Collections with neonates in NICU

A Neonatal Intensive Care Unit (NICU) is an intensive care unit specialising in the care of critically ill newborn infants. Some of these babies are born prematurely and while others are born at term, they often have serious conditions such as congenital heart disease, major surgical and complex medical conditions.

Collecting from neonates in a special care location requires a specialised skill and understanding of the needs of these tiny babies.

Here are several things we must do:

• Nurses provide the specialised care to the babies and must be consulted when entering the unit to undertake a pathology collection • Speak to the Registered Nurse (RN) to ensure this is the right time to proceed • Always include the parent if they want to be involved and be respectful if they choose not to be present • Allow the mum or nurse to comfort the baby • If unsure at any time during the procedure, you should always ask for help

As a collector it is important that you are comfortable with the position of the baby and you must let the RN know if you’re unsure or uncomfortable.

What helps

Calming the baby. After identifying the vein, swaddling the baby or cuddles with mum or RN, or breast feeding promotes endorphins and calms the baby and reduces their stress. Dummies can also be used to keep the babies calm.

Sucrose is also used to calm the baby and will be charted and administered by the RN. Remember, sucrose takes a few minutes to take effect.

Keeping the baby calm and reducing the stress of the procedure will assist both the baby and the collector undertaking the collection procedure.

Effective communication with mum and the nurse looking after the baby. Speak to the RN, ensuring it is the right time to perform the collection. Engage with the mum, let them know why you are there and explain the procedure. Some mums may find it hard to be present whilst others want to be involved. Always be respectful of their decision.

Be mindful that the parent may be experiencing anxiety

over the collection, diagnosis or situation. It can be distressing for the parents, always be professional, respectful, and caring when carrying out the procedure.

Collecting only the minimum volumes. If you have questions or it seems to be a large collection, check with the lab before proceeding.

Once the collection is complete, where possible, give baby back to Mum or the RN to comfort the baby. Overlooking NICU protocols. The NICU and the LHD have strict protocols and infectious control policies in place for the protection of the babies that we must follow.

What hinders

Not acknowledging parent(s) worry or anxiety. Take time to explain your role and the procedure to the parent(s), include them throughout if that is their preference and comfort them where appropriate.

As Rajeshwari from Westmead explains “If the parents are first time parents, they may be more anxious about the procedure on their newborn baby.”

Not advising if you are uncomfortable or unconfident. This is a highly specialised procedure, if at any time you lack confidence or feel uncomfortable with the procedure, let the RN know and/or ask for help from a more experienced collector.

A parent’s experience with their newborn,

shortly after leaving hospital. “I didn’t know what to expect before I took my son for his first blood test - I thought it would be straight forward. Soon after the first attempt he was really distressed. I hadn’t heard my newborn scream like that before. I felt helpless and I was in shock while it was happening. I was distressed and upset afterwards. I still have a sinking feeling when I think back about it. The staff were faultless. I realise now they had full control of the situation and were equally managing me and my son at the same time. They were empathetic, reassuring and comforting me from the very beginning before we went into the collection room. It was an experience I totally underestimated at the time”