Neonatal Home Care

Home Care Team Solna

Karin Sjöberg 072-254 21 57
Rose- Marie Wacker 070-002 14 80

On-call hours: Neonatal Ward Solna 08-123 740 92

Home Care Team Huddinge

Anneli Persson 08-585 812 70
Jessica Söderdahl 08-585 896 28

On-call hours: Neonatal Ward Huddinge 073-745 49 61

Home Care Team Danderyd

Rebecka Sabel 076-050 19 88
Susanna Cambrand 072-596 81 24
Veronica Granath 072 596 81 12
Ellen Spångberg 073 620 42 67
Eva Woodhouse 072 468 66 68

On-call hours: Neonatal Ward 1 Danderyd 08-123 554 2

Your baby can leave the hospital when:

• Breathing and circulation are stable
• The baby is able to maintain a stable body temperature without the help of a heated cot
• A baby car seat is available to transport the baby from the hospital to your home in your own car or a taxi (a hospital transport card can be provided)

The home care team is available from Monday to Friday, during the day. The baby will continue to be registered at the neonatal ward during the period of time that care is necessary. This means that you can call around the clock for advice. Prior to transferring to the community care team, you will receive instructions on how to best monitor your baby. You will also go through the routines connected with any treatments that need to be performed at home, such as tube feeding or light therapy.

Home visits will be planned on the basis of your baby's needs as well as your own, and may vary during the period your baby requires care. It may also be necessary for you to come to the hospital in connection with medical check-ups or e.g. for inserting a feeding tube. The baby will be discharged from the hospital when it is medically stable, can feed orally through breastfeeding or through other methods and is gaining weight satisfactorily. The baby's bilirubin level must have decreased, enabling light therapy to be discontinued. If the baby gets an infection at home and re-hospitalization is required, the baby will not usually be readmitted to the neonatal ward, as the risk of infection for other patients is too great.

The nurse makes an assessment of the baby's general condition – such as its vitality, breathing, whether it has a cold, its body temperature, skin colour, skin folds, stools and urine. The baby's weight is checked and nutritional planning is evaluated together with the parents. If necessary, the feeding tube is changed and relevant tests are carried out. The role of the nurse is to provide support based on the needs of the parents. It is important that you feel informed about the babys' current status and get the chance to ask any questions you may have. 

All patients registered with the home care team need to be able to travel to and from the hospital. If you do not have access to your own car, you are entitled to a hospital transport card, which is preloaded with taxi journeys. A trip to or from the hospital will cost SEK 140. Public transport is not recommended during the period that the baby is receiving care because of the risk of infection. An approved baby car seat should be brought to the hospital for the journey home. It is possible to apply for mileage allowance for travelling in your own car.

• Heat the breast milk or baby formula to about 37°C in a bain-marie.
• Discard any leftover breast milk/baby formula after the feed.
• The community care nurse will replenish your supply of syringes during the period that your baby requires tube feeding at home.
• Always check the position of the tube before commencing tube feeding.
• Make sure the tape is firmly secured.
• Check that the red marking is in the correct position at the wing of the nose and corresponds to the number marking.
• Insert the syringe into the feeding tube and slowly pull back the barrel (return). If stomach contents are aspirated, this is a sign that the feeding tube is in the stomach.
• If no stomach contents are aspirated, try to inject 2 ml of air and try again. You can also change the baby's position or give him/her some food orally on a spoon or using a cup, or breast feed the baby.
• If the baby has started breastfeeding, it is easier to aspirate liquid from the stomach when testing the position of the feeding tube.
• Never tube feed the baby unless you are able to aspirate some stomach contents into the feeding tube. It may mean that the tube is not in the correct position.
• The baby can be tube fed while lying on your chest or in your arms enabling skin-to-skin contact. This is to associate satiety with the breast, to create close contact and to see how the baby reacts to being fed.
• Finish tube feeding by injecting about 0.5 ml of air into the tube.
• Clean the syringes by pulling them apart and rinsing them first with cold and then with hot water. Leave them to dry. Reuse them and change the syringes twice a day, morning and evening.
• The syringes should not be boiled or washed in the dishwasher.
• Tube feeding should only be carried out by parents/relatives who have been instructed on how to perform tube feeding by a nurse.
• The feeding tube will be replaced by a community care nurse at intervals of 1-2 weeks.

As a parent, you know your baby the best. Therefore, observations made by parents are very important. Pay particular attention to:

• The baby's skin colour, for example pallor
• If the baby is tired and does not have the energy to feed
• The baby's body temperature
• Runny nose, blocked nose, sticky eyes - have saline solution at home
• If the baby starts to vomit, irrespective of feeding times, e.g. in a horizontal position and if it grimaces and loses its appetite
• If the baby's belly button is red and sticky – wash it with saline solution and a swab

Items sent home with you from the hospital

• Syringe for tube feeding
• Surgical tape for taping the tube
• Breast pump to borrow/rent
• Formula for premature babies if it is on prescription
• Any additives that need to be mixed into the breast milk/baby formula
• Any medicine that needs to be administered at home

Every family will receive a little take-home-kit, at the first home visit. The kit contains items that the nurse will use during home visits. Keep the box out of the reach for children.

