NHS England » National standards for neonatal qualified in specialty (QIS) education (2024)

Equality and diversity

Learners should understand:

• the value and benefits diversity brings and the reasons for promoting inclusion for all (including families, carers, colleagues and peers) across all settings
• the diversity of the local population their unit serves, and the negative impact inequalities can have on care (and access to services) for infants and their families or carers
• the principles of personalised, family-centred care based on what matters to families and how the expertise, capacity and potential of families and carers can support good care
• the importance of ensuring all service users have equal access and reasonable adjustments are provided
• awareness of the role allyship plays and of the importance of advocating for people from marginalised groups and raising awareness about issues affecting infants, their families and carers and colleagues

Equality and diversity

Learners should be able to:

• champion equality and diversity
• act as an ally within your team or clinical setting
• champion underrepresented groups and seek ways to provide a fairer environment for infants and their families and carers, as well as colleagues

Effective communication and documentation

• the importance of clear, easy to understand and accessible communication and how to provide it (including the use of multiple formats to enable access)
• the importance of providing open and honest information to families and carers at an appropriate level and pace
• the importance of advocacy within practice for infants, families and carers
• the importance of ensuring that documentation reflects the needs of the infants and their families or carers and records any communication that has taken place
• the principles of confidentiality and information sharing
• the importance of communicating or escalating any changes or concerns to relevant team(s)
• the impact of conflict in healthcare settings and of appropriate and timely management to reduce the risk of consequences for healthcare teams, individual staff, and, most importantly, infants and their families or carers

Effective communication and documentation

• encourage and empower families and carers to become confident and knowledgeable in their infant’s care
• support and empower families to ask questions and make suggestions, embedding the principles of family-integrated care (FICare) in all activities
• contribute to the support of people in emotional distress (families, carers and colleagues) and provide relevant signposting and referrals to support services
• respond appropriately and promptly to any questions or concerns raised
• demonstrate safe and effective record keeping and data sharing principles
• demonstrate timely escalation to senior colleagues (nursing, medical, allied health professional and psychological colleagues)
• develop knowledge and skills to improve the recognition of potential conflict and early intervention to manage conflict between families, clinical teams, colleagues and others
• Signpost families or carers to relevant health advocacy services, where appropriate
• demonstrate the ability to effectively handover the care of an infant, using a structured approach
• use communication tools such as SBAR within clinical practice

Teamwork and compassionate leadership

• the importance of upholding standards and promoting good practice across teams and departments, and enabling infants, families, carers and colleagues to feel valued, respected and cared for
• the key principles of effective multidisciplinary team (MDT) working (teamwork, communication, professionalism and mutual respect)
• 5 Cs of compassionate leadership: consciousness, curiosity, compassion, competence and courage

Teamwork and compassionate leadership

• demonstrate an awareness of their own feelings and those of others and the impact of how they act on these feelings
• work collaboratively within a multidisciplinary team (MDT) to ensure the clinical and holistic needs of infants, their families and carers are met
• manage their time effectively and to prioritise and delegate
• demonstrate emotional intelligence, self-awareness, self-regulation, reflection and empathy

Clinical governance

• the key principles and processes of clinical governance and patient safety
• accountability and your role as an individual in the effective use of clinical governance processes to maintain and improve patient safety
• the key principles of openness and the duty of candour, prioritising compassionate engagement with those affected by patient safety incidents
• the importance of learning from incidents to service improvement and quality improvement and the importance of seeking out the service user voice (families and carers) throughout the neonatal journey and post-discharge

Clinical governance

• demonstrate clear understanding of the duty of candour in practice
• work within organisational processes
• escalate concerns, report incidents and risks
• reflect on and embed their learning within their own practice

Legal and ethical principles

• understand the key concepts of ethical decision making and the role of those providing cot-side care in ethical discussions, ensuring decision-making is family-centred and respectful of individual cultural differences

Legal and ethical principles

• identify ethical issues within daily care and describe their role in supporting ethical decision-making

Safeguarding

• understand the key principles of safeguarding
• identifying and initiating the safeguarding process where there are concerns of harm (including staff and families or carers)
• the need to demonstrate professional curiosity by questioning/challenging information, identifying concerns and making connections to enable a greater understanding of a situation
• each individual healthcare professional working in the NHS, to ensure that the principles and duties of safeguarding children and adults are holistically, consistently and conscientiously applied

Safeguarding

• demonstrate clear understanding of principles of safeguarding
• identifying safeguarding processes where there are concerns of harm (including staff and families or carers)
• work within organisational safeguarding processes
• escalating concerns, reporting related incidents

Engagement and quality improvement

• the roles of service improvement and service user engagement through co-production

Engagement and quality improvement

• adopt approaches that support and empower service user engagement

Professional development

• the importance of personal development
• the need to take responsibility in maintaining skills and ensuring accountability
• the importance of ongoing engagement with national and international practice to supporting professional development and high standards of care

Professional development

• apply existing local, regional and national guidance to practice
• adopt critical thinking in evidence-based practice and describe levels of evidence and their reliability

Specialist knowledge

Specialist skills

• career opportunities beyond QIS
• responsibility in maintaining high dependency (HDU) and intensive care skills and accountability

• actively seek opportunities to maintain and further develop clinical skills, support other learners within the multidisciplinary team (MDT) and promote a positive learning environment

Foundation knowledge

Foundation skills

Learners should understand:

Neonatal care pathways and levels of care

• the structure of neonatal services
• neonatal levels of care
• the neonatal care pathways (for example, transitional care, outreach, hospice, transport)

Key principles of neonatal care

• the impact of neonatal pathways, the transfer of infants between services and the impact this has on families and carers
• key neonatal and perinatal organisations involved in supporting infants and families
• the vital role that families and carers provide to support service improvement throughout their neonatal journey and post-discharge. Learners should know about and be able to signpost families and carers to local and national groups (such as maternity and neonatal voice partnerships, parent advisory groups, and relevant voluntary community and social enterprises)

Transport team

• the transport team, in utero transfers, time critical transfers, and repatriation

Professionals working within neonatal and other services

• the roles different professionals working within neonatal and other services have on care provision
• the key principles of neonatal care and the interlinking roles of other professionals within the multidisciplinary team (MDT)

Learners should be able to:

• describe the role of operational delivery networks (ODNs) within the neonatal care pathway
• describe the neonatal levels of care: special care baby unit or special care unit (SCBU or SCU), local neonatal unit (LNU), and neonatal intensive care unit (NICU)
• describe relevant resources and networks to support infants and their families and carers
• identify and signpost people to relevant resources to support infants and their family or carers (recognising varying accessibility requirements and facilitating equal access)

Specialist knowledge

Specialist skills

• the purpose and function of neonatal services at regional level
• the national maternity and neonatal programme and its impact on neonatal care delivery (basic overview)
• the current standards and frameworks that underpin neonatal care (for example, the British Association of Perinatal Medicine)

• articulate the impact the neonatal journey mayhave on families and carers and the information and signposting that can support them
• describe how the operational delivery network (ODN) fits into the wider system (the local maternity and neonatal system (LMNS) and the integrated care board (ICB))
• describe the role of the neonatal transport team within regional neonatal services

Foundation knowledge

Foundation skills

Learners should understand:

Embryology, anatomy and physiology

• the anatomy and physiology of the gastrointestinal system
• gestational development – including the integration of suck, swallow and breathe reflex
• identifying feeding readiness and supporting the transition from tube feeding to cue-based responsive feeding

Learners should be able to:

Embryology, anatomy and physiology

• recognise indicators of normal and abnormal gastrointestinal function and report deviations (for example, stools and abdomen)

Principles of feeding

• the importance of family-integrated care (FICare) in the provision of nutrition and feeding and appropriate sources of information and signposting when supporting families or carers with feeding choices
• the principles of responsive feeding
• early feeding strategies including mouthcare, non-nutritive sucking and supportive tube feeding

Principles of feeding

• use a range of resources to appropriately advise and support families or carers
• label and store all milk types correctly
• recognise and support mothers in identifying infant cues and readiness for feeding
• promote closeness and skin-to-skin contact between families and carers and infants to stimulate feeding behaviours
• advise and support families and carers in sterilisation methods and equipment storage
• support responsive feeding within their practice
• employ appropriate non-nutritive sucking
• complete all feeding-related documentation accurately
• identify deviations from normal trends and escalate accordingly

Growth

• factors affecting postnatal growth(including congenital anomalies)
• The importance of growth measurement, documentation and the identification of concerns (weight, length, head circumference)

Growth

• monitor and document growth (weight, length, head circumference)

Nutritional supplementation

• the role of specialist formulas and supplementation
• the role of probiotics and prebiotics
• the key principles of reconstitution, labelling and storage of artificial feeds and supplements (including fortifier)

Nutritional supplementation

• prepare specialist formulas, fortifier and supplements and administer correctly according to prescription

Role of the multidisciplinary team (MDT)

• the role of other healthcare professionals in the multidisciplinary team (dietician, speech and language therapist, infant feeding lead)
• the role of the multidisciplinary team approach in supporting early intervention and problem prevention
• the importance of optimal nutrition in preterm and sick infants, when to escalate and who to escalate to when problems arise

Role of the multidisciplinary team (MDT)

• initiate appropriate referral to specialist personnel; Dietician/ speech and language therapist/Infant feeding lead

