Neonatal Department’s Outreach Nursing Service (NAST)
The Neonatal Department’s Outreach Nursing Service (NAST) is a voluntary service for babies and parents who have gone home from the neonatal intensive care unit.
Photo: Colourbox
The service is available when your baby is stable enough to be at home but still needs follow-up from the hospital. This may apply to:
- premature babies
- babies with chronic conditions or syndromes
- babies with heart conditions
Most of these babies need to be fed through a feeding tube at first.
Babies and their families are often best at home, as long as the baby’s health is stable enough and the parents feel confident about going home. NAST can provide a gentle transition to taking responsibility for a baby who needs extra follow-up.
Going home earlier
If you use NAST, you can go home from hospital earlier. At home, parents and siblings can be together, and you can return to a more normal everyday life sooner.
The father or co-mother can receive care allowance when you use NAST, so that both parents can stay at home. This gives you both the opportunity to get to know your baby and support each other in caring for your baby and family.
The doctor is responsible for providing the medical certificate needed to apply for care allowance. Parents can find the document in their baby’s medical records on Helsenorge. You apply digitally through NAV.
More information: Care allowance for parents in the neonatal intensive care unit - Helse Stavanger HF
Before going home, your baby must:
- have been medically stable for a few days, meaning that they no longer need medication to stimulate breathing (which many premature babies need for a period of time)
- not need monitoring
- have completed all necessary examinations and treatment
- be at least 35 weeks’ gestation. This is partly to ensure that your baby’s breathing is stable and that they are able to feed some of the time themselves
- be able to maintain their body temperature in a standard cot without a heated mattress
- be able to feed some of the time themselves, either at the breast or from a bottle. If the mother wants to breastfeed and is able to do so, it is important to prioritise breastfeeding and, if necessary, wait a little before introducing bottle feeding.
Your baby’s weight
There is no absolute weight limit for when your baby can go home. This will vary somewhat depending on the baby’s age, the time of year and how well they can maintain their body temperature. Most babies lose some weight after birth. Before your baby can go home, they must have started gaining weight again.
Babies with chronic conditions
Babies with chronic conditions can go home when their condition is stable and their parents have received the necessary training. The paediatrician, named nurse and NAST nurse decide when your baby can go home.
Home visits
Before you leave the neonatal intensive care unit, you will have a consultation with a nurse from NAST.
We usually make home visits on Mondays, Wednesdays and Fridays, but we can arrange visits at other times if needed. Some families need visits more often, while others need them less frequently. We always arrange a time in advance, so you know when we will arrive and who will be visiting you. It can be difficult to give an exact arrival time, but we will try to let you know if we are delayed.
Telephone consultations
You can call us at any time if you have questions or are worried about something. We can also offer video consultations if needed.
The NAST team is available Monday to Friday, 7.30 am–3.30 pm.
In the evenings, at night and at weekends, you can call the neonatal intensive care unit. All NAST nurses also work shifts in the unit, and if none of us are there, there will always be a nurse on duty who is responsible for babies who are at home.
NAST telephone: 95 22 47 62 or 95 17 30 91 (try both numbers if you cannot get through on the first one)
Neonatal intensive care unit telephone: 51 80 44 11
In an emergency requiring immediate assistance, call 113.
Pre-feed weight
We have a limited number of scales available to borrow, but in most cases you will be given a scale to take home. We ask you to take a pre-feed weight of your baby before the NAST nurse comes for a home visit. This means weighing your baby before a feed and at approximately the same time each day. The total amount of milk your baby needs over 24 hours is calculated based on this weight.
Weighing before and after feeds
In the neonatal intensive care unit and postnatal ward, you may have weighed your baby before and after feeds to see how much milk they were taking at the breast. Once you are home, you do not need to be as precise about how much your baby is feeding. Try not to focus too much on the time or on how much your baby weighs before and after each feed. The most important thing is to pay attention to your baby’s signals and needs.
You do not need to weigh your baby before and after feeds when they want to breastfeed for comfort, between feeds or during the night. Instead, you can give milk through the feeding tube based on how much you think your baby has taken at the breast.
As your baby becomes better at breastfeeding, you can stop weighing before and after feeds and weigh your baby just once a day. It is important for the mother to pay attention to how her breasts feel before and after breastfeeding to estimate how much the baby has fed.
