Neonatology in Newcastle - the clinical service
This page is focused on the development of the clinical service, photos and other stories and memoirs rather than research. We are grateful to everyone who have shared photos and their stories. Please email [email protected] if you have photos or stories to share.
Princess Mary Maternity Hospital
Opening of the New Maternity Department at Newcastle General Hospital 1939
Extensions to the Maternity Department NGH 1968
NEONATAL CARE - Newcastle General Hospital - Jenny Ross, Sister
1958 – 1960 Nursing Cadet
1965- 1968 Staff Nurse/Sister
1970 – 1979 Sister/Clinical Nursing Officer
In August 1939 a new Maternity Department on the Newcastle General Hospital site was opened but at this time there were no special provisions for premature or sick babies. In 1945 Dr F Miller when discharged from the armed forces began planning the Premature Infant Service which for a time became a model for the rest of the country. (see pictures above).
1958 – 1960 Nursing Cadet
Autumn 1958 was my first encounter with the Neonatal Service in Newcastle upon Tyne. I began working as a nursing cadet in the maternity nursery of Newcastle General Hospital for work experience before commencing General Nurse training in July 1960. Although I was not involved in the actual care of the “premature” babies I performed general duties helping in the care of all newborns but able to observe qualified nurses providing specialist care. Sister in charge was Georgina Gray who had worked closely with Dr Miller in the setting up of the Premature Baby Service. She was absolutely devoted and meticulous in her care.
My recollection is that there were 2 Oxygenaire incubators but additionally Charlotte Boxes were in use. I remember that warmth, nutrition and control of infection were the paramount factors in care. All equipment was washed by hand including the incubators which were then aired for several hours on the outside terrace before being put back into use. This practice continued throughout the time I was working in the unit until 1979. Oxygen was administered by a rigid face funnel for babies requiring therapy being nursed both in Charlotte boxes and cots. The only oxygen control was setting the flow although humidifiers were being used.
Cleanliness and infection control were so important. Hand washing and cleaning surfaces were as important then as today in the Coronavirus era! No visitors were allowed in the premature baby room with gowns and face masks being worn by nursing and medical staff. Parents were particularly excluded. Expressed breast milk was the nutrition of choice otherwise half cream Cow and Gate formula. (Full term babies were given National Dried milk if not breast feeding!)
At this time the minor sepsis area of the new maternity department had been converted as the Maternity Nursery and the premature baby room was the original treatment room – see plan of New Maternity Department Newcastle General Hospital 1939.
All babies came to the main nursery in this new area to be checked, bathed and examined by the Paediatrician before being taken to their mothers in the postnatal ward. This was still the practice in 1965 when I returned to work in the unit as a qualified nurse and midwife.
1965- 1968 Staff Nurse/Sister
By 1965 there had been an increase in the number of available incubators. Charlotte boxes were no longer in use but the accommodation was unchanged. Nationally there was greater interest in perinatal care. An extension to the unit was planned with extended accommodation, increased number of incubators and cots, additional nursing staff and Dr Cyril Noble had already joined the medical team as a consultant paediatrician. The extension was opened in 1967 – see photograph above of incubator room 2nd page “Extensions to the Maternity Department”. Clinical developments during these 3 years included the exchange blood transfusions for babies of Rhesus negative mothers. Under the management and guidance of Dr Willie Walker this became an efficient successful service. He was always in attendance either as the operator or supervisor of a resident Paediatrician and his good humour helped to make this an excellent training opportunity for medical and nursing staff.
Nursing staff were becoming more skilled and confident in the care they were giving, being more observant to changes in babies conditions given that they did not have the benefit of monitoring equipment which gradually became available in the 1970’s. It was during this time that the maternity nursery became the Special Care Baby Unit (SCBU) as care was increasingly provided for sick and premature babies.
I left the Unit in March 1968 to work in New Zealand and obtained a post in the Neonatal Unit of National Women’s Hospital, Auckland. This was a large unit of 54 incubators/cots with an overflow ward of 16 cots. The additional cots were required as babies were not discharged home until they were 6lbs in weight, whereas at the NGH, premature babies were allowed home when they reached 5lb in weight to the care of the midwife with special expertise in the care of these small babies. New Zealand did not have a community midwifery service.