Nutritional regimens

• the importance of adequate nutrition and essential components
• nutritional requirements depending on gestation (enteral regimes)
• storage of nutrients (for example, glycogen, subcutaneous fat)
• causes and consequences of electrolyte imbalance
• the need for individualized feeding regimes following surgery
• the range of infant formulas available (including pre-term and term formulas)

Nutritional regimens

• calculate daily fluid requirements taking account of local guidance and acknowledging gestational or condition-specific requirements
• monitor and document fluid balance
• identify gestational feeding development and individualised, typical/atypical oral feeding behaviour. Record and report findings

Breastfeeding and breastmilk

• anatomy and physiology of lactation, the breast and breastfeeding
• Baby Friendly Initiative standards and their application to practice
• the short and long-term benefits of breastmilk and breastfeeding for the infant and the mother
• the differences between maternal own milk, donor human milk, and infant formulas, when and how they are used
• human milk fortifiers
• the theory and specifics of breastmilk expressing (hand and mechanical)
• the importance of closeness and skin-to-skincontact
• the assessment of expressionand supporting lactation
• the assessment of readiness for breastfeeding – cues and coordination
• positioning and attachment
• the assessment of breastfeeding intake
• supporting the infant and mother in the transition to breastfeeding
• when to seek support and escalate concerns
• the importance of correct breast or formula milk labelling and checking procedures
• donor breastmilk processes(awareness of the processes and compliance)
• situations in which breastfeeding may not be recommended (for example, maternal medication)
• appropriate sources of information and signposts to employ when supporting families and carers

Breastfeeding and breastmilk

• discuss the short and long-term benefits of breastmilk and feeding with families and carers to support informed decision making
• identify potential and actual barriers to successful breastfeeding (for example, prematurity, separation, lack of support and societal issues) and troubleshoot and seek assistance if necessary
• support the mother and infant in preparation for breastfeeding to optimise outcomes
• support mother and infant in correct positioning and attachment
• support mother and infant throughout breastfeeding
• assess and document breast feed efficiency (observing latch, suck-swallow-breathe pattern and breast condition following feed)
• manage top-up feeds appropriately
• adhere to feeding plans and escalate for review as necessary
• facilitate and support mothers in hand expressing within the first 2 hours of life (when possible)
• help mothers with methods of expressing breastmilk, (hand and pump) and with optimising lactation
• help mothers with appropriate timing and frequency for expressing
• signpost mothers to agencies and organisations that support breastfeeding and expressing (internal, local, regional, and national)
• manage stored expressed breastmilk to optimise the nutritional benefits for the infant and minimise waste
• adhere to local process for donor milk
• complete Baby Friendly Initiative (BFI) training
• adhere to the checking process for milk before administration

Alternative feeding methods

• principles of bottle feeding (side lying and positioning, coordination and fatigue)
• the range of teats available
• the principles of safe preparation and administration of bottle feeds in hospital and at home
• the rationale for alternative methods of feeding such as cup and syringe feeding (under specialist guidance)

Alternative feeding methods

• identify types of formula milk available
• adhere to the international code of marketing of breastmilk substitutes
• prepare and reconstitute formula milk correctly and demonstrate this to families and carers
• select appropriate teats
• help families and carers to understand how to safely make up and administer bottle feeds in hospital and at home
• demonstrate appropriate infant positioning for bottle feeding (cradle hold, side lying)
• demonstrate safe technique for the use of other feeding methods (for example, cup or syringe) in line with specialist advice
• recognise, discuss and respond appropriately to infants at risk of feeding problems (for example, poor co-ordination or fatigue). Seek assistance and escalate as required
• employ and facilitate responsive bottle-feeding strategies

Enteral feeding

• the principles of nasogastric tube (NGT) orogastric tube (OGT) insertion and ongoing care
• the principles of naso-jejunal feeding and ongoing care
• The principles and clinical use of continuous feeds
• safety (assessment of tube position, enteral syringes)
• the principles of non-nutritive sucking (including family or carer consent)
• the principles and correct implementation of alternative feeding methods supported by specialist multidisciplinary teams (MDTs)

Enteral feeding

• explain the physiology and rationale for nasogastric tube (NGT) orogastric tube (OGT) placement to families and carers
• prepare appropriate equipment in line with current National Patient Safety Alert guidance
• prepare infant for intervention appropriately
• measure tube length correctly
• insert and secure gastric tube safely, observing infant physiological status throughout and responding appropriately
• undertake gastric aspirate assessment and document and report findings appropriately
• demonstrate when and how to escalate concerns with gastric aspirates or NGT or OGT placement or position
• complete all documentation correctly
• administer feed safely and observe physiological status throughout
• provide appropriate neurodevelopmental support during tube feeds (oral stimulation and non-nutritive sucking (NNS), pacing, touch or comfort holding, attunement) and settling post-feed
• recognise possible NGT or OGT displacement and demonstrate safe removal
• provide support and information for families and carers regarding tube feeding, including supporting families and carers to tube feed their infant

Conditions and complications that relate to nutrition and feeding

• the characteristics of intrauterine growth restriction (IUGR), associated risk factors and conditions
• differences for IUGR/ low birth weight (LBW) and preterm feeding patterns
• necrotising enterocolitis (NEC): aetiology, infants at risk, prevalence, identifying signs and symptoms
• gastro-oesophageal reflux (GOR): aetiology and strategies to support the infant with reflux
• congenital anomalies affecting feeds and nutrition (for example, cleft lip and palate)
• chronic lung disease
• cardiac and neurological conditions
• genetic conditions and syndromes
• surgical and structural conditions
• the importance of breastmilk and buccal colostrum in surgical infants

Conditions and complications that relate to nutrition and feeding

• identify signs and symptoms of neonatal gastro oesophageal reflux, report findings and implement a plan of care
• identify the signs and symptoms of necrotising enterocolitis, report findings and implement a plan of care

Intravenous nutrition and care of indwelling lines

• contraindications to enteral feeding
• risks and benefits associated with use of peripheral venous lines
• commonly used intravenous fluid regimes and their limitations; changing fluid and electrolytes needs in the first few days
• the use of parenteral nutrition

Intravenous nutrition and care of indwelling lines

• set up, maintain and discontinue peripheral intravenous nutrition
• recognise and escalate complications (including extravasation and risk of over-infusion)

Renal

• anatomy and physiology of renal and lower gastrointestinal structures
• appropriate sources of information and signposts to use to support families and carers
• normal parameters for urine output
• gestational differences
• the role of urinalysis
• the role of diuretics

Renal

• utilise appropriate personal protective equipment (PPE) and observe infection control procedures
• measure urine output and calculate 24-hour fluid balance
• demonstrate care of urinary catheter
• collect and process urine samples correctly using non-invasive methods
• accurate documentation of urine (including descriptive features)
• identify when and how to escalate concerns
• use a range of resources and appropriately advise and support families and carers

Upper gastrointestinal output

• normal and abnormal gastric aspirates or loss
• normal and abnormal vomits or loss

Upper gastrointestinal output

• demonstrate awareness of local guidance regarding gastric loss replacement
• accurately document (including descriptive features) all losses (aspirates/vomits/stool)

Lower gastrointestinal output

• normal and abnormal stool output
• gestational and age differences
• stools in the first 24 hours of life
• common conditions that have an impact upon stool output
• common causes of constipation and immediate care strategies

Lower gastrointestinal output

• demonstrate awareness of normal stoma losses
• administer a glycerine chip as prescribed

Glucose homeostasis

• aetiology and physiology of hypo/hyperglycaemia
• infants at increased vulnerability
• actions at birth to reduce incidence of hypo/hyperglycaemia
• signs and symptoms
• care interventions to support the hypo/hyperglycaemic infant
• transition from IV to enteral nutrition (nasogastric tube (NGT), breastfeeding (BF), expressed breastmilk (EBM), formula)
• maternal factors that impact glucose metabolism (for example, diabetes, obesity, medication)
• when to seek support and escalate concerns
• appropriate sources of information and signposts to employ when supporting families or carers

Glucose homeostasis

• locate and discuss local guidelines for the management of hypo/hyper glycaemia
• identify infants who are at increased risk
• implement care interventions to support the vulnerable/hypo/hyper glycaemic infant
• identify when blood glucose monitoring is required
• coordinate care to minimise invasive painful procedures
• prepare equipment and the infant’s, families’ and carers’ environment appropriately
• collect and process the sample correctly and document results
• use a range of resources and appropriately advise and support families and carers
• support the infant transitioning from IV to enteral nutrition, titrating fluids and feeds accordingly and reflect families and carers feeding choices
• identify and escalate concerns

Hyperbilirubinemia

• physiology of bilirubin production, transport metabolism and excretion
• conjugated and unconjugated bilirubin
• physiological and pathological causes (including ABO and breastmilk).
• significance of hyperbilirubinemia at under 24 hours of age
• prolonged causes (total parenteral nutrition (TPN), gut surgery)
• bilirubin encephalopathy and kernicterus
• awareness of National Institute for Health and Care Excellence (NICE) guidance
• approaches to visual assessment in all skin tones and recognising the limitations
• relevance of maternal bloods
• when to seek support and escalate concerns

Hyperbilirubinemia

• holistically assess the infant for hyperbilirubinemia recognising limitationsdemonstrate awareness of the ongoing need for hyperbilirubinemia assessment and monitoring

Bilirubin monitoring

• the principles of bilirubin monitoring and when to initiate
• measurement options and limitations (considerations for different skin tones)
• documentation (how to plot results)
• treatment thresholds and trajectories and gestational differences

Bilirubin monitoring

• identify and use appropriate bilirubin measurement techniques (transcutaneous bilirubinometer, serum bilirubin)
• prepare the infant and families and carers for relevant procedures and actively engage them in positioning and comforting their infant (according to their comfort level)
• use pain assessment and alleviation strategies throughout and after the procedure
• choose appropriate equipment for the gestation of the infant
• undertake the procedure and label and process the sample appropriately
• identify, complete and accurately interpret gestational appropriate treatment threshold charts

Phototherapy

• principles and physiology
• modes of delivery and appropriate levels of treatment (for example, irradiance levels and intensity of treatment, depending on device used)
• cot-side care (eye and skin care, exposure, thermoregulation)
• side effects
• fluids and feeding
• the process of an exchange transfusion (basic awareness)
• what sources of information and signposts are appropriate when supporting families or carers.

