NMHS33390 Complexities of the Newborn

Academic Year 2022/2023

The purpose of the module is to prepare students to fulfil the role of the registered midwife in the provision of evidence-based, family-integrated care of the neonate that either becomes unwell or is at risk of developing complications that may require specialised care. The student will further develop their ability to conduct a physical, psychological, and social evaluation of the neonate, recognise deviations from the expected norm, and then refer to senior midwifery, nursing and medical personnel when appropriate. The student will acquire the knowledge and simulate the skills necessary to initiate appropriate, timely, individualised care for a neonate that is unwell or at-risk of becoming unwell, requires resuscitation, or requires referral/transfer to the multidisciplinary care team.
This module provides the theory underpinning the clinical experiences of caring for neonates/infants that are unwell that students may encounter across a variety of placements, including Intranatal, Postnatal, Neonatal, and Primary Healthcare.

The theory/knowledge delivered in this module helps students to meet the standards and requirements for midwifery registration with the Nursing and Midwifery Board of Ireland, which state that a midwife must:
" provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications...recognising the warning signs of abnormality in the...infant which necessitate referral to a doctor and assisting the latter where appropriate; examining and caring for the new-born infant; taking all initiatives which are necessary in case of need and carrying out where necessary immediate resuscitation; ...giving all necessary advice to the mother on infant care to enable her to ensure the optimum progress of the new-born infant".

Related clinical skills (delivered face-to-face in simulation lab):

Developmental Care Essentials - nesting, sensory, emotional;
Identifying abnormal neurological signs & symptoms;
Rapid evaluation of the unwell neonate- identifying red flags signs & symptoms & initiating treatment;
Review initial steps of resuscitation skills;
Feeding skills for premature/unwell babies- NG/OG feeding tube placement, cup, supplementary feeding systems, expressing breast milk by hand or electric pump;
Finnegan scoring system.

NB: All 'live' online synchronous or 'in-person' lectures, tutorials and practicals are delivered during a two-week block: Week -1 (week starting Mon 29th Aug) and Week 0 (week starting Mon 5th Sept).

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Curricular information is subject to change

Learning Outcomes:

On successful completion of this module students should be able to:

● Identify promptly ‘at risk’ infants in the neonatal period, and the factors that may pre-dispose them to a deviation from the expected norm, and communicate this information effectively to parents and relevant members of the multidisciplinary team.

● Develop the ability to identify, prevent and ameliorate feeding challenges where a baby’s condition is complicated or the baby is unable to feed.

● Recognise symptoms of the major congenital, cardiovascular, respiratory, metabolic and endocrine disorders that can occur in the neonatal period, and initiate timely referral to senior midwifery and medical personnel for specialised care & treatment.

● Recognise signs of respiratory or circulatory compromise, and can initiate resuscitation measures

● Develop & implement an evidence-based, family-integrated plan of midwifery care for an unwell neonate, in collaboration with the baby's parents/caregivers and the multidisciplinary team.

Indicative Module Content:

Role of the midwife in the provision of neonatal care and monitoring neonatal health and well-being.
The role and responsibilities of the midwife within the Neonatal Unit (NICU/HDU/SCBU) multidisciplinary team.

Promotion of parent/family-infant relationship and facilitating 'family-integrated' care when families are separated from their baby being cared for in a neonatal unit.

Specialised assessment of foetal and neonatal well-being. Non-invasive and Invasive methods of foetal testing and screening- Chorionic Villus sampling/Amniocentesis. Other methods of foetal assessment and treatment -Ultrasound/Biophysical profile/Doppler studies/Anomaly Scan/Intrauterine Growth Centiles; Intrauterine transfusion; Intrauterine surgery; Diagnostic Imaging- Echocardiography, MRI, CXR, PFA, Barium studies.

Birth trauma; Birth asphyxia; The Shocked/Compromised Baby; Neurological Disorders: recognition of signs and symptoms of neurological dysfunction; Cord pH values and interpretation of blood gases/acid-base balance/metabolic acidosis/respiratory acidosis/buffers; Passive and Therapeutic Hypothermia; Follow-up care of the compromised baby; Recognition of neonatal pain; Pharmacological and non-pharmacological methods of pain relief.

The low-birth weight baby; The Preterm Baby- ethical aspects of resuscitation and care; Intrauterine growth restriction; Twins and multiples; Characteristics of prematurity- investigations, care and monitoring.

Pathological Jaundice- recognition, pathophysiology, care & treatment required; Rhesus incompatibility; role of Anti-D Immunoglobulin for Rhesus D prophylaxis; ABO incompatibility; Biliary obstruction; Metabolic disorders; breast milk jaundice.

Congenital and chromosomal disorders- Discuss the recognition and midwifery care advised for the most common congenital abnormalities/birth defects including emotional support for parents.

