No abstract

Introduction: Fetal hydrops is a serious condition which can be caused by immune and non-immune aetiologies. We aimed to review the management of fetal hydrops at our hospital. Materials and Methods: A retrospective review of all cases of fetal hydrops diagnosed in our institution from 2006 to 2013 was carried out. Results: Out of the 30 cases of fetal hydrops diagnosed antenatally, 17 were cases of Bart’s hydrops which were all terminated in-utero. Of the remaining 13 cases, 11 cases consisted of non-immune causes of hydrops. Planned antenatal interventions including in-utero blood transfusions (n = 4) and thoracentesis (n = 5) as well as planned caesarean deliveries (n = 11) were performed in the majority of cases. Postnatal neonatal intensive care with interventions including chest drainage and transfusions were also performed. A majority, 92%, of the cases survived the perinatal period following a variable length of hospital stay ranging from a week to 3 months. Conclusion: Management of fetal hydrops is complex. Close coordination between he obstetric and neonatal teams was the key to good short-term survival of neonates with antenatally diagnosed hydrops, as it allows timely antenatal intervention and anticipation of potential perinatal complications. Key words: Antenatal, Complications, Interventions, Non-immune, Survival

Objectives To assess our baseline for sleeping environments within our unit and then perform interventions and repeat this process in PDSA cycles to improve the sleep environment of our vulnerable patients prior to discharge. Methods We performed sequential PDSA cycles after an initial baseline evaluation of sleeping environments on our neonatal unit. For each cycle we assessed cots according to the defined features of a safe sleep cot. Inclusion criterion was any baby in an open cot admitted to the neonatal unit. Safe sleep cots were defined by current lullaby trust guidelines: Clear without other items, flat and firm mattress, baby sleeping on its back, baby sleeping with their feet to foot of cot and blankets below shoulder level and not loose. The quality improvement project is registered locally. Results Baseline data in 2018 showed that no babies were in a cot consistent with all guidelines, only two thirds were on their back (n=28/42) and only one cot was bare. 83% (n=35/ 42) were on tilted mattresses and only 17% (n=7/42) of babies had feet at the foot of the cot. Blankets were loose in 60% (n=25/42) and only below the shoulders in half the babies.Results were presented to our neurodevelopmental MDT. Initial interventions were around team education, widening the project team and introduction of cot cards to be placed in cots and updated with any individual planned variances. We also liaised with our local Child Death Overview Panel, for whom SIDS is a local priority.Repeated PDSA cycles in 2020 showed some initial improvement from baseline with 80% (n=8/10) of babies on their backs, 60% of cots bare, 60% of babies at the foot of the cot, and blankets only loose in 20% and above the shoulders in 30%. Subsequent interventions included laminated signs being placed on all cots. Progress stalled at the most recent completed cycle with 79% (n=22/28) of babies on their back but only 11% (n=3/28) of cots bare.Further planned work includes increasing parent engagement and education earlier in admission and incorporating sleeping environment into standard daily documentation. Conclusions This ongoing quality improvement project shows that over time safe sleep environments can improve on a neonatal unit, which is known to have a positive influence on this vulnerable patient group being in a safe cot at home after discharge.