Phototherapy

• identify and set up appropriate equipment
• prepare and provide ongoing care for infants receiving phototherapy
• support family and carers to navigate equipment etc., actively engaging them in positioning and comforting their infant
• identify when phototherapy should be discontinued
• consider exposure, eye and skin care, and thermoregulation
• identify when and how to escalate concerns
• demonstrate awareness of the ongoing need for hyperbilirubinemia assessment and monitoring
• manage fluid and feeding
• use a range of resources and appropriately advise and support families and carers

Specialist knowledge

Specialist skills

• the current national feeding guidelines for the preterm (overview)
• the impact of intensive care on long-term feeding outcomes
• the benefits and regimens for trophic feeding
• the expected growth patterns of the preterm infant
• adequate calorific intake for growth
• high risk-feeding regimens
• parenteral nutrition (PN) constituents (micro and macro nutrients): administration, risks and benefits
• the importance of fluid and electrolyte balance
• the nutritional considerations for infants who are ‘nil by mouth’ (for example, necrotising enterocolitis)
• the care principles, risks and benefits of central lines (umbilical vein/arterial lines, percutaneous venous long lines and peripheral arterial lines)
• metabolic disorders

• devise feeding plans in partnership with families and carers and review appropriately
• insert and manage a naso-jejunal (NJ) tube
• implement nutritional regimens for the high-risk infant
• calculate intravenous nutritional requirements for the extreme preterm or sick infant
• set up, maintain and discontinue intravenous nutrition via central access
• titrate intravenous nutrition and other infusions accurately
• recognise appropriate administration sites and contraindications of infusions

Renal and fluid balance

• the importance of accurate fluid balance in the extreme preterm and sick infant, including considerations of additional fluid losses (for example, bloods sampling or flushes)
• water homeostasis, reabsorption of electrolytes, excretion, and acid-base balance; sensible and insensible water losses in the newborn
• the relevance of urinary pH or specific gravity
• the relevance of glycosuria, leucocytes, haematuria or proteinuria
• expected urine output and the causes of oliguria and polyuria)
• acute renal failure – acute tubular necrosis(ATN)
• the recognition and management of renal failure or fluid overload
• situations leading to fluid restriction or liberation
• awareness of haemodialysis methods

Renal and fluid balance

• demonstrate accurate elimination and fluid output monitoring and documentation in the sick or extreme preterm infant
• demonstrate care of urinary catheter
• identify when to escalate concerns
• identify concerning gastric aspirates and vomit and escalate promptly
• use a range of resources and appropriately advise and support families and carers

Glucose homeostasis

• the clinical situation in which infants may require insulin infusions
• the role and action of administered insulin

Glucose homeostasis

• care for the infant receiving insulin infusion
• prepare, calculate and administer insulin infusions
• prepare, calculate and administer increased glucose concentrations

Hyperbilirubinemia

• haemolytic disease (risk factors, causes, and possible consequences including hydrops)
• intensive phototherapy
• intravenous immunoglobulin (IVIG)
• cot-side care

Exchange transfusion

• rationale and effect (dilutional, double or single volume)
• process and methods
• risks
• cot-side care/role in exchange transfusion

Exchange transfusion

• identify local guidance and the equipment required to undertake an exchange transfusion
• observe and monitor throughout the process
• demonstrate awareness of how to access blood units
• complete pre-transfusion screening (if the infant is less than 5 days old)
• use a range of resources and appropriately advise and support families and carers

Related foundation equipment

• feed warmers
• scales
• infant measuring boards tool
• pH strips
• breast pumps and kits
• sterilising equipment
• feeding cups
• nipple shields
• bottles/ teats
• equipment for supporting side lying (cushions, stools)
• privacy screens
• chairs
• enteral feeding pump
• ward urinalysis testing (if relevant)
• nappy scales
• blood glucose monitoring devices
• blood gas analysers
• lancets
• phototherapy units
• billibeds or billiblankets
• ward-based serum bilirubin (SBR) analysis (where relevant)
• transcutaneous monitoring

Related specialist equipment

• blood warmers
• IV pumps

Related resources

• Breastmilk provision for preterm and sick neonates
• Infant feeding

Foundation knowledge

Foundation skills

Learners should understand:

Respiratory care and conditions

• the embryology, anatomy and physiology of the respiratory system
• how positioning can be used to optimise respiratory function
• gestational differences
• surfactant production and function
• infants at greater risk of respiratory compromise
• normal respiratory parameters and behaviours
• holistic respiratory assessment and indicators of respiratory distress and deterioration(visual assessment, respiratory monitoring, basic blood gas interpretation, investigations)
• how to recognise deterioration and ensure appropriate and timely clinical escalation
• the principles of basic life support
• oxygen therapy
• the principles and cot-side care of non-invasive ventilation modes
• the principles of humidity in respiratory therapy
• the principles of nasal and oral suction
• the importance of seeking support and escalating concerns
• the principles of an accurate 24-hour oxygen saturation record (as part of discharge planning)
• appropriate sources of information and signposting when supporting families and carers

Learners should be able to:

Respiratory care and conditions

• use a variety of resources to provide relevant support and information for families and carers regarding respiratory care so that families and carers are actively engaged in all care activities
• demonstrate awareness of respiratory differences between term and preterm infants
• demonstrate awareness of clinical deterioration and escalation
• identify signs of respiratory distress (respiratory rate, oxygen saturation, recession, grunting, nasal flare), intervening and auscultating appropriately
• demonstrate the ability to set up, apply and provide ongoing care for a range of respiratory therapies (low flow regulators, high flow delivery systems, continuous positive airway pressure (CPAP), synchronized inspiratory positive airway pressure (SiPAP) and duo positive airway pressure (DuoPAP) delivery systems
• demonstrate clinical application and interpretation of respiratory monitoring (alarm parameters, limitations and possible sources of error)
• demonstrate basic pathophysiology and cot-side care of common respiratory conditions
• undertake and document respiratory assessment
• plan and implement nursing care of a baby at risk of apnoea of prematurity
• respond appropriately to the apnoeic or desaturating infant
• check resuscitation equipment correctly
• demonstrate safe use of resuscitation equipment
• employ positioning to optimise respiratory statusincluding the use of supportive equipment and demonstrate the ability to consistently position infants appropriately to safeguard airway and optimise respiratory function. Support kangaroo care (skin-to-skin contact) to ensure optimal comfort and stability
• follow safe nasal and oral suction technique
• discuss the rationale for and demonstration of the safe use of humidity within respiratory therapy
• evaluate the effectiveness of care interventions on respiratory status
• demonstrate basic knowledge of blood gases, identifying abnormal parameters and responsibilities for escalation and documentation
• document, evaluate and report all aspects of respiratory care appropriately
• discuss how to facilitate a 24-hour oxygen saturation recording and how to troubleshoot and escalate concerns

Cardiovascular care, monitoring and assessment

• the embryology, anatomy, and physiology of the cardiac system including foetal circulation and adaptations at birth
• the principles of cardiac monitoring and assessment
• gestational appropriate parameters for heart rate, blood pressure, perfusion (including different skin tones)
• the significance of deviations from the norm and cardiovascular instability
• the importance of documentation and trends in data

Cardiovascular care, monitoring and assessment

• demonstrate applied knowledge of normal cardiovascular parameters, including gestational differences
• identify and utilise appropriate cardiac monitoring for low dependency infants with a range of care needs
• set correct alarm parameters for health status and gestation and identify limitations and possible sources of error
• identify physiological and visual indicators of cardiovascular instability and respond appropriately
• document, evaluate and report all aspects of cardiac care appropriately and identify when and how to escalate concerns

Cardiac conditions

• common congenital heart conditions (basic awareness)
• Patent Ductus Arteriosus (PDA) and its role and impact (basic awareness)

Cardiac conditions

• demonstrate applied knowledge of condition-specific cardiovascular parameters
• provide relevant support and information for families and carers regarding cardiac care including preparation for investigations and procedure

Haematology

• normal blood values (basic understanding)
• anaemia of prematurity symptoms and causes
• transfusion of blood products; indication, risks, process (basic overview)
• when to seek support and escalate concerns