Congenital infections- Group B strep, HIV/hepatitis/Syphilis/ TORCH infections/Rubella; Pregnancy disorders e.g. diabetes in pregnancy, pre-eclampsia; drug/alcohol exposure and their effects on the foetus and neonate;

Neonatal and infant morbidity and mortality. Midwifery care for the following: The Stillborn Baby; Sudden Unexpected Postnatal Collapse; Early Neonatal Death; Sudden infant death syndrome (SIDS); Critically appraise the Irish and international data and trends around perinatal morbidity and mortality and consider the role of midwife in the prevention and/or care of those affected- legal requirements, palliative care, spiritual support, bereavement care.

Neonate and Infant Safeguarding- Children's First Legislation; Legal aspects of care- consent for treatment, legal parents and guardians,

Revision of theory and skills of the 'initial steps' of neonatal resuscitation.

Critically appraise national and international evidence-based guidelines and original (primary) research regarding neonatal care.

Four hours of research-focused, didactic lectures and an interactive online workshop will build upon knowledge of the research methods and activities midwives employ to develop and promote evidence-based midwifery care of the neonate. This 4-hours builds upon 4-hours of research-focused theory delivered in Stage 2 (NMHS20690 The Newborn Infant) and an additional hours of research-focused theory in Stage 1 (shared module NMHS10360 Scholarship of Enquiry).

Student Effort Hours: 
Student Effort Type Hours
Lectures

36

Practical

4

Specified Learning Activities

5

Autonomous Student Learning

76

Online Learning

4

Total

125

Approaches to Teaching and Learning:
Lectures, Tutorials, Simulation & Skills Workshops, Reflection on Practice, In-class Quizzes, Class Discussion of Case-Studies, Breakout Groups; Problem-Based Learning Activities. 
Requirements, Exclusions and Recommendations

Not applicable to this module.


Module Requisites and Incompatibles
Not applicable to this module.
 
Assessment Strategy  
Description Timing Open Book Exam Component Scale Must Pass Component % of Final Grade
Practical Examination: Competency-based skills assessments in the Simulation Lab during 2-week block. Will include skills: initial steps of resuscitation; placement of an NG/OG tube; Finnegan scoring exercise. Throughout the Trimester n/a Pass/Fail Grade Scale Yes

10

Assignment: Chose from one of four/five assignment titles. Prepare a written submission in the style of a journal article, following the 'Guidelines for Authors' of a chosen maternity-focused healthcare journal. Coursework (End of Trimester) n/a Standard conversion grade scale 40% No

60

Examination: A one-hour, multiple choice questionnaire examination. Focus of questions: anatomy, physiology, and disease processes underpinning the major neonatal disorders. 1 hour End of Trimester Exam No Alternative linear conversion grade scale 40% Yes

30


Carry forward of passed components
Yes
 
Resit In Terminal Exam
Spring No
Please see Student Jargon Buster for more information about remediation types and timing. 
Feedback Strategy/Strategies

• Feedback individually to students, on an activity or draft prior to summative assessment
• Feedback individually to students, post-assessment
• Online automated feedback
• Self-assessment activities

How will my Feedback be Delivered?

- Online Feedback individually to students, post-assessments via Brightspace - Online Group/class feedback, post-assessment - Online automated feedback - Self-assessment activities

