Welcome to the newborn intensive care unit 3D

The unit is on the third floor of the West Block. As well as the patient’s rooms, the unit has family rooms, a lounge for parents, kitchenette and several other facilities. The unit is open to parents 24 hours a day.

Due to patient confidentiality, the use of a headset is required during doctor’s rounds.

3D’s 24-hour routine:

• Shift change at 07:15 – 07:30
• Doctor’s ward rounds approximately 09:30 – 11:30
• Shift change at 14:45 – 15:15
  
• Shift change at 22:00 – 22:15
  

You can telephone the unit at any time, day or night, to hear how your baby is doing.

• Cot room +47 51518467
• Incubator room +47 51518465
• Intensive care room +47 51518491
  

The unit may be closed due to emergency treatment.

You will find several different types of professionals working in the Newborn Intensive Care Unit (3D). Nurses, nurse specialists, doctors and kitchen assistants. We also cooperate with social workers, family therapists, physiotherapists, chaplains, psychiatrists, bio-engineers, radiographers, nutritional therapists and local authority health visitors.

You may also meet medical and nursing students, as well as nurses specializing towards newborn and children’s nursing and midwifery. A contact team will be set up consisting of a doctor and several nurses who will have the overall responsibility for the care and follow-up of your baby on the unit. You will be able to talk to the doctor and nurse when your baby is admitted and discharged. Nurses will also be available to answer any questions you may have each time you visit. If you need to talk
to a doctor at other times, this can also be arranged.

The 3D unit was certified as a mother-baby friendly ward in autumn 2007, in accordance with WHO and UNICEF criteria. Mother-baby friendly wards emphasize the importance of contact & bonding with the parents. We will strive to give mothers and babies the help they need to make the best start with breastfeeding.

Parents have a right to information about their baby’s condition, treatment and medical records. Staff are bound by the code of confidentiality and cannot answer questions about other people’s babies. We cannot answer telephone enquiries from family and friends without the consent of the baby’s parents. Please let us know if someone is going to visit your baby when you are unable to be there.

Many of the babies on the unit are highly vulnerable to infections. To reduce the risk of infection, everyone who visits your baby must be healthy. That means not having any infectious diseases, cold or flu sickness or diarrhoea. During periods when there is a generally high public risk of the spread of infectious diseases, the unit will restrict visiting. The staff will let you know what restrictions apply at any given time.

We kindly request that visitors, other than parents and siblings, stay on the unit for only short periods of time (5-10 minutes).

We also ask you only bring two visitors in at a time. This is out of consideration to the small babies who need as much peace and quiet as possible.

Remember that you are entering the baby’s bedroom. Please talk quietly. Sound is a significant sensory stimulant that can be stressful.

Good hand hygiene is the most important action you can take to protect your baby from infection. Please read the unit’s brochure ‘Beskytt ditt barn’ (Protect your baby)

Chickenpox

The staff must be notified if you think you may have come into contact with chickenpox. The incubation period for chickenpox is three weeks. Unfortunately, if you have been exposed to chickenpox and have not already had chickenpox, we cannot allow you onto the unit until the incubation period is over.

Oral herpes – cold sores

Parents with cold sores should stay away from the unit. They should start antiviral treatment with Zovirax, Antix or Vectacir cream, and may come back into the department when the cold sore has dried up.

Parents whose baby is on 3D often spend a lot of time at the hospital. For the first 72 hours, you will have to pay the full parking fee (NOK 100 for 24 hours). After that, you can ask us for a requisition form that entitles you to buy a one-week parking pass for NOK 350. You can buy the parking pass in the hospital’s reception in the main entrance (1).

There is a restaurant and shop which you can find at the main entrance. You can buy food 24 hours a day. See the hotel’s brochure for meal times.

• When parents are admitted to the patient hotel, they are entitled to full board at the restaurant.
• When parents are staying in family rooms in the neonatal intensive care unit they are entitled to free food from the canteen to a certain amount. We issue canteen food passes for breakfast, lunch and dinner. When staying with the baby for more than seven hours a day, the parent(s) are entitled to free food from the canteen.
• Canteen opening hours – see the unit’s noticeboard located in the corridor.

There is a small kitchen with kettle, coffee machine and fridge located near parent rooms 3 and 4.