Haematology

• discuss anaemia of prematurity and list the signs and symptoms of anaemia in the preterm or sick infant
• participate in the safe administration of blood products

Specialist knowledge

Specialist skills

Respiratory care and conditions

• relevant embryology, anatomy and physiology of the respiratory system
• the pathophysiology of respiratory conditions
• the impact of surfactant deficiency on respiratory status and treatment strategies
• surfactant administration
• holistic respiratory assessment and indicators of respiratory distress and deterioration (visual assessment, respiratory monitoring, blood gas interpretation and responsibilities, investigations)
• airway positioning and management
• additional considerations of saturation monitoring
• the principles of supporting intubation procedure
• the pharmacology of intubation pre-medication
• the principles and cot-side care of invasive ventilation modes
• the principles and practice of cot-side care for infants receiving nitric oxide
• the principles of humidity
• the principles of suctioning airway devices
• clinical indications for respiratory physiotherapy referral and positional approaches to optimise airway function
• the principles and cot-side care of an infant with a chest drain in situ
• the importance of seeking support and escalating concerns
• the principles of neonatal resuscitation
• the pharmacology of medications used in resuscitation
• the principles of safe extubation
• the pharmacology of commonly used respiratory medications
• appropriate sources of information and the signposts to use when supporting families and carers
• the cardiac component of persistent pulmonary hypertension of the newborn (PPHN), respiratory distress syndrome (RDS), and acute hypoxia
• awareness of the roles of the wider multidisciplinary team (MDT) and how to refer
• when to seek support and escalate concerns
• fluid compartments within the body

Respiratory care and conditions

• undertake a systematic assessment (using the ‘ABCDEF’ approach) to prioritise and escalate care
• actively engage families or carers throughout assessment, seeking their feedback and observations, supporting and empowering them to raise any concerns and ask questions
• plan and implement care activities to optimise respiratory status, including handling and positioning
• recognise respiratory compromise (observations, monitoring and behaviours) and provide appropriate support
• evaluate the need for monitoring, taking into account the infant’s condition
• support radiological investigations to optimise imagery
• provide neonatal resuscitation in line with current national guidelines
• participate in the preparation and administration of medications used within resuscitation
• participate in the intubation process to support the infant, neonatal team and carers
• participate in the preparation and administration of pre-medication for intubation
• participate effectively in surfactant administration procedures and subsequent care
• demonstrate emotional intelligence and compassion when supporting families and carers in relation to a resuscitation or acute care episode
• participate and contribute professionally to the debrief process
• demonstrate the ability to set up, apply and provide ongoing care for a range of respiratory therapies(oxygen therapy, conventional and high frequency oscillatory invasive ventilations, nitric oxide)
• apply humidity within respiratory therapy
• demonstrate effective airway positioning
• maintain airway patency via suctioning techniques
• demonstrate knowledge of blood gases, identifying abnormal parameters and responsibilities for escalation and documentation
• identify indicators for respiratory physiotherapy and initiate the referral process
• demonstrate care required for an infant requiring a chest drain (supporting insertion and removal and cot-side care)
• demonstrate safe extubation processes
• prepare and safely administer commonly used respiratory medications
• utilise a range of resources, appropriately advise and support families and carers

Monitoring and assessment

• the physiology of blood pressure (the impact of hyper/hypotension, trends and parameters in sick and preterm infants)
• the potential impact of cardiovascular instability on cerebral blood flow
• the principles of invasive blood pressure monitoring
• The impacts of poor perfusion
• the assessment of perfusion (capillary refill and toe or core monitoring)in different skin tones
• the principles of pre- and post- ductal saturation monitoring

Monitoring and assessment

• use the appropriate cardiovascular monitoring in response to clinical condition
• undertake holistic, individualised cardiovascular assessment, respond appropriately to deviations from the norm and escalate appropriately
• provide safe care of arterial lines

Cardiovascular instability

• strategies for the management of cardiovascular instability (pharmacology, volume, blood products) indications, risks, and cot-side care
• the impact of cardiovascular instability on other body systems

Cardiovascular instability

• participate in the immediate care of and in meeting the stabilisation needs of the infant with cardiac compromise
• demonstrate safe practice in the preparation, administration and cot-side care related to inotropes, blood products and fluid bolus
• demonstrate safe practice in the calculation and titration of intravenous infusions for the fluid restricted infant

Cardiac Conditions

• antenatally agreed place of birth and the importance of early communication with cardiac centre or transfer teams
• common congenital cardiac conditions and patent ductus arteriosus (PDA)
• pathophysiology
• signs and symptoms
• stabilisation
• infusion pump height relative to the baby for inotropes and other short half-life drugs
• treatment strategies
• pharmacology
• cot-side care

Cardiac Conditions

• demonstrate safe practice in the preparation, the administration and the cot-side care related to cardiac medication (for example, prostaglandin E2)
• use a range of resources to appropriately adviseand support families and carers

Relevant foundation equipment

• respiratory monitoring (oxygen saturation, respiratory rate)
• low flow regulators
• high flow delivery systems
• continuous positive airway pressure (CPAP), synchronized inspiratory positive airway pressure (SiPAP) and Duo positive airway pressure (DuoPAP) delivery systems
• humidifiers
• suction equipment (oral and nasal)
• apnoea alarms
• blood gas analyser
• oxygen and air blenders
• oxygen cylinders and portable blenders
• flow-driven devices (neopuff)
• manual resus devices (ambu bag)
• electrocardiogram (ECG) leads
• cot-side monitor
• saturation probe
• stethoscope
• blood pressure (BP) cuff
• blood gas analyser

Relevant specialist equipment – equipment competencies required

• respiratory monitoring (end tidal CO2/ transcutaneous/saturation)
• ventilator – modes
• nitric delivery systems
• blood gas analyser
• respiratory humidifiers
• suction equipment and disposables
• chest drain kit and thoracic suction
• arterial transducer
• arterial line
• toe or core monitoring
• Resuscitaire

Foundation knowledge

Foundation skills

Learners should understand:

Embryology, anatomy, physiology

• brain development including germinal matrix and cerebral blood flow and auto regulation)
• nervous systems including role of cerebrospinal fluid (CSF)
• the musculoskeletal system
• normal neurological development (gestational differences): tone, posture, movements
• development of the 5 main senses and the environmental impacts on these
• birth injuries (including caput succedaneum, cephalohematoma, subgaleal haemorrhage, skull fractures)

The role of the multidisciplinary team (MDT)

• the role of specialist personnel (including physiotherapists, speech and language therapists, occupational therapists, and psychological professions)
• how to seek support and escalate concerns to specialist personnel

The role of multidisciplinary team (MDT)

• demonstrate the local referral process to specialist personnel

Infant neurodevelopmental care

• developmental risks associated with preterm birth (short and long-term impacts)
• strategies to support bonding and their impact upon short and long-term wellbeing
• the considerations for families of multiple birth
• the importance of family and carer education and empowering families and carers with developmental care
• infant behaviour and sleep and wake states
• behavioural cues
• positioning and the correct use of aids
• appropriate handling (clinical and by family and carers)
• comfort strategies
• skin-to-skin contact (including the principles of infant transfer)
• the differing sensory experience in utero and ex-utero
• gestationally appropriate play
• supporting for a language-rich environment (language, communication and interaction)
• neurological assessment tools
• when to seek support and escalate concerns
• appropriate sources of information and signposts to employ when supporting families and carers

Infant neurodevelopmental care

• actively engage families and carers to employ positive touch and wider comfort strategies
• use a range of resources to appropriately advise, educate and support families and carers during neurodevelopmental care, empowering them to be partners in care
• recognise and appropriately respond to sleep and wake states and to behavioural cues
• employ strategies to support gestationally normal posture, movement and tone
• promote and facilitate regular skin-to-skin contact and plan and support safe infant transfer
• implement ‘wrapped’ care interventions
• Implement side-lying nappy changes
• promote bonding throughout care activities
• use boundaries, positioning aids and incubator coversappropriately
• plan and implement interventions to minimise the impacts of environmental stress and to evaluate effectiveness
• facilitate gestationally appropriate play
• identify when and how to escalate concerns, liaise and refer to specialist personnel
• document developmental care in line with local practice

Family integrated care(FICare)

• understand the rationale for and principles of family integrated care (partnership with families and carers, empowerment, wellbeing, culture, environment, staff and family and carer education)

Family integrated care (FICare)

• provide education and support to families and carers, enabling them to be partners in care
• advocate for families or carers and demonstrate behaviours that promote a supportive collaborative culture, empowering them to be active in the planning and delivery of care activities
• signpost and promote peer and psychosocial support opportunitiestofamilies and carers

Pain, distress and discomfort

• the anatomy, physiology of the central and peripheral nervous system and gestational differences
• Normal behaviour in infants of different gestations (for example, tone, posture, movement, and sleep/awake states)
• the differences between stress, distress, pain and discomfort in infants
• the behavioural and physiological indicators of pain, distress or discomfort, including gestational differences
• the range of care interventions that might cause pain, distress or discomfort
• the short- and long-term impacts of pain, distress or discomfort
• the importance of accurate and timely assessment of neonatal pain using assessment tools
• non-pharmacological and pharmacological supportive strategies and the importance of timely implementation
• the pivotal role of families and carers in supporting the infant in pain, distress or discomfort
• appropriate sources of information and signposts to employ when supporting families and carers
• when to seek support and escalate concerns