Items you need to buy

• Diapers (diapers for premature babies can be purchased at the pharmacy)
• Saline solution for the baby's nose and washing the baby's eyes
• Thermometer for checking the baby's temperature
• Nipple shield, if needed, and a dummy
• Bottles in which to warm the baby's food
• Creams and lotions

• The feeding tube detatches and you do not have a planned home visit within the next few hours
• The baby's body temperature is below 36.5°C, even though you have tried to warm the baby up
• The baby's breathing pattern and skin colour changes
• The baby is unusually tired and does not have the energy to eat normally
• You are unable to aspirate any stomach contents when you check the position of the feeding tube

Outside of office hours, contact the Neonatal Ward.

The MR10 apnoea alarm for newborns continuously monitors breathing in babies up to 18 months of age. The alarm emits an audio-visual signal if the baby stops breathing for a predetermined period of time of 10 or 20 seconds.

Breathing

• When monitoring the baby, it is very important that the user is close enough to the alarm for the signals to be detected. Breathing is detected by a soft foam-filled sensor (breathing sensor) that is attached to the baby's abdomen, where breathing movements are clearly visible.
• During breathing, the abdominal wall is raised and a small amount of air passes through the sensor and the tube attached to the alarm (a small device/box). It emits an audible click and a simultaneous visual signal. The clicking sound can be turned off. The sensor does not detect the breathing itself, but rather it detects the small bodily movements which occur when the baby breathes in and out.
• The sensor should be moved to a different position approximately every three days and replaced with a brand new device every six to seven days. Read the instructions that come with the device.
• Other electronic devices can interfere with the control unit. Therefore, remove any electrical and electronic equipment – such as listening devices or mobile phones – within a 1-2 metre radius of the apnoea alarm.
• The sensor must be placed next to the navel as shown in the picture. It must be moved to a new position every three days and secured with Mefix tape.
• The alarm sensor is reused and, if necessary, can be cleaned with soap, water and alcohol wipes.
• Please note that the alarm sensor must be removed before bathing the baby.
• The alarm is intended for use in a cot or on a stable surface. It cannot be used in a car, pram or when the baby is lying on the parent's chest, as it may then register movements in its immediate surroundings.

How should an alarm be interpreted?

The alarm may be triggered for different reasons:

• The baby stops breathing for more than 10 or 20 seconds. See the instruction, "Föräldrautbildning i Lungräddning" (Parental Training in Infant Resuscitation.)
• Poor contact between the baby's skin and the sensor. The most common cause for an alarm being triggered is that the sensor on the abdomen has started to come loose.
• The baby is breathing in a way that the device is not detecting as movement. Slow exhalations, for example after a sigh or straining, are not registered as breathing. The sensor may also have difficulty detecting and recording shallow breathing during deep sleep.

Information reviewed by: Pernilla Dillner, Care Manager, Community Care

An apnoea alarm is used to control and monitor breathing in infants. The alarm emits a signal when the baby stops breathing for 20 seconds. Breathing is recorded by breathing movements being converted into electrical signals by the breathing sensor via compression and bending movements.

Breathing

• When monitoring the baby, it is very important that the user is close enough to the alarm for the signals to be detected.
• Other electronic devices can interfere with the control unit. Therefore, remove any electrical and electronic equipment – such as listening devices or mobile phones – within a 1-2 metre radius of the apnoea alarm.
• The sensor must be placed next to the navel as shown in the picture. It must be moved to a new position every three days and secured with Mefix tape.
• The alarm sensor is reused and, if necessary, can be cleaned with soap, water and alcohol wipes.
• Please note that the alarm sensor must be removed before bathing the baby.
• The alarm is intended for use in a cot or on a stable surface. It cannot be used in a car, pram or when the baby is lying on the parent's chest, as it may then register movements in its immediate surroundings.

Testing the control unit

Control unit testing must be carried out once a week. Start the control unit with the breathing sensor connected, but without attaching it to the baby.

Make sure the sensor is still and that nothing is interfering with it. After 20 seconds, the alarm will sound and the RED light comes on. The control unit must remain on. Remove the breathing sensor. The indicator light on the control panel should then light up (YELLOW light) and the alarm will sound.

What can trigger an alarm?

• The baby has stopped breathing for more than 20 seconds. The RED light comes on and an audio signal is emitted. See the instruction, "Föräldrautbildning i Lungräddning" (Parental Training in Infant Resuscitation.)
• It may be difficult for the alarm to detect and register shallow breathing during deep sleep – in this instance frequent alarms will be triggered indicating abnormal breathing. The RED light comes on and an audio signal is emitted.
• Poor contact between the baby's skin and the sensor. Sensor sensitivity is largely determined by the location of the sensor (adjacent to the navel) and the strength of the movements of the diaphragm. The RED light comes on and an audio signal is emitted.
• If the apnoea sensor emits an alarm indicating sensor error – the YELLOW light comes on and an audio signal is emitted. Contact "Medicinsk apparatur i hemmet" (Medical Devices in the Home) on the following phone number: 08-123 675 00.

