admitted to the Peadiatric Intensive Care Unit/High Dependency Unit at Alder Hey?

Information for parents and carers

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What can I expect when my baby is admitted to the Peadiatric Intensive Care Unit/High Dependency Unit at Alder Hey? (298kB)

We understand that your baby being admitted to the Intensive Care Unit (PICU) or High Dependency Unit (HDU) can be a challenging time during their neonatal journey.
We hope the information contained within this leaflet:

• Provides you with more information about what you can expect during your baby’s admission to PICU / HDU
• Helps to identify ways that you can be involved in your baby’s care during this time
• Helps you to feel familiar with what you can expect from the PICU/ HDU team who are caring for your baby
• Points you in the right direct for additional support / advice

What is an Intensive Care Unit (PICU)/ High Dependency Unit (HDU)?

The PICU and HDU at Alder Hey provide specialist care for infants, children and young people with a wide range of medical and surgical conditions. The teams working on PICU and HDU are highly skilled and experienced in caring for the sickest children in the hospital.

Due to the number of patients being cared for, and their varying needs, the PICU / HDU wards tend to feel larger than environments that care for infants only. The pods can feel busy and for some families, overwhelming, as the teams work to care for a wide range of patients safely. We understand this can feel like a big change if you have been used to your baby being cared for in a smaller environment where all of the patients are pre-term or poorly infants.

What can I expect from the PICU / HDU teams during my baby’s admission?

A warm welcome –
When you arrive at Alder Hey the clinical team will focus on taking a full handover and addressing your baby’s immediate medical needs. This might mean that you are asked to wait in a quiet room on the unit. As soon as the team are able, they will introduce themselves and you will be given access to an admissions pack containing information about the unit. You will be supported to access accommodation, facilities for expressing breastmilk and shown where you can make a drink or take a break.

Communication with key members of your baby’s team –
You will receive regular updates from the medical and nursing teams. The Alder Hey team is large and there may be multiple specialities involved in your baby’s care. This means that you may meet lots of different people at different times. There is a helpful poster in the atrium helping you identify some of the different staff roles from the colour uniforms they wear.

Everyone should introduce themselves and explain why they are visiting your baby. It is ok to ask who they are, even if you have met them before. Your bedside nurse can help you to remember who has visited, why and when. They can also join you in meetings and help you prepare your questions for the team.

Support for you to be involved in your baby’s care –
We welcome your involvement in your baby’s care and appreciate that you may have been looking after your baby at home or in other hospital settings before this admission. Alternatively, you might be getting to know your baby for the first time. This admission might be unexpected or part of a plan which was made during your pregnancy.

All these scenarios are quite different and working out what is best for you and your baby will be an ongoing conversation with the team. We aim to support you to be a parent in this environment, acknowledging that this might look different than it has before or from how you imagined.

Care for your baby safely –
The PICU / HDU is designed to ensure the highest standards of care and safety for all our patients.

This means that we take infection prevention seriously. We ask that you follow guidelines such as removing outdoor clothing, washing your hands and avoid visiting other bedspaces. You can help us keep our units safe by reminding your visitors of these same rules and by raising any concerns regarding infection control with our senior nursing team.

On PICU / HDU we ask that only two people visit a bedspace at any one time. This may differ from the visiting arrangements in other settings where your baby has been cared for. We understand that a change in visiting rules might feel difficult, especially if you and your baby have benefited from having the support of close family or friends. We hope you understand that these rules are in place to keep all the patients safe.

We also ask that parents do not take responsibility for completing observations, adjust any of the medical equipment or move their baby without the guidance of the medical team.

Your baby’s pod may be closed for surgical or high-risk procedures, during which it becomes a theatre environment for patients who are too poorly to be moved. Each pod is routinely closed twice a day for approximately 30 mins to allow for nurse-to-nurse handover. We close our units at this time to protect the confidentiality of our patients and to make sure critical information is handed over ready for the next shift.