Pain, distress and discomfort

• recognise the infant in pain, distress or discomfort
• plan care to minimise painful experiences and promote rest and recovery and actively engage families and carers as advocates for their infant throughout this time
• observe infant behavioural cues to pace interventions accordingly.
• undertake pain assessment (utilising tool) and documentit
• use non-pharmacological care strategies to promote stability and reduce pain, distress and discomfort
• support families and carers as key partners in the management of the pain, distress or discomfortof their infant
• provide relevant support and information for families and carers about neonatal pain, distress or discomfort and use a variety of resources to enhance the family integrated approach
• use holistic assessments to advocate for the infant in pain, distress or discomfort and escalate concerns
• implement pharmacological strategies as prescribed
• evaluate the efficacy of non-pharmacological and pharmacological interventions to modify ongoing care appropriately
• document care in relation to pain management

Neonatal abstinence syndrome (NAS)

• basic aetiology of neonatal abstinence syndrome (NAS)
• the signs, symptoms and behaviours
• the impact of NAS on growth and development
• the use of assessment tools and documentation
• care strategies to minimise the adverse effects of NAS (pharmacological and non-pharmacological)
• when to seek support and escalate concerns
• specialist referrals to support areas of development (for example, neurobehavior and feeding)
• the importance of developing effective relationships with families and carers to support their understanding of the infant’s complex needs
• appropriate sources of information and signposts to employ when supporting families and carers

Neonatal abstinence syndrome (NAS)

• assess the withdrawing infant utilising scoring tools and associated documentation
• engage families and carers to employ positive touch and wider comfort strategies
• implement a variety of non-pharmacological care strategies to support the infant with NAS and evaluate their efficacy
• use assessment data effectively to advocate for the infant who requires adjustment to pharmacological support
• identify when and how to escalate concerns
• communicate with other agencies to support continuity of care
• use a range of resources to appropriately advise and support families and carers

Specialist knowledge

Specialist skills

Neurological conditions and management

• the aetiology and antenatal and perinatal factors contributing to neurological conditions
• the treatment and outcomes of the most common neonatal neurological conditions(hydrocephalus and spina bifida)
• the impact of physiological instability on cerebral blood flow and the developing brain
• strategies to reduce the risk and severity of neurological injury
• neurological observations and assessment tools

Neurological conditions and management

• identify infants at risk of neurological injury
• employ interventions to reduce the risk and severity of neurological injury
• perform holistic neurological observations and escalate concerns
• measure head circumference (hydrocephalus and spina bifida)

Intra ventricular haemorrhage (IVH) and periventricular leukomalacia (PVL)

• pathophysiology
• classification
• the signs and symptoms
• strategies to minimise the incidence and severity
• treatment strategies
• follow up and outcomes

Intra ventricular haemorrhage (IVH) and periventricular leukomalacia (PVL)

• identify signs and symptoms
• employ strategies to minimise fluctuations in cerebral blood flow

Hypoxic ischemic encephalopathy (HIE)

• pathophysiology
• classification
• the signs and symptoms
• the criteria for therapeutic hypothermia
• the principles of therapeutic hypothermia
• the care of the infant undergoing therapeutic hypothermia
• outcomes

Hypoxic ischemic encephalopathy (HIE)

• identify signs and symptoms of hypoxic ischemic encephalopathy (HIE)
• demonstrate awareness of the criteria for therapeutic hypothermia
• initiate cooling interventions
• provide care to infants undergoing therapeutic hypothermia

Cerebral function monitoring (CFM)

• awareness of cerebral function monitoring (CFM) and its uses
• basic recognition of normal and abnormal CFM trace
• the care of the infant receiving CFM monitoring

Cerebral function monitoring (CFM)

• support the set up and application of cerebral function monitoring (CFM)
• provide ongoing care for the infant receiving CFM
• recognise normal and key abnormal CFM trace and escalate

Seizures

• common causes
• the signs and symptoms
• investigations
• common anti-convulsant therapies, side effects and monitoring

Seizures

• identify and monitor infants at risk of seizures
• recognise seizure activity and respond appropriately
• provide care for an infant who is having seizures
• safely administer anticonvulsant treatment and monitor its efficacy and side effects

Infant neurodevelopmental care in intensive care

• the application of family-integrated care (FICare) within an intensive care environment
• the preparation and facilitation of skin-to-skin contact for extremely preterm or sick infants
• strategies to support bonding in the sick and extremely preterm infant
• the environmental impacts of intensive care
• the supportive positioning of extremely preterm or sick infants
• neurodevelopmentally supportive handling
• the roles of allied health professionals (AHPs) and psychological professionals within intensive care

Infant neurodevelopmental care in intensive care

• facilitate family integrated care from admission to intensive care and actively engage families and carers with positive touch and wider comfort strategies
• employ strategies to facilitate bonding and promote and facilitate regular skin-to-skin contact (when clinically appropriate)
• plan and support safe infant transfer
• employ strategies to support musculoskeletal development
• minimise negative environmental stimuli
• undertake safe preparation and facilitation of skin-to-skin contact for extremely preterm or sick infants
• employ neurodevelopmentally supportive handling
• collaborate with allied health professionals (AHPs) to support neurodevelopmental care
• use a range of resources and appropriately advise and support families and carers to provide neurodevelopmental care

Pain, distress and discomfort

• pain pathways, pain perception and modulation
• intensive care factors influencing pain assessment (for example, intubation, sedation, muscle relaxation and neurological impairment)
• pain assessment tool limitations
• pharmacological supportive strategies in the intensive care setting

Pain, distress and discomfort

• demonstrate awareness of pharmacological strategies, pain assessment tool limitations, and pain assessment in the sedated and paralysed infant

Neonatal abstinence syndrome (NAS)

• the clinical situation where neonatal abstinence syndrome (NAS) may have an iatrogenic cause (for example, opiate infusions)

Neonatal abstinence syndrome (NAS)

• identify infants at risk of iatrogenic neonatal abstinence syndrome (NAS)

Related foundation equipment

• positioning aids
• earmuffs
• cot canopy
• incubator covers
• decibel monitors
• reclining chairs
• camp beds
• kangaroo wraps
• eye masks
• locally employed pain assessment tools
• non-pharmacological aids
• locally employed NAS assessment tools

Related specialist equipment

• cooling mattress
• rectal temperature probes
• cerebral function monitor (CFM) monitor
• measuring tape

Foundation knowledge

Foundation skills

Learners should understand:

Thermoregulation

• the anatomy and physiology of neonatal thermoregulation:

• non-shivering thermogenesis
• effects of low birthweight, differing 
• gestational ages
• surface area (body weight ratio)
• development of skin
• subcutaneous fat stores
• vasoconstriction
• posture
• brown adipose tissue stores
• energy and O2 in heat production
• central nervous system (CNS) response

• hypo and hyper thermic parameters
• the signs and symptoms of the infant with temperature instability
• the impacts upon physiological state (short and long term)
• cold and heat stress:

• the energy triangle
• 4 types of heat loss
• environmental impacts
• clinical care and handling that may cause thermal stress (cold/heat)
• bathing (appropriate clinical status, environment and preparation)

• monitoring modes and appropriate clinical use:

• axilla
• central and toe
• tympanic
• central (including servo mode)

• the range of thermoregulatory support (skin-to-skin contact, incubators, Resuscitaire or radiant heater, heated mattresses, the principles of humidity, the appropriate use of clothing and betting)
• health promotion (sudden infant death syndrome (SIDS), appropriate clothing at home and in car seats, education of carers in thermal care monitoring and intervention in unit and at home)
• appropriate sources of information and signposts to employ when supporting families or carers (the effectsoflowbirthweight atdifferinggestationalages, brownadiposetissuestores, energyand O2 in heat production)

Learners should be able to:

Thermoregulation

• identify and use the correct temperature monitoring (as locally available) for low and stable high dependency infants with a range of thermal care needs (axilla, central and toe, tympanic and skin)
• determine the frequency of assessment
• document thermal care data
• interpret thermal data as part of a holistic assessment, escalate concerns and identify sources of error
• employ relevant strategies to minimise thermal impacts, maintain thermoneutrality throughout all care activities, and evaluate effectiveness and respond appropriately (commencing and maintaining humidity as required – environmental or respiratory)
• use bedding and clothes appropriately for a low or high dependency infant being cared for with a cot, incubator, heated mattress or radiant heater.
• locate and discuss local, network or national policy and guidelines relating to thermal care
• educate and support families and carers about thermal care and use a variety of resources to engage families or carers with managing thermal care
• use a range of resources and appropriately advise and support families and carers about:

• sudden infant death syndrome (SIDS)
• appropriate clothing at home and in car seats
• thermal care monitoring and interventions (in unit and at home)

Hygiene

• underpinning principles of developmentally appropriate hygiene care

Hygiene

• engage families and carers with using positive touch and wider comfort strategies
• provide developmentally appropriate hygiene care, including:

• assessment of umbilicus/eyes/skin/stoma
• bathing
• relevant hygiene regimes (such as mouth care and eye care)
• nappy care