The ‘Regulation on children in health care institutions’ (Forskrift om barns opphold i helseinstitusjon –in Norwegian only) states that:

• Section 6: Children are entitled to have at least one parent with them during stays in institutions, provided that this is in accordance with section 6-2 of the ‘Act relating to patient rights’ (Lov om pasientrettigheter – in Norwegian only).
• In cases of serious or life-threatening illness, both parents shall be able to stay with the child.
• Section 8: One of the parents staying with the child shall be entitled to stay overnight in the institution, preferably within reasonable proximity to the child. If the institution cannot provide facilities for overnight stays, the institution shall cover the expense of a hotel
  or boarding house allocated by the institution.

The unit has family rooms. As your baby grows and becomes better then you can be with your baby together in the family room. The hospital  cleaners mop the floors, but other housekeeping duties are your responsibility. You will find bed linen and towels in the cabinet in the corridor.

The hotel is an alternative if there are no available parent rooms on 3D. We will cover the cost for one parent to stay at the hotel. You will not be able to have your baby with you at the hotel because it is too far from the ward. Remember to check out before you leave the hospital, by 12:00 noon at the latest.

As parents to a newborn baby that is admitted to the Neonatal Intensive Care Unit (3D) you may be entitled to an attendance allowance if you are a member of Folketrygden.

You are entitled if: worked for a period of no less than 4 weeks immediately prior to your absence from work, or have been a recipient of unemployment benefits, sickness benefits, parental benefits, an attendance allowance or a training allowance from NAV

• had an income equivalent to no less than half of 1G (the National Insurance basic amount), and
• suffered a loss of income as a result of your caring for the child during his or her illness or injury.

If the child is hospitalized and a physician documents the need, two carers may qualify for simultaneous attendance allowances at 100 percent  coverage. If the child is receiving care at home, the physician must provide documentation that the child’s care needs are so great that it requires two people to care for the child simultaneously.

Please ask the doctor or nurse if you need an application form for attendance allowance.

When benefitting from attendance allowance you have to be present in the Newborn Intensive Care Unit.

NAST (Nyfødt avdelingens ambulerende sykepleietjeneste – Newborn Care Unit’s mobile nursing service): Fathers complete an application for attendance allowance from the day of discharge until the anticipated need for tube feeding is over.

You have access to your babys’s medical record. Please log in at www.helsenorge.no.

You will find an electric breast pump in all family rooms. If you are staying in the hotel, please hire one.

You can hire an electric breast pump from the following places:

Stavanger hospital pharmacy (Sykehusapoteket): 51519238
Madla Amfi pharmacy (Apotek1): 51597070
Sandnes: Boots pharmacy: 51609760
Bryne: Boots pharmacy (apotek), M 44: 51770900
Nærbø baby health clinic (helsestasjon): 51799970
Egersund, Sentrum helsestasjon: 51468150
Jørpeland helsestasjon: 51742180
Tau helsestasjon: 51742160

The expenses for hiring a breast pump will be refunded for the period your baby is admitted to the unit as well as benefiting from NAST mobile nursing service.

Fill out the form for pump hire or travel expenses. Remember to get the form signed by one of the nurses on the unit. The form and the receipts should be sent to the accounts office at SUS.

1. According to Pasientreiseforskriften are travel expenses to and from the health institution refunded for one parent, once a week, when the baby has been admitted a fortnight. The limitation is that one parent only will be refunded travelling from the institution, and one will be refunded travelling to the institution.
2. Parents will be refunded for one leave home, together with the baby, if the baby is serious or life-threatening ill, and it is verified. Please check documentation below.

Pasientreiseforskriften – main principle

The expenses are refunded according to a standard rate, regardless what means of transportation that is used. If travel due to healt issues cannot be done without assistance, it is possible to get a requisition for transport, i.e. taxi.

Documentation

Parents that are accompanying their baby that is admitted in the institution, must verify that the baby is serious or lifethreatening ill, when both parents are demanding refunding expenses according to § 10 (første ledd siste punctum).

Patient’s charge (egenandel)

Parents travelling without the baby, have to pay a certain amount, if free card is not achieved (149 NOK back and forth in 2019), even if refunding is demanded.

Application for refunding travel expenses can be done digitally by logging at www.helsenorge.no or using a paper version, which can be found at www.helsenorge.no More information: https://helsenorge.no/rettigheter/pasientreiser

As parents, you are the most important people in your baby’s life. You represent love, familiarity, safety and continuity for your baby while it is in hospital and for the rest of its life. Your baby will get to know you very soon.