The most important thing is that your baby is content and gaining weight well. We will support you along the way!
At the hospital, you will receive thorough training in how to feed your baby through a feeding tube.
NAST is responsible for inserting a new feeding tube. Parents can be trained to do this themselves if they wish, particularly if you live a long way from the hospital or if your baby is likely to need a feeding tube for a longer period.
If your baby pulls out the feeding tube in the evening, at night or at the weekend, you will need to come to the neonatal intensive care unit to have a new tube inserted. If your baby is managing to feed some of the time independently, you can often wait until the following day to have a new tube inserted. If you are unsure, call the neonatal intensive care unit for advice. On weekdays, we can usually arrange an extra home visit to insert a new tube.
Equipment for tube feeding
The hospital will provide you with the equipment you need for tube feeding. We bring extra supplies when we visit you at home, so you can get more when needed.
The syringes can be reused several times. We recommend changing to new syringes twice a day. The other times, remove the plunger completely from the syringe and rinse all the parts thoroughly under running tap water. First use cold water to remove proteins, then hot water (as hot as you can manage). This removes most of the fat. Leave the parts to dry under a clean towel until the next feed.
Reports from home visits are added to your baby’s electronic medical record. You can access these through Helsenorge (website or app).
The doctor does not usually join home visits. If needed, we can contact a doctor from the neonatal intensive care unit for advice. You can also come to the neonatal intensive care unit if your baby needs to be examined by a doctor.
As long as your baby is receiving support from NAST, you do not need to contact your GP or out-of-hours medical service if your baby becomes unwell. Sometimes your baby may need to be admitted to hospital again after you have gone home. In this case, your baby will be admitted to the Paediatric and Adolescent Outpatient Clinic (BUMO). Outpatient follow-up appointments take place in the neonatal intensive care unit.
Please do not hesitate to call us if you are worried or have any questions. We are here to help.
If your baby becomes acutely unwell and you need urgent medical attention, call 113.
Breast pump and other equipment
Mothers who have milk and are tube feeding their baby need to express milk to give through the feeding tube. This is also important for maintaining milk production until the baby is able to feed entirely by themselves. We recommend using an electric breast pump that can express milk from both breasts at the same time. These pumps can be hired from, among other places, the hospital pharmacy.
You hire the breast pump itself. Other equipment, such as bottles, nipple shields and tubing (pump kits), must be purchased separately. NAST covers the cost of hiring a breast pump during the NAST period and the purchase of one pump kit. If you need additional kits, you will have to pay for these yourself. We recommend having two pump kits so that you do not have to clean the equipment as often.
When you hire a breast pump, you will need to pay a deposit (usually equivalent to two weeks’ hire). Keep all receipts. The cost of hiring the pump will be reimbursed when your NAST period ends. If you choose to keep the pump for longer than the NAST period, you will need to pay the hire cost for those additional days yourself.
How to clean the equipment
The equipment can be reused several times and should not be thrown away after a few uses, as the syringes are. Plan ahead so that you have clean equipment ready for the next time you express milk. This is particularly important at night, so you don't have to spend a lot of time cleaning then.
Bottles used for expressing and storing milk, breast shields and connectors must be washed in washing-up liquid (such as Zalo) and rinsed thoroughly after each use.
Milk residue can cause bacteria to grow, which can give your baby an upset stomach. The equipment should therefore be sterilised once a day. Boil it in water for 5 minutes or use an electric steam steriliser.
How to store breast milk
Put expressed milk straight into the fridge after expressing to keep it fresh. Fresh breast milk can be kept in the fridge for three days. If you express more milk than your baby needs, it is a good idea to freeze it for later use. Milk can be frozen in single-use plastic containers.
Freezer storage:
- Milk expressed during the first three weeks after birth can be kept in the freezer for three months.
- Milk expressed after the first three weeks can be kept in the freezer for six months.
Fridge storage:
- We recommend defrosting frozen milk in the fridge. This takes a little longer, but the milk can then be kept in the fridge for three days.
- If you need to defrost it quickly, you can thaw the milk on the kitchen worktop or in a water bath (use cold water). It can then only be kept in the fridge for one day.