Skin

• anatomy and physiology (skin and immune system)
• common neonatal infections
• its role in infection prevention
• gestational differences
• possible causes of iatrogenic skin injury
• skin assessment tools for different skin tones
• understanding of broader skin care products and their suitability for infants
• principles of wound care (wound sites, extravasation injury)
• common skin infections in different skin tones

Skin

• undertake regular head-to-toe assessment of skin integrity in different skin tones
• employ strategies to minimise pressure injury
• identify pressure injuries (using appropriate scoring system) in different skin tones and modify care accordingly
• referral to a local tissue viability service
• identify commonly used skin dressings and when they are appropriate

Infection

• sources of infection
• routes of transmission (vector, nosocomial)
• the timing of presentation (congenital, early, late and onset)
• common infections (bacterial, viral and fungal)
• the signs and symptoms of local infection and systemic sepsis-escalation in different skin tones
• the identification of risk factors and ‘red flags’
• tools used to determine the risk of early onset infection in newborn infants
• short- and long-term impact on outcomes

Infection

• undertake:

• effective hand washing
• donning and doffing personal protective equipment
• clean procedures
• aseptic non-touch technique (ANTT) and sterile procedures

• routine infection control actions (in line with local policy):

• damp dusting
• the storage of milk (formula and expressed breastmilk)
• feed preparation (including additives)
• the use of single use or single patient use equipment
• the decontamination of equipment

• identify signs and symptoms of infection in an infant and when and how to escalate concerns
• initiate and maintain barrier nursing procedures
• undertake screening swabs in line with local policy
• collect specimens (urine, stool, nasopharyngeal aspirate (NPA))
• support the multidisciplinary team (MDT) with specimen collection (for example, lumbar puncture)
• conduct observations and document them using a recognised early warning tool, escalating concerns as appropriate
• identify sepsis protocol in their area and recognise red flags
• access and discuss local infection control policies and related guidelines

Strategies to minimise infection

• hand hygiene
• appropriate use of personal protective equipment
• barrier nursing
• differentiation between clean and aseptic non touch technique
• disinfection/sterilisation techniques
• appropriate milk storage and feed preparation
• environmental considerations
• routine infection and colonisation screening (swabs and specimens)
• equipment (single use, single patient, reusable)
• local cleaning procedures
• septic screen

Strategies to minimise infection

• identify infants at risk of early and late onset infection

Intravenous (IV) or central line care

• the underpinning principles of IV or central line care

Intravenous (IV) or central line care

• undertake site assessment and use relevant scoring systems
• assess the integrity of dressings and fixation methods and initiate changes appropriately
• deliver relevant cot-side care
• identify the signs or symptoms of the concerning or deteriorating infant and use scoring systems
• identify departmental and trust infection control personnel
• use a family integrated approach to educate and support families and carers to understand susceptibility to infection, participate in infection prevention, recognise signs of infection and manage care or escalate when discharged
• Signpost family and carers to information and resources

Antimicrobials

• commonly used antibiotics, antivirals and antifungals
• indications
• side effects

The roles of specialist personnel

• the local infection control and prevention team

Specialist knowledge

Specialist skills

• delivery room strategies
• extreme prematurity and effects upon thermostability
• skin physiology of the extreme preterm and trans-epidermal water loss (TEWL)
• thermal management of the infant who is undergoing intensive care procedures
• supporting thermal care during transfers (intra- and inter-hospital)
• impact of humidity on thermal stability (environmental, respiratory)
• monitoring modes and appropriate clinical use:

• central and toe
• central – (including servo mode)
• rectal

• infections associated with intensive care (invasive procedures, ventilation associated pneumonia)
• increased vulnerability of the preterm infant and sick infant
• importance of rapid recognition and response to deterioration
• impact of systemic infection (for example, disseminating intravascular coagulation (DIC))
• basic principles of microbiology
• tole of specialist personnel (including the role of the microbiologist)

• correctly identify and use thermal care delivery room strategies and equipment (as locally available)
• implement thermal care strategies to support the transition from delivery suite to neonatal unit
• apply and manage environmental and respiratory humidity in the extreme preterminfant
• employ proactive thermal care strategies for the infant receiving intensive care to maintain thermoneutrality
• evaluate the effectiveness of thermal care strategies and interventions and respond appropriately
• identify when and how to escalate concerns
• Support the infant appropriately and advocate for them throughout the infection screening
• carry out assessments and provide care for infants with indwelling central and peripheral catheters
• assist the neonatal team during invasive procedures

Related foundation equipment

• temperature monitoring (axilla, skin, toe)
• incubators
• heated mattresses
• trans warmers
• cots
• radiant heaters
• Resuscitaire
• humidifiers for respiratory therapy
• feeding equipment.
• sterilisation procedures
• fridge/freezer temperature management

Related specialist equipment

• Thermal elements of Resuscitaire utilised at delivery
• Thermal elements of transport mode
• Rectal probes and monitoring
• Plastic thermal covering

Foundation knowledge

Foundation skills

Learners should understand:

Admissions

• embryology and foetal development, including multiple pregnancies
• adaptation to extrauterine life
• maternal health factors that impact the infant
• obstetric issues contributing to neonatal admission
• preparing families for admission (pre-birth)
• health inequalities and their relationship with maternal and neonatal care
• risk factors for preterm delivery
• perinatal optimisation strategies
• avoiding unnecessary admissions (for example, ATAIN)
• the range of criteria for admission to neonatal care
• additional considerations for families of multiple birth

Learners should be able to:

Admissions

• locate and discuss related policies and guidelines

Admission process

• preparation for admission (environment, equipment, team roles and responsibilities)
• holistic assessment of a low dependency infant (history, visual, handling, vital signs)
• when to seek support and escalate concerns
• data collection and documentation at admission
• appropriate sources of information for families and carers and signposting to relevant services for at point of admission

Admission process

• identify any additional support or resources that may support families and carers on admission (for example, finance, transport, accommodation and interpreters)
• prepare the environment and use equipment required for the admission of a special care or high dependency infant
• communicate effectively with the multidisciplinary team (MDT) during the admission process
• conduct an appropriate holistic initial assessment of the infant, assimilating data from a variety of sources and responding appropriately
• prioritise actions to respond to the infant’s status
• identify when and how to escalate concerns and recognise their own professional boundaries
• participate in a team approach to admissions and support colleagues
• complete the relevant documentation
• use a range of resources to appropriately advise and support families and carers during admission and orient them to the special care (SC) environment
• recognise infants and families that are vulnerable or have existing safeguarding concerns
• identifying and initiating the safeguarding process where there are concerns of harm (from families/carers, staff etc)
• referring to relevant professionals in line with local and national safeguarding guidance
• use opportunities and interventions to support bonding and attachment during the admission process
• check all resuscitation and safety equipment

Screening

• examinations and screening:

• newborn infant physical examination (NIPE)
• newborn blood spot (NBS) screening
• retinopathy of prematurity (ROP) screening
• hearing screening
• infection screening
• hip ultrasound
• cranial ultrasound

• the rationale for screening programmes
• the nationally recognised processes and methods of screening
• the information to provide families and carers when gaining consent
• preparation of equipment and the infant’s, families’ and carers’ environment and equipment
• supporting the infant and family during screening
• the key specialist personnel
• supporting the professional undertaking the screening
• documentation
• awareness of local and national support groups
• when to seek support and escalate concerns
• the most commonly seen neonatal genetic disorders and their management and prognoses
• the most commonly seen neonatal metabolic disorders and their management and prognoses
• where applicable:

• relevant anatomy and physiology
• pathophysiology
• risk factors and prevention
• classification
• treatment options
• possible short-term effects and long-term outcomes

Screening

• provide relevant information and signposts to families and carers, using a variety of resources and communication methods to support the consent process for screening programmes
• prepare equipment
• support the infant and their family or carers throughout the screening process
• assist the professional doing the screening
• coordinate care to minimise pain and distress for the infant
• identify when and how to escalate concerns
• collect and process samples correctly
• complete documentation

Core principles of infant transfer (intra- and inter-hospital)

• stabilisation before transfer
• planning and preparation:

• communication (team, families and carers, receiving area)
• equipment
• key safety aspects
• destination preparedness

• the importance of recognising personal abilities and professional boundaries
• the impact of intra- and inter-hospital transfers on families and carers and strategies for support
• potential problems during transfer and troubleshooting strategies
• the impact of transfer on unit workload and the importance of teamwork

Core principles of infant transfer (intra- and inter-hospital)

• locate information about local transport teams
• locate guidance for the preparation of infants for intra- or inter-hospital transfer
• check and prepare transport equipment
• communicate with the receiving team to ensure preparedness
• prepare the infant for transfer
• undertake an intra-hospital transfer
• prepare additional items for transport (for example, personal belongings and mother’s milk)
• undertake a comprehensive verbal handover using a structured approach
• complete all transfer documentation
• use a range of resources to appropriately advise and support families or carers throughout the transfer process
• offer support and resources to the attending transfer teams
• recognise individual abilities and professional boundaries
• demonstrate appropriate moving and handling techniques during transfer activities

Inter-hospital transfer

• reasons for transferring to another unit (surgery, escalation, repatriation, capacity)
• clinical situations requiring time critical transfers
• the role of the transport team
• network guidance
• the importance of timely referral to the transport team

Intra Hospital transfer

• the reasons for transferring within hospital (admission, escalation and de-escalation of care within the unit, transitional care, investigations)
• the use of key transfer documentation