Research and education were given high priority in the National Women’s unit. There was a constant stream of staff undertaking various aspects of research but clinical developments were no further advanced than in Newcastle. The consultants in Newcastle were more clinically involved providing better support to the resident medical staff. Nurse staffing at the NGH was certainly more stable providing better teamwork.
1970 – 1979 Sister/Clinical Nursing Officer
I returned to the NGH Special Care Baby unit in 1970 and it was at this time that the first ventilator was introduced - a Bennet model - which was a small unit on a metal stand with humidifier attached to the pole. My recollection is of endless plastic tubing, infusion stands with Ivac drip counters, electric sockets, adapters and cables to accommodate the various pieces of equipment. One could say it had a Heath Robinson look!!! Everything was in an experimental stage. Screwdrivers were essential tools of the trade!
Dr Cyril Noble took the lead in the clinical developments avidly reading journals for the current research to enhance neonatal care then putting it into practice. Continuous Positive Airways Pressure (CPAP) was introduced by using a prototype perspex box with a seal around the neck (which could leak!) made to Dr Noble’s instructions in the hospital engineering department.
I have been fascinated to hear “new” treatments for patients with Covid 19 over the past year which we were using in the neonatal unit in the 1970’s eg CPAP, use of Dexamethasone, prone nursing (which is how we always nursed babies with respiratory problems).
An additional ventilator was acquired, this time a Drager model – very different from the Bennett. It was a large grey cumbersome piece of equipment but more efficient than the Bennett and required less additional attachments. A blood gas analyser was also acquired. From my recollection, it seemed to require a great deal of calibration on a regular basis.
There was an increasing interest in this level of neonatal care. The paediatric Senior Registrars who had not previously been involved began to visit frequently. Nursing staff became increasingly skilled by “learning on the job”. There was no formal training as this level of care was in its infancy around the country.
On the retirement of Sister Gray I was appointed the Clinical Nurse manager and as part of my orientation I spent 3 weeks at the University College Hospital unit in London. This was a busy unit – plenty of hustle and bustle - with several medical personnel undertaking research. Nurse staffing was a problem as it was obvious that although senior nursing staff were confident and efficient the use of agency nurses created many difficulties. Lack of knowledge of the unit in geography, storage of supplies, and new developments caused stress to everyone. I involved myself in being an extra member of staff which surprised everyone but was much appreciated.
I certainly appreciated the steady workforce in Newcastle where agency nurses were never used and collaborative team work helped to reduce stress. This experience was extremely useful but it was encouraging to observe that the clinical developments in 1975 were no further advanced than in Newcastle. Gradually everyone gained greater experience. Parental nutrition was introduced with all its trial and tribulations. The Head Pharmacist took an active interest and arranged for the daily preparation of the fluid.
There had always been a close collaboration with other specialities eg Neurosurgery for babies with spinal defects, Dr John Burns for babies with genetic disorders, Orthopaedic medical staff for babies with bone deformities but in the later 1970’s there was increased collaboration with Cardiologists, Paediatric Surgeons, Radiologists etc. using the new technologies being developed across all medical fields. This was a time when advances were rapidly taking place in all areas of medicine.
Increasingly the NGH was providing a regional service for sick and preterm babies. Historically the NGH paediatricians had provided cover to the maternity unit at Hexham General Hospital but also to Dilston Maternity Home and Bridgend Maternity Home at Corbridge. The latter two had closed but Hexham continued to provide a maternity service. Babies requiring special care were always referred to the NGH but other maternity units were also referring their sickest babies.
Initially transport equipment consisted of a metal crib with a Perspex dome, hot water bottles and an oxygen cylinder strapped underneath the crib. An Oxygenaire transport incubator was acquired and a team from the NGH would go out to stabilise the baby before transfer to the unit. Mothers were transferred to the NGH whenever possible and in the latter part of the 1970’s parents were “allowed” into the unit and able to have physical contact with their baby.
To help the referring regional units neonatal care, the two Newcastle neonatal units (PMMH and NGH) working in collaboration, set up a planning group in association with the Midwifery Education Department to deliver the English National Board for Nurses Midwives and Health Visitors (ENB) Neonatal Care programme. The ENB which was responsible for standards and education had responded to increasing demand for a neonatal programme and 6 units across the country agreed to deliver the newly developed course. The course was held successfully in Newcastle and was well received by participants who were given the opportunity to gain clinical experience in both units.