Green light: light indicating breathing

Red light: patient alarm: the permitted time for cessation of breathing has been exceeded

Yellow light: technical alarm: sensor error, battery alarm

Information reviewed by: Pernilla Dillner, Care Manager, Community Care

Jaundice in newborn infants occurs when there is too much of the naturally occurring substance bilirubin in the blood. The skin turns yellow because the bilirubin pigment sticks to the fatty tissue under the skin and the whites of the eyes. Because the liver is not fully developed, the breakdown of bilirubin does not occur quickly enough. Light therapy, also know as phototherapy can help to accelerate the breakdown of bilirubin. The rate at which bilirubin is broken down is checked through blood tests and sometimes a skin test – transcutaneous measurement.

How does phototherapy work?

We have two phototherapy devices, one called Bilisoft and one called Bilicocoon. By placing the baby either on a light cushion or between two light cushions, the baby's skin is exposed to blue LED light, which helps to lower the bilirubin levels in the body.

When your baby undergoes light therapy at home, they should be naked apart from their diaper. Light therapy should be carried out continuously during the day, only being interrupted for nappy changing and feeding. The therapy can continue during breastfeeding by holding the baby together with the light cushion in your arms.

For hygiene reasons, the baby should not be placed directly on the cushion; always use the protective cover. Remember to protect the cover when changing the baby's diaper, etc. The protective cover is patient-specific, will be replaced if stained and discarded when the light therapy is completed.

If you are using a Bilisoft device, place the baby on its back so that its head is also exposed to the light. Wrap the baby in the light cushion, ensuring that as much of its body as possible is exposed to the light. Make sure that the correct side of the cushion is against the baby's body. Wrap the light-cushion in a blanket if needed; the cushion does not emit any heat. Put the eye mask on the baby to protect its eyes.

If you have a Bilicocoon, use the protective bag to cover the light cushions and place the baby between the cushions. If the baby is positioned so that no light reaches its eyes, the eye mask can be removed, for example during breastfeeding.

The baby should not lie on its stomach in the light therapy device. The pillow and cable can be bent, but must not be folded. To start the therapy, insert the fibre-optic cable and press the on/off button.

Check your baby's body temperature once a day during therapy to make sure your baby is not getting too hot or too cold. Normal body temperature should be between 36.7 and 37.2°C.

As soon light therapy initiated, the bilirubin value will be checked regularly through blood tests or transcutaneous testing (measuring externally through the skin). When the therapy is complete and the bilirubin value is steadily declining, the baby will be discharged. Unless there are other medical reasons to keep the baby in the ward.

Babies who need extra oxygen can be cared for at home with support from the home care team. Before you bring oxygen home, it is important that you feel confident about how to handle it. Our staff will go through the equipment with you.

Important information:

• How to connect the flowmeter/regulator to the cylinder
• How to open and close the oxygen cylinder
• How to tell that the oxygen is running low
• How the nasal cannula should sit and when to replace it

The equipment/accessories for the oxygen can be rented from Hjälpmedelscentralen (the Medical Aids Centre) and delivered to the hospital. This does not cost anything for parents, as the baby is still a patient at the hospital. There is a brochure that comes with the equipment, "Syrgas i hemmet" (Oxygen in the Home), explaining how the equipment works as well how to handle oxygen in the home.

Oxygen cylinders can be ordered from the phamacy (Apoteket). The first delivery will arrive at the hospital before you go home, so you can try to connect it and start using it before leaving the hospital. When the oxygen in the cylinder starts to run low, you will need to order a new one, this will be delivered to your home. Deliveries take place on specific days of the week, depending on where you live. Different residential areas have different delivery days. When it is time to return the oxygen cylinders, you call the same phone number that you called when you ordered it. The cylinders will then be picked up from your home. Other equipment can be returned to Hjälpmedelscentralen.

Babies using oxygen are monitored with a pulse oximeter that shows the oxygen saturation (oxygen level) in the blood and indicates how much oxygen the baby needs. The oximeter is attached to the foot or hand.

The consulting physician will determine:

• when the baby needs to use oxygen.
• the appropriate range for oxygen saturation.
• how much oxygen the baby will need when it goes home.

Contact Apoteket

Phone: 0771-450 450 (Fast service menu option 1.3). Orders must be placed no later than one day before delivery.

Costs

Medical gas is considered to be a drug and is included in the high-cost protection scheme in the same way as other medicines.

The cost consists of:

• The gas – SEK 190.50 per cylinder. Home delivery – SEK 250 per occasion + SEK 45 per cylinder.
• Rental charges for each gas cylinder, SEK 5 per day.