A Day in the Life of a Neonatal Dietitian

My name is Catherine Casewell and I’d like to share with you what a day in the life of a Neonatal Dietitian looks like for me! I work full time with a split role between Ashford and St Peter’s Hospitals NHS Foundation Trust (ASPH) three days a week and as the Kent, Surrey and Sussex Operational Delivery Network (KSS ODN) Neonatal Dietitian two days a week. In my clinical role, I work on our Level 3 Neonatal Intensive Care Unit (NICU) two mornings a week, delivering dietetic care to those infants born prematurely, or who require additional support following birth. As well as working as a Neonatal Dietitian, I also spend some of my time supporting the Paediatric Allergy Team as a Specialist Allergy Dietitian.

My day working in the NICU start at 8.30am with checking my emails and reviewing the babies who may have come into the unit on the days that I’m not working at ASPH. This is then followed by a multi-disciplinary team (MDT) meeting at 9am, where we discuss the babies currently in our care and review any medical and social issues. We also look at whether any support is required from an Allied Health Professional (AHP) to care for the babies. Clinical support from a Dietitian can include monitoring their weights and heights, and adjusting feeding regimens as required, discussing and optimising breast milk supply with breast feeding mums and supporting with the transition from naso-gastric tube feeding to oral feeding. We also discuss non-clinical duties that maybe required from the AHP team on the unit such as providing information for the parent information board ‘Theme of the Week’ , updating the information for both staff and parents on the intranet and internet, and training and education for staff.

During this meeting, the team will highlight any infants that require dietetic input. This includes supporting those neonatal infants who aren’t growing as expected and those who aren’t tolerating their current feeding regimens, which can be for a wide variety of reasons. Together we consider alternative feeding strategies to meet their nutritional requirements and help to support growth and development.

At St Peter’s Hospital, there are three different rooms providing different levels of care; the first room covering Intensive Care, the second for High Dependency Care and the third for babies who require special care. During my ward rounds, I will check the infants’ weight, length and head circumference to document and plot these on BadgerNet, our maternity and neonatal electronic records system. This enables me to identify and monitor the trend in growth. I’ll then talk to the team, including Nurses, Doctors, Developmental Care Lead, other AHPs including Speech and Language Therapists (SLT) and Physiotherapists, and the parents about feed tolerance and current volumes prescribed, and review relevant biochemistry.

The unit promote a parent led-ward round on a Tuesday morning, which all parents are encouraged to be attend to share decisions and take an active role in the management of their baby whilst on NICU. In St Peter’s Hospital NICU, we follow the principles of family integrated care (FiC), which means fully involving the parents in their babies’ care to improve chances of a healthier future.  As part of FiC, I use the ward round as an opportunity to discuss with parents regarding their feeding preferences, both in the long and short-term. I speak with new breastfeeding mum’s regarding strategies to optimise breast milk production and ensuring their dietary intake is adequate. I also provide clear information to all parents on the different feeding strategies available to optimise growth and development

A feeding plan is then agreed, following the NICU’s  nutritional guidelines where possible, to ensure that each individual infant is meeting their nutritional requirements. Babies who are born early need a higher than average amount of energy, protein, vitamins and minerals than babies who are born on their due date – they’re like the super athletes of the baby-world! Each baby is reviewed once or twice a week, where time allows. . Any changes required to the feeding regimen are discussed when preparing  for discharge home, as well as the support available to ensure their baby continues to grow and develop once they leave our unit.  Around 1pm, we receive a visit from the hospital Chaplain and it’s time for some of her homemade cake that she kindly bakes for the NICU every week –it’s the best cake ever!

On a Friday morning, as well as the ward round, I also have a catch-up meeting with the Neonatal Community Outreach team (NCOT), also known as the Supportive Discharge Clinic (SDC). During this session, the team reviews all the babies currently at home and requiring on-going monitoring for growth and feeding. The NCOT team will usually inform parents of any changes to feeding plans; if more complex dietetic intervention is required, then I arrange to call parents for further discussion. I also have a regular dietetic outpatient clinic where I can continue ongoing dietetic management once the community team are able to discharge the babies from their care.

I work closely with a wonderful team of so many other professionals including Doctors, Nurses, Speech and Language Therapists, Physiotherapists, Psychotherapists and Infant Feeding Specialist Nurses. Dietitians from other specialist units (surgical, renal, liver, and metabolic) are always on hand to help guide an infants’ management if they are transferred back with weird and wonderful feeding regimens!

In addition to the clinical work load, there is always the need to input into non-clinical activities. I am involved in the mandatory training for Nurses and Doctors on the unit, updating Trust Neonatal nutritional guidelines, as well as writing parent education leaflets and baking cakes for the Neonatal Charitable Fund which is run by the NICU team!

I love my job and being part of such a committed Neonatal team.  It’s a real privilege working with babies and families at such a vulnerable and special time in their lives.