It’s important for parents and babies to have contact with each other at an early stage. Parents’ voices, and their smell and touch have a calming effect on babies. As soon as it is medically safe, you can hold your baby skin to skin. As parents, you will actively participate in your baby’s daily care. Your assessment of the baby thriving is valuable information to the professional team.

Feel free to talk to us about how you experience the stay, also if something seems difficult. It may help you to talk about your feelings and reactions. We want to help and support you, so that your time on the Neonatal Intensive Care Unit can be as pleasant as possible for your family. Ask about things that you’re not sure of; there is no such thing as a ‘silly’ question. When parents and staff communicate well, a lot of anxiety can be avoided. The hospital chaplain is the person who support the next of kin and is available in the unit weekly. The chaplain can be contacted when necessary. Parents have benefited from these informal conversations.

During your stay, the nurses will suggest talks to you and your family. The conversations will include these basic subjects: your baby’s sleep and wakefulness, getting into a routine, stimulating and supporting your baby, daily care, attention and interaction.

Group topic discussions also take place in the lounge on Tuesdays and Thursdays between 12:30 – 13:30. See notices posted in the unit.

Together, you and the staff of 3D will focus on what is best for your baby at all times.

There is a lot of different technical equipment on the unit, such as incubators and monitoring equipment with alarms. It is the nurse’s and doctor’s responsibility to know why an alarm is going off and whether they need to take any action.

Having a new family member admitted to the Newborn Intensive Care Unit affects the entire family, including older sibling. Older siblings can have different reactions to this. You can help siblings to manage the situation by:

• giving the siblings some information before they enter the unit for the first time. Try to adjust the information according to the child’s age and to any questions the child might ask.
• showing some pictures of their little brother or sister, and answering any questions they might ask about the equipment around the newborn baby.
• involving the siblings. They can make drawings that can be hung near the incubator or cot. They can help with daily care if their little brother or sister can cope with this. They can hold the baby, once the baby is stable.
• ask the staff to take photos of the newborn baby that the siblings can keep, which they can show to their friends at nursery or school.
• give siblings some attention. They can find it tiring to answer questions from people at school, kindergarten, neighbours or other family members about their new brother or sister. You can help older siblings by talking to them & listen to any concerns they have at school or kindergarten. Together you can formulate answers that they can give to people. You might like to inform their school or nursery about the new family situation.

The unit has two paediatric nurses who have responsibility for siblings as next of kin.

Most babies admitted to the Newborn Intensive Care Unit will need breastmilk or other kinds of nutrition shortly after admission. Breastmilk is the preferred nutrition to all newborn babies. Research indicates that ill newborn as well as premature babies have greater survival and will have fewer long-term complications if they get breastmilk. If the baby needs donated breastmilk before the mother has milk, the parents must agree.

A breastmilk bank is established on 3D. Volunteers donate their excess breastmilk. The volunteers are screened like blood donors. Bacteriological samples are taken from the breastmilk.

Most babies admitted to the Intensive Care Unit will need help establishing breastfeeding. Initially the babies may be too small, too ill or too exhausted and cannot breastfeed. They will have a soft feeding tube placed in their nose or mouth which goes directly down to their stomach.

Breast milk is the best nutrition your baby can get. It is food as well as medicine. Breast milk is particularly important for premature babies or newborn babies who are ill, as it is easy to digest. Breast milk contains a vast number of components that support and strengthen your baby’s immune system.

If your baby has been born too early, you will produce breast milk containing more fat and protein. Collect the first yellow colostrum, even if there is only a few drops. The best thing your baby can get is fresh breast milk. Most babies will be able to cope with a few drops in the stomach. If a mother is not producing enough milk, we can give the baby donor milk from our milk bank.

Expressed milk should be refrigerated or frozen immediately after it has been expressed if you are not going to use it.

Warm, freshly expressed milk must be chilled before it is mixed with cold milk. It can be poured directly onto milk that is already frozen.

Fresh breast milk can be stored for 72 hours in the fridge  (4°C).

Frozen breast milk that has been thawed in the fridge can be stored for 48 hours once it has been fully thawed.

Frozen breast milk that has been thawed in cold water can be stored for 24 hours in the fridge.

Colostrum is the milk that you produce for the first three weeks. It can be stored for three months in the freezer.

Milk that you produce after three weeks can be stored for six months in the freezer.

Most mothers whose babies are transferred to 3D express by hand in the beginning. You can ask for a hand pumping kid. Mother’s will need to use a breast pump after they have started and to maintain their milk production. Pumping over long periods is tough, and we will encourage you when needed.

