Inside Limerick’s new neonatal unit caring for babies born weighing as little as 600g

The expanded Limerick neonatal unit blends cutting-edge medicine with family-integrated care for babies born extremely premature

Rooms in the new neonatal unit. Picture: HSE Midwest

The revamped and extended neonatal unit in Limerick offers a new type of care to its tiny patients, some weighing as little as 600g at birth, according to one of the country's leading neonatologists and paediatricians.

Professor Roy Philip said the difference lies in how closely parents and staff partner to bring these delicate humans into their new life, in rooms painted with local flowers.

“It is a newer version of what we call a neonatal unit. It’s not like parents are kept out. We want the parents to be with the baby as much as possible,” the neonatologist and paediatrician at the UL Hospital Group said.

“People think that the equipment is the biggest thing in any neonatal unit, but what the mum is offering, I don’t think any of us can offer.” 

Making it easier for mothers to breastfeed and have skin-to-skin time (when the baby rests on a parent’s chest without barriers) is a key part of the plans.

“If we can get the milk from mum on day one, that tiny baby will definitely show a better prognosis compared to those without,” he said.

This builds on how the unit has long worked with mothers.

“For the last 14 years, for every baby who weighs below 1,000g at birth — that is the tiniest of all babies — 100% of them were exposed to human milk. Not 90% but 100%,” he said.

Prof Roy, as he is known, pointed out that mothers and staff achieved this despite concerns nationally about low breastfeeding rates.

A lactation station offers advice to new mothers in a project short-listed at the Friends of Breastfeeding Awards this year.

The two-storey extension and refurbished clinical space opened in June.

“If a baby is getting sick tonight, and we want the parents to be here, we can comfortably now offer them a place to stay overnight or a couple of days,” he said.

“It is so important during those stressful days to have continuous access.” 

The unit now also has more space in its intensive care unit, high dependency unit and purpose-built isolation areas.

We developed a true family integrated care model. That means when you have a tiny baby born at 25 or 26 weeks, they usually stay with us for 2.5 to three months before they go home.

Some are so small at birth that an adult could hold the baby in their hand. They can grow to about 2kg by the time they go home.

“On one side, they are extremely vulnerable, but on the other, they are extremely resilient as well,” he said.

Care has improved significantly in his years as a neonatologist, he said. 

This is the best time to invest in them when they are very, very young and particularly ill as infants, he added.

“We’ve had babies from 23 weeks, and to my recollection, 23 weeks and four days was our youngest in this unit,” he said.

Across Irish neonatal units, technology and support systems have changed survival rates, with babies as young as 22 weeks surviving.

“But at the same time, we have to be careful in saying that, that it doesn’t mean every baby born at this gestation time is going to make it either,” he cautioned.

University Maternity Hospital Limerick sees about 4,000 births every year. 

Roy Philip, adjunct professor of neonatology and consultant neonatologist and paediatrician at University of Limerick Hospitals and University of Limerick School of Medicine standing next to artwork of herbs traditionally used in healing painted on the walls of the new neonatal unit. Picture: HSE Midwest

He estimated between 700 and almost 800 need neonatal care. This includes sick full-term babies as well.

“Now I would say equipment-wise and facility-wise it is definitely state-of-the-art,” he said.

"In the past, we used to get infection outbreaks because the babies were close to each other. So now we can really separate them.” 

The hospital also recently switched to using electronic health records, making paper folders a thing of the past.

It has seen “significant improvements” in midwifery and obstetrician/gynaecologist numbers also.

“If you ask me, is there room for improvement in the staffing levels? Definitely, there is, and mainly I would say from a nursing point of view,” he said.

“That doesn’t mean we don’t have nurses, but if we had more nurses, we would be able to hold onto babies during surges [in numbers].” 

For anyone interested in working with these delicate patients, he said: “I would strongly recommend people to come and look at the place, so people would be tempted to apply here.” 

Prof Roy returns to the idea of the nurturing environment, pointing out beautifully rendered artwork.

“We have plants and flowers used for infection protection, and some to improve breastmilk flow; this was historically known in Ireland,” he said.

Visual artist Tracey Sweeney won a competition to create the project. 

Her ideas were inspired, she said by “quiet resilience of plants that grow in the Burren, delicate but determined".

Among others, she drew honeysuckle, an ancient cure for jaundice and milkwort, used to support lactation.

Prof Roy said: “When you come here, you will see flowers on the walls and so on, and each one has a meaning and why it is actually put there.” 

Every tiny detail is ready for the tiniest of patients.