Documentation and communication (transfers)

• structured approaches for verbal handover
• when to seek support and escalateconcerns
• appropriate sources of information and signposts to employ when supportingfamilies or carers whose infants are being transferred
• communication with other professionals before admission and on admission (for example, community midwives, health visitors)

Neonatal outreach

• the role and function of outreach services within the neonatal care pathway
• local service provision and specialist personnel
• local criteria for outreach

Neonatal outreach

• identify key features of neonatal outreach services that support the infant and family throughout neonatal care
• identify local unit criteria for outreach services
• locate local guidelines aimed at helping families and carers to prepare for transfer to outreach care (where relevant)
• liaise effectively with local outreach services to support the ongoing care of infants, families and carers

Discharge

• the importance of starting the discharge process early and of incorporating planning within daily nursing care to empower families
• the purpose of a discharge planning meeting and the procedures for initiating one
• the range of services and equipment that may need to be coordinated before discharge (Basic Life Support (BLS), medicines, outreach, home oxygen)
• the importance of health promotion opportunities before discharge
• the local discharge criteria
• the possible ongoing care needs of the preterm infant and family after discharge and liaising with relevant teams (including outreach, surgical outreach, and specialist nurses)
• the appropriate sources of information and signposts to employ when supporting families and carers whose infants are approaching discharge
• when to seek support and escalate concerns
• the circumstances in which discharge processes may include safeguarding considerations
• the follow-up pathways and early interventions or outcomes relevant to continuing a developmentally appropriate care approach after discharge
• supporting transition to home (working with outreach team or paediatric services)
• follow-up processes

Discharge

• prioritise timely discharge planning when nursing the low dependency infant
• use all local care plans and checklists to support families and carers in preparing for discharge
• coordinate and participate in a discharge planning meeting
• teach families and carers the required infant care skills before discharge
• discuss all current and relevant health promotion communications with families and carers
• advise families and carers about how to comfort a crying infant and how to cope. Signpost them to relevant resources and services
• access supportive community resources (for example, breast pump hire and breastfeeding peer support groups)
• contribute to local referral processes that support infants, families, and carers who require outpatient or community care
• initiate local referral processes for infants who require home oxygen
• identify families with ongoing additional social needs and liaise with key referral personnel (for example, social workers, safeguarding leads or foster families)
• complete all discharge documentation in line with local guidance, facilitating a safe and comprehensive handover of care to the wider multidisciplinary team(MDT)
• input information to data collection systems accurately
• use a range of resources, appropriately to advise and support families or carers

Documentation and communication (outreach and discharge)

• key documentation and communication actions that ensure a comprehensive handover of care to the wider multidisciplinary team (MDT)
• data collection processes and systems
• communication with other professionals within pre-discharge planning (for example, community midwives and health visitors)

Specialist knowledge

Specialist skills

• the implications of right place of birth for the following infants: preterm, surgical, cardiac
• preparation for an intensive care admission (environment, equipment, team roles and responsibilities)
• the practical implications of attending the delivery of and admitting multiple births
• holistic assessment of a high dependency or intensive care infant (history and visual)
• resuscitation at birth as per Resuscitation Council UK guidance:

• principles of neonatal resuscitation
• the importance of appropriately stocked and checked safety equipment
• escalating concerns (method dependent upon level of urgency)
• documentation (the importance of contemporaneous record keeping)
• supporting the family during resuscitation

• preterm optimisation at birth
• the role of delivery room cuddles
• the importance of efficient and well organised early care and admission processes
• the role of the multidisciplinary team (MDT) in the admission and stabilisation of a sick or preterm infant
• appropriate sources of information and signposts to employ when supporting families and carers

• locate and discuss related policies and guidelines
• prepare the environment and use the equipment required for the admission of an intensive care infant
• demonstrate resuscitation skills (appropriate to role) and support the resuscitation process in line with Resuscitation Council guidance
• correctly employ relevant monitoring or equipment to support the resuscitation and admission process
• support preterm optimisation interventions at birth
• undertake holistic initial assessment of the preterm or sick infant, assimilating data from a variety of sources
• prioritise actions in response to infant status
• identify when and how to escalate concerns and recognise their own professional boundaries to optimise outcomes
• communicate effectively throughout the resuscitation, stabilisation and admission processes
• work with wider nursing team to support admissions and transfers; recognising impact of unit acuity
• complete all relevant documentation
• use a range of resources, appropriately to advise and support families and carers during admission and orient them to the high dependency or intensive care environment
• facilitate opportunities and interventions to support bonding and attachment during the intensive care admission process

Related foundation equipment:

• incubators
• monitoring:

• temperature (axilla, skin, toe)
• electrocardiograms (ECGs)
• saturations
• Resuscitaire

• heel lancets
• local transport equipment (basic awareness of location, checking procedures and responsibilities)
• computer access and training to complete key data capture

Foundation knowledge

Foundation skills

Learners should understand:

Embryology, anatomy, physiology of the surgical infant

• the clinical presentation of common neonatal conditions that may require surgical intervention, including:

• abdominal wall defects
• cardiac
• diaphragmatic hernia
• ear, nose and throat (ENT)
• inguinal hernia
• intestinal obstruction
• necrotising enterocolitis (NEC)
• neurological
• trachea oesophageal fistula and oesophageal atresia (TOF and OA)
• urology

• the wider multidisciplinary team (MDT) in the care of the infant who requires surgery (for example, Transport, surgical link nurses, surgical centre, stoma nurse)
• appropriate sources of information and signposts to employ when supporting families and carers before and after surgery
• the use of training materials and relevant teaching resources
• care of an infant requiring surgery (basic introduction)

Learners should be able to:

Embryology, anatomy, physiology of the surgical infant

• identify common conditions requiring surgery in the neonatal period and highlight the impact of the condition on the infant, families and carers
• demonstrate awareness of the general principles of care for an infant requiring surgery (pre- and post- operative care)
• promptly escalate the infant who has concerning gastric aspirates or vomit
• identify and promptly escalate red flags for conditions that may require surgical review
• promptly action changes to an individualised plan of care
• undertake basic surgical wound care assessment and management
• recognise the need for post-operative pain assessment and management, including pharmacological and non-pharmacological strategies
• use a range of resources to appropriately advise and support families and carers

Stoma care

• the relevant anatomy and physiology of lower gastrointestinal conditions that may require formation of a stoma
• different types of stomaand appropriate care
• altered anatomy and physiology in stoma formation and the implications of stoma site
• the principles of cot-side care for the infant with a stoma (for example, perfusion, fluid balance, skin integrity, assessment, stoma bag management)
• immediate post-surgical care of the stoma
• when to seek support and escalate concerns (within the unit, within the trust or to regional specialist personnel)
• appropriate sources of information and signposts to use when supporting families and carers)

Stoma care

• locate and discuss local stoma guidelines and supporting information
• use a range of resources to appropriately advise and support families and carers to provide stoma care
• use appropriate personal protective equipment and observe infection control procedures
• change a stoma bag as per the individual plan and support parents, families and carers with stoma care in preparation for discharge (as appropriate)
• assess and document the nature, characteristics, colour, consistency and volume of stoma output
• assess the skin integrity of stoma site and provide skin care in line with local guidance
• recognise deviations from the norm and identify when and how to escalate concerns

Specialist knowledge

Specialist skills

• maternal histories associated with congenital abnormalities that may require surgical intervention
• prenatal management and foetal medicine related to conditions that may require surgery (basic awareness)
• the importance of timely escalations and reviews to outcomes
• the importance of medication management in infants with conditions that may require surgical intervention
• how to recognise and provide immediate care for and stabilisation to infants with conditions that may require surgical intervention, including:

• abdominal wall defects
• cardiac
• diaphragmatic hernia
• ear, nose and throat (ENT)
• inguinal hernia
• intestinal obstruction
• necrotising enterocolitis (NEC)
• neurological
• trachea oesophageal fistula and oesophageal atresia (TOF and OA)
• urology

• the importance of close liaison with regional services (surgical and transport)
• the stabilisation of babies with the acute abdomen or OA and their preparation for transfer to surgical centres (these are babies that often come from district general hospitals (DGHs)
• the use of Replogle tubes in stabilising OA infants for transfer
• the surgical management and outcomes of necrotising enterocolitis (NEC)
• potential short and long term sequalae
• awareness of surgical complications:

• haemorrhage
• wound
• anastomosis
• stoma
• infection
• requirement for specialist feeding and nutritional needs (please refer) to domain 3

• the role and functions of specialist personnel (for example, paediatric specialty surgeons, specialist surgical nurses, stoma care nurses)
• when to seek support and escalate care

• provide care as part of the neonatal team at delivery and provide ongoing stabilisation for the infant with common conditions that may require surgery
• promptly action changes to individualised plans of care
• ensure timely referral and effective communication with the surgical centre and the transport team
• prepare infants, families and carers for transfer to the surgical centre
• use a range of resources to appropriately advise and support families and carers
• liaise with the relevant multidisciplinary team (MDT)

Condition specific care

• care for infants with tracheoesophageal fistula or oesophageal atresia before surgery (including Replogle tube insertion and ongoing cot-side care)
• undertake a holistic assessment of an infant with bilious aspirates or vomiting and escalate appropriately for review
• identify an infant with inguinal hernias or testicular torsion and appropriately escalate concerns
• provide tracheostomy care