It is important to start stimulate your breasts as early as possible after giving birth, preferably within 6 hours. Information about expressing milk by hand, pump and breastfeeding will be provided by the staff.

Spend plenty of time close to your baby. Offer skin to skin contact every day, or as soon as your baby can cope with this. Skin contact is the first step towards breastfeeding. Use a cup rather than a bottle to feed your baby while you are getting started. Ensure a good, steady milk supply by pumping regularly. 

As your baby matures, it will gradually be able to suck. The amount that the baby takes from the breast will gradually increase, and tube feeding can be reduced accordingly. Your baby’s ability to breastfeed will vary according to the time of day or night. It’s normal for premature babies to take short breaks while feeding from the breast. In order to maintain your milk supply, you will have to continue supplementary pumping, until your baby is taking full feeds.

At the beginning, you should not go more than three hours between feeds or pumping. We will work with you to set up a breastfeeding schedule that  will help to get you started.

Sometimes it is not possible to maintain your milk production no matter how hard you try. Formula milk is very nutritious for your baby. You will still be able to give your baby skin contact and your presence when bottle feeding.

Your local health centre can help with advice and assistance. Ammehjelpen (Breastfeeding Help) is a network of mothers who can give advice and guidance. www.ammehjelpen.no

Smoking and smokeless tobacco

Nicotine easily passes into breast milk particularly, and gives a higher concentration in breast milk than in the mother’s blood. The nicotine concentration is highest immediately after you have had a cigarette or used smokeless tobacco. You should therefore avoid smoking several hours before breastfeeding or pumping. It’s also a good idea to avoid smoking well before you plan to be close to or cuddle your baby. Remember that the smell will linger for some time on your clothes and in your breath.

Alcohol

The concentration of alcohol in breast milk is equivalent to the  concentration in the mother’s blood. We do not know for certain what the limit is before it will have a harmful effect on your baby. We therefore recommend that you are careful when drinking alcohol.

Medicines

If you need any medication while breastfeeding, please contact your local medical doctor.

It’s important for an immature baby to maintain a natural, lightly curled position, with bent arms and legs and the hands near the face. This helps the baby to breathe, and promotes better sleep. A good position also helps the baby to have eye contact with you. A sick full-term baby also needs a good, natural position.

How you can help your baby:

• Lay your baby on its side, so that it can get its hands up
  towards its mouth, and its feet together.
• Make a nest of rolled-up towels that support the baby’s feet, and that also provide boundaries around the baby’s body. The baby will then feel safe and gain a sense of body awareness.
  

The smallest babies have more stable breathing patterns and digestion when they are lying on their stomachs. Eventually, as the baby gradually grows and stabilises, it should gradually get used to sleeping on its back, the position recommended by national guidelines.

Sleep is a vital requirement, and it is an important factor in allowing the premature baby’s brain to mature. Babies born prematurely have unclear boundaries between sleep and wakefulness (alertness). They can quickly fluctuate between dozing, light sleep and deep sleep. Periods of sleep help the baby to get its energy back. As the baby matures, its sleep will become deeper and it’s sleeping pattern more robust. Full term newborns who are also sick need a lot of rest and sleep.

How you can help your baby:

• Respect your baby’s sleep periods.
• Avoid waking your baby when it is in a deep sleep.
• Hold your baby skin to skin.
• Help your baby back into rest and sleep after care activities, by  placing your hands gently around the baby. Some babies like to hold onto your finger until they fall asleep.
• If it is necessary to wake your baby up, please support your baby by placing your hands around it. Talk quietly. Your baby knows your voice.

Sound and light can be stressful for the baby, especially if it's very small and fragile.

How you can help your baby:

• Cover the incubator or cot with a dark coloured cover.
• Shield your baby’s eyes from direct light when you remove the incubator cover.
• When your baby becomes more mature, it needs more light during the day and less at night, support it as it develops a natural day-night rhythm.
• Speak quietly in the room, particularly near the incubator or cot.

When you are holding your baby outside the incubator, we make it a priority to try to be as quiet as possible.

The sense of smell develops very early. The mother’s and father’s smell is safe and comforting to the baby. 

• Your baby can smell you when it is lying skin to skin.
• Strong, unpleasant smells like perfume, cigarette smoke, hand sanitiser and the like are stressful to babies. Allow the alcohol in the hand sanitiser to airdry before you touch your baby.