Follow up of babies was always an integral part of neonatal care and early review of more babies having received intensive care and meeting their milestones was encouraging. It was amazing to see developments in later years but a privilege to be involved in the embryonic phase of neonatal intensive care.
Jennifer Ross, March 2021
1965- 1968 Staff Nurse/Sister
1970 – 1979 Sister/Clinical Nursing Officer
In August 1939 a new Maternity Department on the Newcastle General Hospital site was opened but at this time there were no special provisions for premature or sick babies. In 1945 Dr F Miller when discharged from the armed forces began planning the Premature Infant Service which for a time became a model for the rest of the country. (see pictures above).
1958 – 1960 Nursing Cadet
Autumn 1958 was my first encounter with the Neonatal Service in Newcastle upon Tyne. I began working as a nursing cadet in the maternity nursery of Newcastle General Hospital for work experience before commencing General Nurse training in July 1960. Although I was not involved in the actual care of the “premature” babies I performed general duties helping in the care of all newborns but able to observe qualified nurses providing specialist care. Sister in charge was Georgina Gray who had worked closely with Dr Miller in the setting up of the Premature Baby Service. She was absolutely devoted and meticulous in her care.
My recollection is that there were 2 Oxygenaire incubators but additionally Charlotte Boxes were in use. I remember that warmth, nutrition and control of infection were the paramount factors in care. All equipment was washed by hand including the incubators which were then aired for several hours on the outside terrace before being put back into use. This practice continued throughout the time I was working in the unit until 1979. Oxygen was administered by a rigid face funnel for babies requiring therapy being nursed both in Charlotte boxes and cots. The only oxygen control was setting the flow although humidifiers were being used.
Cleanliness and infection control were so important. Hand washing and cleaning surfaces were as important then as today in the Coronavirus era! No visitors were allowed in the premature baby room with gowns and face masks being worn by nursing and medical staff. Parents were particularly excluded. Expressed breast milk was the nutrition of choice otherwise half cream Cow and Gate formula. (Full term babies were given National Dried milk if not breast feeding!)
At this time the minor sepsis area of the new maternity department had been converted as the Maternity Nursery and the premature baby room was the original treatment room – see plan of New Maternity Department Newcastle General Hospital 1939.
All babies came to the main nursery in this new area to be checked, bathed and examined by the Paediatrician before being taken to their mothers in the postnatal ward. This was still the practice in 1965 when I returned to work in the unit as a qualified nurse and midwife.
1965- 1968 Staff Nurse/Sister
By 1965 there had been an increase in the number of available incubators. Charlotte boxes were no longer in use but the accommodation was unchanged. Nationally there was greater interest in perinatal care. An extension to the unit was planned with extended accommodation, increased number of incubators and cots, additional nursing staff and Dr Cyril Noble had already joined the medical team as a consultant paediatrician. The extension was opened in 1967 – see photograph above of incubator room 2nd page “Extensions to the Maternity Department”. Clinical developments during these 3 years included the exchange blood transfusions for babies of Rhesus negative mothers. Under the management and guidance of Dr Willie Walker this became an efficient successful service. He was always in attendance either as the operator or supervisor of a resident Paediatrician and his good humour helped to make this an excellent training opportunity for medical and nursing staff.
Nursing staff were becoming more skilled and confident in the care they were giving, being more observant to changes in babies conditions given that they did not have the benefit of monitoring equipment which gradually became available in the 1970’s. It was during this time that the maternity nursery became the Special Care Baby Unit (SCBU) as care was increasingly provided for sick and premature babies.
I left the Unit in March 1968 to work in New Zealand and obtained a post in the Neonatal Unit of National Women’s Hospital, Auckland. This was a large unit of 54 incubators/cots with an overflow ward of 16 cots. The additional cots were required as babies were not discharged home until they were 6lbs in weight, whereas at the NGH, premature babies were allowed home when they reached 5lb in weight to the care of the midwife with special expertise in the care of these small babies. New Zealand did not have a community midwifery service.
Research and education were given high priority in the National Women’s unit. There was a constant stream of staff undertaking various aspects of research but clinical developments were no further advanced than in Newcastle. The consultants in Newcastle were more clinically involved providing better support to the resident medical staff. Nurse staffing at the NGH was certainly more stable providing better teamwork.