Post-surgical care

• the principles of care for the infant with a tracheostomy
• the principles of care for an infant with a trans-anastomotic tube (TAT)
• the potential need for nutritional plans and dietetic referral
• the complex feeding issues of infants before and after surgery
• speech and language referral
• medicine management, discharge planning and parental training

Post-surgical care

• offer relevant parental training in preparation for discharge (for example, stoma care, specialist nutritional care, wound care and safety netting)

Related foundation equipment

• stoma bags

Related specialist equipment

• Replogle tubes
• stoma bags

Foundation knowledge

Foundation skills

These principles are based on the Children’s Palliative Care Education and Training (CPET) Education Standard Framework: Universal

Supported by BAPM Integrated framework for palliative care in perinatal medicine

Learners should understand:

Neonatal pathway

• the uncertainty of the neonatal journey and that families or carers can experience grief without the loss or death of their baby

Learners should be able to:

Neonatal pathway

• sensitively care for infants with an uncertain future and their families and carers (with support and guidance from senior staff and/or a psychological professional)

Communicating effectively

• the importance of emotional intelligence throughout all communications
• the importance of memory making for families

Communicating effectively

• support families and carers with memory making (tangible and non-tangible), enhancing and nurturing the families and carers experience

Working with others in and across various settings

• local policies and procedures that support palliative and end-of-life care
• the role of the children’s hospice
• the key principles of safeguarding infants with palliative and end-of-life care needs

Working with others in and across various settings

• discuss indicators of safeguarding concerns
• seek support and escalate concerns as required

Identifying and managing symptoms (holistic)

• common reactions and mental health issues and strategies to support wellbeing for infants and for families or carers who are experiencing grief and/or loss

Identifying and managing symptoms (holistic)

• listen and respond to individual families’ and carers’ needs, signposting and referring as appropriate

Sustaining self-care and supporting the wellbeing of others

• how their own behaviours, beliefs and practices may influence others.

Sustaining self-care and supporting the wellbeing of others

• demonstrate an awareness of their own feelings and the impact of their actions on others
• listen and respond to families’ and carers’ needs, signposting and referring as appropriate and seeing support and escalating concerns when required

Specialist Knowledge

Specialist Skills

These principles are based on the Children’s Palliative Care Education and Training (CPCET) Education Standard Framework: Core

Supported by BAPM Integrated framework for palliative care in perinatal medicine

Neonatal pathway

• ethical principles relating to viability
• awareness that some infants may deteriorate and need to transition to end-of-life care
• the legal and ethical aspects of end-of-life care and the withdrawal of survival focused treatment
• the importance of individualised care for the dying infant and their family that takes account of:

• cultural diversity
• spiritual or religious beliefs
• variations in behaviours and preferences
• language and communication styles
• memory making
• agencies supporting families throughout the bereavement process
• support networks
• family composition and dynamics
• life experiences
• maternal health (post-natal)

Neonatal pathway

• support the team and the family or carers if the infant deteriorates and needs transition to end-of-life care
• participate in ethical discussions with emotional intelligence
• sensitively care for the dying infant and the family or carers
• Sensitively care for the infant who has died and the bereaved family or carers in accordance with local and national bereavement protocols (with support and guidance from senior staff)
• seek support and escalate concerns as required
• liaise with support services and agencies to support the family of dying infants and ensure individualised needs are met
• demonstrate insight into how the unique experiences, preferences and dynamics of families may affect the care approach required

Communicating effectively

• positive patterns of communication when delivering bad or unwanted news or information to families and carers
• the role of the nurse as an advocate for the infant and family throughout palliative and bereavement care

Communicating effectively

• communicate sensitively during difficult conversations or when breaking bad news
• initiate and lead individualised planning for end-of-life care in line with families and carers’ wishes

Working with others in and across various settings

• the professional roles and responsibilities within an multidisciplinary team (MDT) relating to the delivery of palliative and end-of-life care
• local and national policies, procedures and reporting requirements following the death of an infant
• the concepts of parallel planning and advance care planning within palliative care
• the circumstances in which an infant postmortem may be required and when the coroner should be informed
• the criteria and process for infant organ donation

Working with others in and across various settings

• participate in individualised and parallel planning for end-of-life care in line with the families’ and carers’ wishes
• sensitively care for infants with an uncertain future and those diagnosed with a life-limiting condition and care for their families and carers (with support and guidance from senior staffand/or a psychological professional)
• initiate and lead advance care planning discussions with the family
• be aware of choices available about location post death (hospital, hospice or home)
• sensitively care for dying infants and those with palliative care needs and care for their families and carers
• identity processes of caring for and maintaining the optimum condition of the body of an infant who has died
• identify procedures for preparing the body for the mortuary and postmortem
• support the team and families and carers relating to organ donation

Identifying and managing symptoms (holistic)

• how to recognise deterioration and ensure appropriate escalation in line with the end-of-life care plan
• key concepts of bereavement, grief, and loss and how these may be manifested by families and carers

Identifying and managing symptoms (holistic)

• initiate ongoing support for families and carers, including signposting or referring to local and national agencies

Sustaining self-care and supporting the wellbeing of others

• their own experiences of delivering and their interactions with those receiving care and the team delivering care. Learners should have opportunities to reflect on and discuss this.
• the impact of infant death on a neonatal unit

Sustaining self-care and supporting the wellbeing of others

• consider and support needs across the wider neonatal unit (including other families and carers who may be affected or impacted)
• support the team, families and carers in situations where there are difficult or challenging discussions for infant(s) transitioning to end of life care

Related specialist equipment

• consideration of care of the baby’s body after death. This may be in a side room within a hospital or home (using a portable air conditioning unit or cold cot) or in a cold bedroom at a local children’s hospice

Related resources

E-learning to support some of the content above is available from NHS England’s e-Learning for healthcare website.

Programme leads should promote additional local, regional or national education resources related to this domain.

Foundation knowledge

Foundation skills

Learners should understand:

Psychologically informed neonatal care (PINC)

• the aims of psychologically informed neonatal care (PINC)
• relational care and containment, the potential effects of trauma and the importance of trauma-informed care
• the creation of a psychologically informed environment
• the importance of PINC supporting the principles of family-integrated care (FICare)

Learners should be able to:

Psychologically informed neonatal care (PINC)

• contribute to the development of a psychologically informed environment
• employ strategies to reduce the impact of admission and the neonatal environment on family life
• support family and carers who are experiencing loss and grief
• listen and respond to individual family member’s or carer’s needs and signposting or referring as appropriate
• promote a partnership approach to care and decision making
• facilitate memory making with families and carers from admission
• support practices that promote the caregiver and infant dyad, recognising individualised needs
• consider the needs of siblings, extended family and wider support networks within care
• discuss indicators of safeguarding concerns and instigate local processes to support family and carers
• provide support mechanisms for the family and carers following an emergency or incident
• respect and support the individual needs of each family member or carer:
• • cultural diversity
  • spiritual or religious beliefs
  • language and communication styles
  • support network
  • family composition and dynamics
  • life experiences

Infant wellbeing on the neonatal unit

• the importance of the caregiver-infant dyad in supporting infant wellbeing and development
• the development of the brain in a social context
• the importance of interaction in buffering the effects of pain and toxic stress
• the impact of the neonatal experience on the infant
• family responses to neonatal admission
• the relationship between families and carers and infant trauma
• how to support mechanisms of healthy interactions, between families, carers and infants

Family and carer wellbeing on the neonatal unit

• the impact of trauma (both infant, family or carer) and associated feelings of constant sense of threat
• the sense of family/carer being empowered in their role as caregiver, feeling connected to their infant and understanding co-occupations (tasks, or occupations, that require the participation of both a caregiver and the infant)
• how to attend to families and carer needs
• the multiple ways of showing distress
• the importance of providing an opportunity to regulate their emotion; relate (with others) and reason (achieve a state in which they can think clearly)
• access to a psychological professional
• how to support specific needs of families or carers (for example, language, access to information, and logistical, practical or financial issues)

Staff wellbeing on the neonatal unit

• that working in a neonatal environment can be stressful and staff need to feel cared for
• stress induced psychological and physical reactions
• the mental and physical effects of repeated stress
• long-term psychological consequences
• the prevention of distress following a traumatic event
• the support that is available

Recognition of the individual needs and characteristics of families and carers:

• cultural diversity
• spiritual and religious beliefs
• language and communication styles
• support networks
• family composition and dynamics
• life experiences

Specialist knowledge

Specialist skills

Developing compassionate and psychologically informed neonatal teams

• developing compassionate and psychologically safe teams and systems, including:

• the development of relational care and containment
• trauma informed care and psychologically informed environments

• the mental health needs of staff, families and carers and how to support them, including

• psychological trauma
• the management of risk (including referral to neonatal psychological professionals and community services)

• the purpose of huddles, debriefs and reflective spaces and a nurse’s role within these
• verbal and non-verbal communication strategies

Developing compassionate and psychologically informed neonatal teams

• support team members in distress
• participate in huddles, debriefs and reflective spaces
• engage professionally with any medical/ethical conversations

Related resources

E-learning to support some of the content above is available from NHS England’s e-Learning for healthcare website.

Programme leads should promote additional local, regional or national education resources related to this domain.