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Going the extra millimetre in neonatal care: Hazel Talbot at DFTB19


Hazel Talbot graduated from one of the country’s leading medical schools just one year after Andrew Tagg. Whilst he has fled the NHS for warmer climes, she has remained in the UK and works as a neonatologist for Embrace, the Yorkshire and Humber Infant and Children’s Transport service, part of Sheffield Children’s Hospital. She is also an Honorary Consultant at Leeds Children’s Hospital, where she can indulge her desire to look after kids in a slightly less restrictive space than in the back of an ambulance.

Neonatal care is a field where the tiniest details can profoundly impact the lives of our tiniest patients. In her insightful talk, Hazel Talbot, who works with Embrace, the intensive care transport service for children and babies in Yorkshire and Humber, shed light on the importance of making marginal gains in neonatal care. As medical professionals dedicated to the well-being of newborns, we must understand how these small improvements can make a world of difference.

The Tale of the Princess and the Pea

Hans Christian Andersen’s “The Princess and the Pea” teaches us that even the tiniest of things can have a significant impact. In the story, a single pea hidden beneath multiple mattresses causes discomfort to the princess, revealing her true royal nature. Similarly, the smallest improvements in neonatology can lead to better outcomes for neonates.

Borrowing from the World of Cycling

Hazel Talbot draws inspiration from Dave Brailsford, the director of cycling for Team GB, who revolutionized British cycling with the concept of “marginal gains.” Brailsford’s approach involved breaking down every aspect of cycling into smaller components and making each component just 1% better. When these marginal gains were combined, they led to remarkable improvements in performance. This concept, known as the law of increasing returns, can be applied effectively in neonatal care.

The Power of Tiny Gains

Marginal gains, when accumulated over time, can lead to substantial improvements. Neonatology, focusing on the smallest and most fragile patients, is ripe for these incremental improvements. So, what are some of the small gains we can achieve in neonatal care?

Public Health Matters

One significant area where we can make a difference is public health. Neonatal care begins even before birth. Addressing issues like smoking, illicit drug use, obesity, and domestic violence during pregnancy can significantly reduce the risk of preterm birth and neonatal complications. Additionally, advocating for responsible family planning can help prevent teenage pregnancies associated with higher risks.

Kangaroo Care and Bonding

Implementing kangaroo care – skin-to-skin contact between parents and newborns – is a simple yet powerful practice. Studies show that this practice can regulate a baby’s heart rate, improve oxygenation, initiate breastfeeding earlier, and enhance bonding between parents and infants. These early bonds can have lasting effects on a baby’s development.

Promoting Breastfeeding

Breastfeeding is not only natural but also a crucial element in neonatal care. It provides numerous health benefits, including reducing the risk of diseases such as NEC (Necrotizing Enterocolitis) and retinopathy of prematurity. Furthermore, it promotes bonding between mother and baby, ensuring a nurturing environment for neonates.

Family-Centered Care

Family-centered care is an innovative approach that empowers families to participate actively in their baby’s care. It fosters bonding and nurturance, reduces depressive symptoms in parents, and ultimately leads to earlier discharge from the neonatal unit. This approach aligns with the World Health Organization’s goal of transforming neonatal services.

Infection Control and Antibiotic Stewardship

Maintaining strict infection control measures is another way to improve neonatal outcomes. We can protect newborns from potentially life-threatening infections by developing and following infection control guidelines. This, in turn, reduces the need for antibiotics, contributing to antibiotic stewardship, a critical concern in healthcare today.

High Flow and Delayed Cord Clamping

High-flow humidified nasal cannula oxygen and delayed cord clamping are two more areas where we can achieve marginal gains. High-flow systems improve nurse-facility interactions and give parents more access to their babies. Delayed cord clamping is a simple, cost-effective practice that reduces the risk of complications in newborns.

Embracing the World Health Organization’s Goals

The World Health Organization outlines five key goals for neonatal care: surviving, thriving, transforming, investing, and counting. These goals emphasize the importance of quality care, access to specialized units, training and recruitment of nurses, global transformation of neonatal services, and empowering parents to be active participants in their baby’s care.

Going the extra millimetre in neonatal care involves recognizing the significance of small gains. It is our responsibility to embrace these tiny improvements in public health, bonding practices, breastfeeding, family-centred care, infection control, antibiotic stewardship, and innovative techniques like high-flow systems and delayed cord clamping. By doing so, we can make a tremendous difference in the lives of neonates and their families, ensuring they not only survive but thrive in a nurturing and supportive environment. Together, we can create a brighter future for the tiniest members of our society.

This talk was recorded live at DFTB19 in London, England. With the theme of  “The Journey”, we wanted to consider the journeys our patients and their families go on, both metaphorical and literal.

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