The more immature and/or sicker your baby is, the more support it needs. You can support your baby with your hands during care activities. Take a short break from care activities if your baby shows signs of stress or anxiety.

Premature babies stretch their arms and legs out during care activities. Let your baby support its feet against your hand, and bring your baby’s arms and hands close to its mouth. If your baby splays its fingers, hiccups, sneezes, yawns, grimaces, cries, burps, falls asleep during care activities or its breathing pattern changes, these are also signs that it needs a break and support.

Your baby might also need a dummy or pacifier to self-soothe. Check to see if your baby searches for its dummy if you touch its mouth. Your baby will also calm down if it can curl its hand round your finger and hold on to you.

When bathing your baby, wrap it in a soft cloth. Your baby finds this supportive and calming. You should also wrap your baby when it is being weighed.

The staff will show you how to hold and handle your baby. You will gradually become more confident and will be able to take over the care of your baby.

Assemble everything you will need beforehand, so that you don’t have to turn away to fetch something. Never leave your baby unattended on the changing table.

All newborn, from those who are born extremely early, to fullterm babies, can communicate with you and are aware of your presence.

When your baby is very small, it gets to know you by holding its hand around your finger, and feeling your hands when you place them gently around its body. You are the person who can best help your baby to relax and achieve restful sleep.

As your baby matures, it will become better able to see you, and to focus on your face for short periods. Babies manage better when other sensory impressions are reduced (light, noises, movement). Let your baby lie in a naturally curled, foetal position.

If your baby looks away from you, hiccups, and burps or closes its eyes, it means your baby needs to take a break. Hold your baby against your skin, to give it a break from eye contact. Be patient; your baby is maturing every day, and will gradually be able to cope with your cuddles and voice more often and for longer periods.

Comfort, relief and pain assessment

During painful procedures, we hold around the baby, give it glucoses and offer a pacifier. This will relieve pain and stress.

As parents, you are welcome to participate. The comfort received from parents is important and effective. The baby is regularly assessed for pain and stress by a pain assessment tool called ALPS-Neo. When needed the baby will get pain medication.

Before you can hold your baby skin to skin, you can give your baby skin contact by holding your hands softly and gently over your baby inside the incubator.

As soon as your baby is medically stable, you can hold your baby skin to skin. Place your baby against your breast inside your shirt and cover with warm blankets. This is called kangaroo care, and is a unique opportunity to provide mutual closeness, security and love. www.kangaroomothercare.com

Kangaroo care has many advantages:

• Your baby’s breathing is stimulated by your breathing.
• Your baby’s temperature is regulated through your body temperature.
• Your familiar voice and heartbeat calms your baby and makes it feel secure, giving it a better quality of sleep.
• Your baby’s digestion improves, uses fewer calories, and it puts on weight.
• Your baby becomes better able to handle the environment of the NICU.
• Skin to skin is the first step towards successful breastfeeding and helps promote milk production.

Before you hold your baby skin to skin, we recommend:

• that you have been to the toilet
• that you have something to drink, a mirror and maybe some reading material nearby
• that your baby has on a clean nappy
• that you take off your bra

You will provide closeness, and the staff will be responsible for your baby’s safety and any alarms from the equipment. The nurse will assist you when your baby is lifted out to you. This will make the move as stress-free as possible for the baby. After a while, you as parents will be able to do this by yourselves, when you are ready and it is safe to do so.

We recommend at least one hour in the kangaroo position, so that your baby calms down and has a good period of sleep.

When you and your baby feel that it is time for the period of kangaroo care to end:

Help your baby back to restful sleep by placing your hands around it in the incubator. Take your hands away carefully and gradually. Your baby will then be able to stay calm even when you are apart.

All newborn babies at Stavanger University Hospital undergo a hearing test that examines how the inner ear is functioning. The test does not hurt, and is carried out when the baby has been fed and is sleeping. The room must be quiet. A small earpiece is inserted into the baby’s ear, and gentle clicking noises are sent down the ear. The response sent back by the ear is measured. Mothers and fathers can be present, and you can find more information in the unit and upon enquiry.

All newborn babies in Norway are examined for a total of 23 congenital disorders, including thyroid hormone deficiency (congenital hypothyroidism) and for the metabolic disorder phenylketonuria (PKU) or Føllings disease. A blood sample is taken sometime around 48 hours after birth. Parents will receive more written information when the sample is taken.