American Academy of Pediatrics (2021) Neonatal Resuscitation Programme 8th edition.
Baston H. and Durward H. (2017) Examination of the Newborn- A Practical Guide, 3rd edition. Routledge Publications.
Boxwell, Petty and Kaiser (2020) Neonatal Intensive Care Nursing 3rd edition. Routledge.
Chalia, M. & Austin, T. (2018) "Practice guide to neonatal seizures", Paediatrics and Child Health, vol. 28, no. 10, pp. 488-491.
Department of Health (2016) Chief Medical Officers’ Alcohol Guidelines Review. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/489795/summary.pdf
Grieg C. (2014) Trauma During Birth, Haemorrhages, Convulsions- Chapter 31. In Myles Textbook for Midwives (Marshall & Reynor eds.), pp. 618-629.
HSE (2018) My Child: 0 to 2 years- Expert advice for every step. Available at: https://www2.hse.ie/file-library/child-health/my-child-0-to-2-years-book.pdf
HSE (2012) Sleep Safe For Your Baby. Available at: http://www.hse.ie/eng/services/list/5/publichealth/publichealthdepts/resources/safesleep.pdf
HSE (2016) Breastfeeding and Expressing For Your Sick or Premature Baby. Available at: https://www.healthpromotion.ie/hp-files/docs/HPM00972.pdf
Johnson & Taylor (2016) Assessment of the baby: assessment at birth- Chapter 37. In: Skills for Midwifery Practice 4th edn. Pgs. 292-299.
Kocherlakota P. (2014) Neonatal abstinence syndrome. Pediatrics 134(2), pp. 547-561.
Kuzniewicz, M.W., Puopolo, K.M., Fischer, A., Walsh, E.M., Li, S., Newman, T.B., Kipnis, P. & Escobar, G.J. 2017, "A Quantitative, Risk-Based Approach to the Management of Neonatal Early-Onset Sepsis", JAMA Pediatrics, vol. 171, no. 4, pp. 365-371.
Lomax A. (2016) Examination of the Newborn, An Evidence-Based Guide, 2nd ed. Wiley Blackwell
McEwan T. (2017) Adaptation to extrauterine life 1: haematological, cardiovascular, respiratory and genitourinary considerations- Chapter 48. In Physiology in Childbearing with Anatomy and Related Biosciences 4th edn. (Rankin J. ed), Edinburgh: Ballière Tindall, pp. 533-544.
McEwan T. (2017) Developmental Anatomy: related cardiovascular and respiratory problems- Chapter 51. In Physiology in Childbearing with Anatomy and Related Biosciences 4th edn. (Rankin J. ed), Ballière Tindall, Edinburgh, P.501-520.
National Institute of Clinical Excellence (2021) Neonatal infection: antibiotics for prevention and treatment [NG195]. Available at: https://www.nice.org.uk/guidance/ng195
National Perinatal Epidemiology Centre (2019) Perinatal Mortality in Ireland Annual Report 2017. Available at: https://www.ucc.ie/en/media/research/nationalperinatalepidemiologycentre/NPECPerinatalMortalityinIrelandAnnualReport2017.pdf
HSE (2018) A Practical Guide to Newborn Bloodspot Screening in Ireland- 7th edition. Available at: https://www.hse.ie/eng/health/child/newbornscreening/newbornbloodspotscreening/information-for-professionals/a-practical-guide-to-newborn-bloodspot-screening-in-ireland.pdf
HSE (2019) National Infant Feeding Policy for Maternity & Neonatal Services. Available at: https://www.hse.ie/file-library/infant-feeding-policy-for-maternity-neonatal-services-2019.pdf
Johnson & Taylor (2016) Assessment of the baby: assessment at birth- Chapter 37. In: Skills for Midwifery Practice 4th edn. Pgs. 292-299.
Lomax A. (2016) Examination of the Newborn, An Evidence-Based Guide, 2nd ed. Wiley Blackwell
McEwan T. (2017) Adaptation to extrauterine life 1: haematological, cardiovascular, respiratory and genitourinary considerations- Chapter 48. In Physiology in Childbearing with Anatomy and Related Biosciences 4th edn. (Rankin J. ed), Ballière Tindall, Edinburgh, P.501-520.
National Institute of Clinical Excellence (2021) Postnatal Care Guideline [NG194]. Available at: https://www.nice.org.uk/guidance/ng194
Nursing and Midwifery Board of Ireland (2021) Code of Professional Conduct & Ethics for Registered Nurses & Registered Midwives. Available at: https://www.nmbi.ie/NMBI/media/NMBI/Code-of-Professional-Conduct-and-Ethics.pdf?ext=.pdf
Nursing and Midwifery Board of Ireland (2015) Practice Standards for Midwives. Available at: https://www.nmbi.ie/nmbi/media/NMBI/Publications/Practice-Standards-for-Midwives-2015.pdf?ext=.pdf
Nursing and Midwifery Board of Ireland (2015) Scope of Nursing & Midwifery Practice Framework. Available at: https://www.nmbi.ie/nmbi/media/NMBI/Publications/Scope-of-Nursing-Midwifery-Practice-Framework.pdf?ext=.pdf
Royal College of Paediatrics and Child Health (2013) UK-WHO 0-4 yr Growth Charts http://www.rcpch.ac.uk/child-health/research-projects/uk-who-growth-charts/uk-who-growth-chart-resources-0-4-years/uk-who-0
O’Reilly K. and J. Simpson (2014) Congenital Malformations- Chapter 32. In Myles Textbook for Midwives 16th edn. pp. 645-666.
Royal College of Paediatrics and Child Health (2013) UK-WHO 0-4 yr Growth Charts http://www.rcpch.ac.uk/child-health/research-projects/uk-who-growth-charts/uk-who-growth-chart-resources-0-4-years/uk-who-0
van Kempen et al. (2020) Lower versus Traditional Treatment Threshold for Neonatal Hypoglycemia. New England Journal of Medicine. DOI: 10.1056/NEJMoa1905593
Verklan M. T. and Walden M. (eds.) (2015) Core Curriculum for Neonatal Intensive Care Nursing 5th edn. St. Louis: Elsevier.
Wackernagel, D., Gustafsson, A., Edstedt Bonamy, A., Reims, A., Ahlsson, F., Elfving, M., Domellöf, M. & Hansen Pupp, I. 2020, "Swedish national guideline for prevention and treatment of neonatal hypoglycaemia in newborn infants with gestational age ≥35 weeks", Acta Paediatrica, vol. 109, no. 1, pp. 31-44.
Wardle S. P. and C. England (2014) Significant problems in the newborn baby. In Myles Textbook for Midwives. Marshall & Raynor (eds), pgs. 668-701. Churchill Livingstone
World Health Organisation (2014) Thermal Management. Available at: http://www.newbornwhocc.org/2014_pdf/Thermal%20management%202014.pdf
Name Role
Ms Mary Curtin Lecturer / Co-Lecturer
Dr Deirdre O'Donnell Lecturer / Co-Lecturer
Dr Lisa Rogers Lecturer / Co-Lecturer