NMHS33390 Complexities of the Newborn

Academic Year 2023/2024

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 the neonate to senior midwifery, senior nursing, and medical personnel when appropriate for further care and treatment. The student will acquire the knowledge and simulate the skills necessary to: initiate appropriate, timely, individualised care for a neonate that is either unwell or at-risk of becoming unwell, requires resuscitation, or requires urgent referral/transfer to the multidisciplinary care team.

This module provides the theory underpinning the clinical experiences of caring for neonates/infants that students may encounter across a variety of placements, including Intranatal, Postnatal, Midwife-Led Care, 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;
Resuscitation of the neonate (as per the AAP 'Newborn Resuscitation Programme' 8th edition) the lab based OSCE assessment for these skills is a must-pass component;
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**).

*Higher Diploma in Midwifery students taking this module will not attend in-person for Week -1. Access to asynchronous recordings of the lectures from Week -1, Brightspace discussion boards, and a bespoke lecture will be provided to HDM students.
**BSc and HDip students will attend lectures and labs in-person together on Week 0.

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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 or at-risk 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,

Theory and skills of neonatal resuscitation.

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

BSc Midwifery students ONLY: 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).
Higher Diploma in Midwifery students ONLY: attend a full-day neonatal resusciation workshop/OSCE, adhering to the AAP 'Newborn Resuscitation Programme, 8th edition' textbook. Theory pre-requisites to be completed prior to workshop attendance.

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
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

Practical Examination: OSCE assessing core skills for midwifery practice, including resuscitation of the neonate. Unspecified n/a Pass/Fail Grade Scale Yes

10

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

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
HSE (2022) A Practical Guide to Newborn Bloodspot Screening in Ireland- 9th 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
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.
Knight M. and Marshall J.E. (2020) The healthy low birthweight baby. In Myles Textbook for Midwives, 17th edition. Marshall & Raynor (eds), pgs. 857-873. Churchill Livingstone
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.
Ledward A. and Marshall J.E. (2020) Care of the dying baby: end-of-life issues and rights of the fetus/neonate. In Myles Textbook for Midwives, 17th edition. Marshall & Raynor (eds), pgs. 955-969. Churchill Livingstone
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.
McIntyre J. (2020) Significant problems in the newborn baby. In Myles Textbook for Midwives, 17th edition. Marshall & Raynor (eds), pgs. 917-954. Churchill Livingstone
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 (2022) Perinatal Mortality National Clinical Audit in Ireland - Annual Report 2020. Available at: https://www.ucc.ie/en/npec/npec-clinical-audits/perinatalmortality/perinatalmortalityreportsandforms/
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 (2022) Practice Standards for Midwives, 2nd edition. Available at: https://www.nmbi.ie/Standards-Guidance/Midwives-Standards
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
Ohja, Tsilika, and Mistry (2020) Trauma During Birth, Haemorrhages, Convulsions- Chapter 35. In Myles Textbook for Midwives 17th edition (Marshall & Reynor eds.), pp. 874-891.
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
Patrick, S. W. et al. (2020) 'Neonatal Opioid Withdrawal Syndrome', Pediatrics, 146(5).
Simpson J. and O’Reilly K. (2014) Congenital Malformations- Chapter 36. In Myles Textbook for Midwives 17th edn. pp. 892-916.
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.
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
Timetabling information is displayed only for guidance purposes, relates to the current Academic Year only and is subject to change.
 
Autumn
     
Online Learning Offering 1 Week(s) - -1 Fri 09:00 - 13:50
Lecture Offering 1 Week(s) - -1 Mon 09:00 - 12:50
Lecture Offering 1 Week(s) - 0 Mon 09:00 - 12:50
Lecture Offering 1 Week(s) - -1 Mon 14:00 - 15:50
Lecture Offering 1 Week(s) - 0 Mon 14:00 - 15:50
Lecture Offering 1 Week(s) - -1 Thurs 09:00 - 12:50
Lecture Offering 1 Week(s) - 0 Thurs 09:00 - 12:50
Lecture Offering 1 Week(s) - -1 Tues 09:00 - 12:50
Lecture Offering 1 Week(s) - 0 Tues 09:00 - 12:50
Lecture Offering 1 Week(s) - -1 Wed 09:00 - 12:50
Lecture Offering 1 Week(s) - 0 Wed 09:00 - 12:50
Laboratory Offering 2 Week(s) - 0 Fri 09:00 - 13:50
Laboratory Offering 2 Week(s) - -1, 0 Tues 14:00 - 15:50
Laboratory Offering 3 Week(s) - -1, 0 Wed 14:00 - 15:50
Autumn