1970 – 1979 Sister/Clinical Nursing Officer
I returned to the NGH Special Care Baby unit in 1970 and it was at this time that the first ventilator was introduced - a Bennet model - which was a small unit on a metal stand with humidifier attached to the pole. My recollection is of endless plastic tubing, infusion stands with Ivac drip counters, electric sockets, adapters and cables to accommodate the various pieces of equipment. One could say it had a Heath Robinson look!!! Everything was in an experimental stage. Screwdrivers were essential tools of the trade!
Dr Cyril Noble took the lead in the clinical developments avidly reading journals for the current research to enhance neonatal care then putting it into practice. Continuous Positive Airways Pressure (CPAP) was introduced by using a prototype perspex box with a seal around the neck (which could leak!) made to Dr Noble’s instructions in the hospital engineering department.
I have been fascinated to hear “new” treatments for patients with Covid 19 over the past year which we were using in the neonatal unit in the 1970’s eg CPAP, use of Dexamethasone, prone nursing (which is how we always nursed babies with respiratory problems).
An additional ventilator was acquired, this time a Drager model – very different from the Bennett. It was a large grey cumbersome piece of equipment but more efficient than the Bennett and required less additional attachments. A blood gas analyser was also acquired. From my recollection, it seemed to require a great deal of calibration on a regular basis.
There was an increasing interest in this level of neonatal care. The paediatric Senior Registrars who had not previously been involved began to visit frequently. Nursing staff became increasingly skilled by “learning on the job”. There was no formal training as this level of care was in its infancy around the country.
On the retirement of Sister Gray I was appointed the Clinical Nurse manager and as part of my orientation I spent 3 weeks at the University College Hospital unit in London. This was a busy unit – plenty of hustle and bustle - with several medical personnel undertaking research. Nurse staffing was a problem as it was obvious that although senior nursing staff were confident and efficient the use of agency nurses created many difficulties. Lack of knowledge of the unit in geography, storage of supplies, and new developments caused stress to everyone. I involved myself in being an extra member of staff which surprised everyone but was much appreciated.
I certainly appreciated the steady workforce in Newcastle where agency nurses were never used and collaborative team work helped to reduce stress. This experience was extremely useful but it was encouraging to observe that the clinical developments in 1975 were no further advanced than in Newcastle. Gradually everyone gained greater experience. Parental nutrition was introduced with all its trial and tribulations. The Head Pharmacist took an active interest and arranged for the daily preparation of the fluid.
There had always been a close collaboration with other specialities eg Neurosurgery for babies with spinal defects, Dr John Burns for babies with genetic disorders, Orthopaedic medical staff for babies with bone deformities but in the later 1970’s there was increased collaboration with Cardiologists, Paediatric Surgeons, Radiologists etc. using the new technologies being developed across all medical fields. This was a time when advances were rapidly taking place in all areas of medicine.
Increasingly the NGH was providing a regional service for sick and preterm babies. Historically the NGH paediatricians had provided cover to the maternity unit at Hexham General Hospital but also to Dilston Maternity Home and Bridgend Maternity Home at Corbridge. The latter two had closed but Hexham continued to provide a maternity service. Babies requiring special care were always referred to the NGH but other maternity units were also referring their sickest babies.
Initially transport equipment consisted of a metal crib with a Perspex dome, hot water bottles and an oxygen cylinder strapped underneath the crib. An Oxygenaire transport incubator was acquired and a team from the NGH would go out to stabilise the baby before transfer to the unit. Mothers were transferred to the NGH whenever possible and in the latter part of the 1970’s parents were “allowed” into the unit and able to have physical contact with their baby.
To help the referring regional units neonatal care, the two Newcastle neonatal units (PMMH and NGH) working in collaboration, set up a planning group in association with the Midwifery Education Department to deliver the English National Board for Nurses Midwives and Health Visitors (ENB) Neonatal Care programme. The ENB which was responsible for standards and education had responded to increasing demand for a neonatal programme and 6 units across the country agreed to deliver the newly developed course. The course was held successfully in Newcastle and was well received by participants who were given the opportunity to gain clinical experience in both units.
Follow up of babies was always an integral part of neonatal care and early review of more babies having received intensive care and meeting their milestones was encouraging. It was amazing to see developments in later years but a privilege to be involved in the embryonic phase of neonatal intensive care.
Jennifer Ross, March 2021