We understand that these safety mesures (including spending periods away from your baby) can be difficult to adjust to if you have spent time in different medical settings or at home. You are welcome to ask us questions about how our unit runs or call the unit for updates during pod closures. You may also wish to leave bonding squares so your baby can soothed by your familiar scent. You can find up to date information regarding the opening / closing of pods displayed at our reception desk.

Encourage you to care for yourselves –
Your wellbeing is important to us and it is important that you get rest when you can so that you can be there for your baby. We will encourage you to eat, drink and take breaks from the unit.

This is particularly important for parents who are in the early days of the post-partum stage and may have had surgery themselves, be expressing breastmilk or adjusting to the normal physical and emotional changes post birth.

The Trust midwife is available Monday and Friday and appointments are allocated by the volunteer team. If you need support at any other time, ask your nurse to make contact with the Midwife.

If you are breastfeeding or expressing breastmilk, you are entitled to meal vouchers which can be used in the restaurant.

Support you with your infant feeding preferences –
Alder Hey encourages breastfeeding or expressing breastmilk as a way of providing nutrition for your baby. Whilst your baby is on critical care, you may not be able to breastfeed. During this time we encourage you to express breastmilk which can be fed to your baby wherever possible. Your baby’s nutritional needs will be assessed by a Dietician who will work with you to formulate the most appropriate feeding plan.

For infection control reasons, use of your own pump on PICU is not recommended. You can use your own pump in Ronald MacDonald if you wish but, when in hospital, please use our hospital grade pumps with disposable packs.

All staff are able to support you with your feeding preferences. However, if you any any questions or concerns regarding infant feeding, please ask your bedside nurse who can arrange for a referral to be made to the Deitician or Infant Feeding Team as appropriate.

The infant feeding and volunteer team hold coffee mornings in the quiet room on alternate Fridays. All parents are welcome.

Welcome and respond to your feedback –
We value your feedback and encourage you to raise any concerns with our senior nursing team in the first instance. In the majority of cases, they can respond to your feedback in the most efficient and effective manner.

How can I be actively involved in my baby’s care during their PICU / HDU admission?

The PICU and HDU teams at Alder Hey believe that a strong partnership between families and professionals allows our patients to receive the best care. We aim to work alongside you to look after your baby at all stages of their admission. Medical management is of paramount importance on PICU/ HDU but we also recognise the vital role of parental involvement and bonding to enable your child to feel safe, secure and of course to develop. We support this but need to keep your baby safe at all times.

At Alder Hey we assess stability on PICU/HDUby looking at lots of information about your baby. This allows us to decide an activity level (Seed/Shoot/Leaves) which guides us to identify the activities you can do with your baby.

Seed These babies are likely to be on a high level of suppoort. Although cuddles and your involvement in cares may not be possible at this time, there are still activities you can do such as;

• Read or sing gently to them
• Offer them your comforting touch
• Settle and soothe them with your familiar smell (e.g use of bonding squares)
• Help us get to know them by sharing what they have liked/ disliked at different stages of their journey
• Help us shape their environment

Shoot

These babies are more stable and you can be more involved. Talk to your baby’s bedside nurse about;

• Changing their nappy
• Eye and mouth care
• Washing them
• Notice them communicating and have ‘conversations’
• Help us to work with your baby’s routines
• Cuddles at this time may be possible

Leaves

These babies are usually well enough to be leaving PICU/HDU. They would be
breathing themselves or or on less support, for example, high flow. At this stage
we would welcome and encourage;

• Your ideas to help us prepare for the next transition (e.g. moving back to
  your ‘home’ hospital)
• You to spend more time cuddling your baby independently – You to be involved in their cares
• You to be following a neurodevelopmental plan with the support of
  Physiotherapy or Occupational Therapy

We welcome your questions and ideas and are happy to discuss ways in which you can help your baby while on PICU/HDU.

Where can I find additional support/information?

This leaflet only gives general information. You must always discuss the individual treatment of your child with the appropriate member of staff. Do not rely on this leaflet alone for information about your child’s treatment.
This information can be made available in other languages and formats if requested.

This information can be made available in other languages and formats if requested.

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