Keeping track of feeds
To make it easier to keep track of your baby’s feeds, we have created a feeding record that you can use. You can record:
- how much your baby feeds independently
- how much milk your baby receives through the feeding tube
- when your baby feeds
- when your baby brings up milk or has a bowel movement
We also use the record to note the time of the next visit and who will be coming. There is also space for anything else you would like to make a note of. All the important telephone numbers are included in the record.
How often should your baby feed?
In hospital, your baby will usually feed every three hours, around the clock. When your baby is ready at home, we try to move towards seven feeds a day. This means feeding approximately every three hours during the day, with four and a half hours between feeds at night. These times will vary from baby to baby, and the aim is for your baby to gradually start deciding when they need to feed.
Try to establish a daily routine that works for both your baby and the rest of the family. It is helpful if your baby sleeps as much as possible at night and is more active during the day. The total amount of milk over 24 hours stays the same, but the night-time feeds will then be slightly larger.
Every baby and family have different needs. Together, we will find out what works best for you and your baby. There is no one-size-fits-all answer.
Vitamins and iron
Babies born prematurely have smaller iron and vitamin stores and therefore have a greater need for iron and vitamin supplements.
Babies with a birth weight below 2.5 kg need some additional iron. They should start taking this when they are four weeks old. All babies who are breastfed should have vitamin D from one week of age.
You will be given an overview of the vitamins and iron your baby should take. These are available without a prescription from pharmacies.
More information about dosage: Vitamins, iron supplements and nutrition during the first year of life for infants with a birth weight under 2.5 kg - Helse Stavanger HF
Many parents wonder how much clothing their baby needs, how warm to keep the home, and whether they can go for walks or have visitors at home. This varies from baby to baby and between seasons.
Try to get to know what your baby needs. Feel the temperature under their clothes on their back. Your baby should feel comfortably warm, but not sweaty or clammy. Keep your home at a temperature that feels comfortable for you.
You can keep the bedroom window open for most of the year, but your baby should then sleep at the other end of the room. Many babies will need to wear a hat at night in this situation.
You can take your baby out in the pram, but consider the temperature and wind conditions and dress your baby according to the weather. Feel free to ask us for advice when we visit you.
Premature babies have a less developed immune systems and are more likely to catch infections than other newborn babies. It is therefore important to be extra careful with hygiene. Always wash your hands thoroughly before feeding and caring for your baby, and after changing nappies. Everyone who is going to hold your baby should wash or sanitise their hands first.
Particularly during the winter, many people may be carrying infections. Ask visitors if they are well before they come, and try to limit your baby’s contact with children of nursery age as much as possible. Teach your baby’s siblings to wash their hands and not to cough or sneeze on the baby. Take sensible precautions without restricting everyday life more than necessary.
Avoid taking your baby to places where there are large crowds indoors, such as shopping centres, soft play centres and similar venues. This is both because of the risk of infection and because the noise and sensory stimulation may be too much for your baby.
It is important that siblings are allowed to take part in caring for the new member of the family. Let them help with safe tasks, such as getting a clean nappy or singing to the baby. Older siblings can hold the baby if they are sitting safely on the sofa with an adult.
Teach young children that they must not pick the baby up on their own or walk around while carrying the baby.
We usually continue to support you until your baby is feeding entirely by themselves and the feeding tube has been removed.
Before we finish the NAST service, we arrange a joint home visit with the health visitor who will continue to support your baby at the child health centre. We talk about your baby’s progress, both in hospital and at home. The health visitor will usually explain what to expect from the child health centre and the plans for follow-up. This is a good opportunity for you all to get to know each other.
In the first few weeks after NAST ends, you are welcome to visit the child health centre for a few extra weight checks in addition to the routine appointments.
Chronic conditions and feeding difficulties
Some babies receiving NAST have chronic conditions or long-term feeding difficulties. In these cases, it may be appropriate to end NAST after a while, even if your baby still needs tube feeding. This is always done in consultation with the parents, when you feel ready.
How long we continue to support your baby depends on their needs. In some cases, the local health services in your municipality will take over the follow-up. Some babies may be referred for follow-up with the Paediatric Rehabilitation Service (HABU) or Advanced Home Care for Children (AHS).