Newborn & Neonatal Care from Optimal Healthcare

We’re the calm, safe pair of hands on hand to both support but also to step in should a complication arise. Do you need a paediatrician in delivery? All c-section deliveries in Cayman need a paediatrician or neonatologist present, in case of complications. It’s optional for a normal vaginal delivery (but that could become a c-section in delivery itself) but the absolute majority of of parents want that safety net and support. We’ll conduct an immediate newborn assessment, address any immediate care needs and then we’ll conduct baby checks calmly later, but before you leave hospital.

There is a great deal happening at once in delivery and it is easy for a busy birth team to overlook specific wishes, like delayed cord clamping, or providing skin-to-skin immediately after birth. We’ll ensure these are kept to the fore and make sure they are both safe and joyous experiences. You’ll also find Optimal Paediatricians a calming influence always happy to keep you informed of what is going on around you.

There’s a huge amount to think about and decide upon as part of your pregnancy journey. Much of it will be new too. We’ll help you every step of the way in making great choices, based on reliable guidance. We’ll ensure you baby receives its NeoGen newborn screening test at around 24 hours and we’ll guide you through the Cayman Islands Immunisation Schedule as it relates to newborns (we tend to discuss this ahead of delivery).

Based on the 10+ million birth study Unexpected complications of low-risk pregnancies in the United States, the rate of birth complications was 57% in high-risk pregnancies. However, what is more important is that in low risk pregnancies it was still 29%, nearly a third of all births, but certain neonatal complications were higher in the low-risk group, presuambly because they were less likely to be planned for and managed. Necessary intervention of a neonatologist in even low risk pregnancies is a possibility and when it is necessary, experience matters, whether its an infant needing a tiny amount of assistance to breath or the requirement for full resuscitation in a more urgent care situation. We always ensure our resuscitation and newborn urgent care skills are fully up-to-date.

We provide full neonatal intensive care for a wide variety of both term and preterm complications. In the UK, USA and most other similar systems, care in NICU is conducted by a dedicated, specifically accredited Neonatologist, a paediatrician with a far more in-depth training in this area. As an example, Dr Sara Watkin has 30 years of tertiary experience post-specialisation as a neonatologist, including use of advanced techniques such as therapeutic hypothermia (cooling) for birth asphyxia, or use of nitric oxide for hypoxemic respiratory failure (HRF) associated with persistent pulmonary hypertension of the newborn (PPHN). You don’t need to understand these, only that we do, with decades of experience in them. When these are needed, experience really matters, including the experience of when not to use them too.

In the UK, around 1 in every 13 babies (around 7.6% based on data published in 2021) will be born prematurely and the number is increasing. This figure is 8.7% when looking at data from the black ethnic group. Although data from the Cayman Islands is sparse, from our own practise we know that rates are at least similar. Whereas some preterm births come with notice, many do not and it is a reason we advocate not leaving your choice of newborn paediatrician to the last moment). Even moderately preterm infants (born between 32 and 37 weeks gestation) have an increased rate of breathing difficulties, more problems feeding, and more developmental problems. It’s important that all preterm infants get the right care, whether it’s what we used to call ‘special care’ or full on intensive case. Our team is led by Dr Sara Watkin, who has 30 years experience of caring for preterm infants from 23 weeks onwards.

Jaundice in newborn babies (neonatal jaundice) is common and something we see frequently here in Cayman. It causes a distinct yellowing of the skin and the whites of the eyes, although the skin changes can be more difficult to see in brown or black skin. We are expert in diagnosing jaundice and check for it specifically at around 72 hours of age, but it can occur later too and we always make sure our mums know just what to look for. Most will clear up without too much input from your paediatrician but where it does need treatment, that treatment is both important and fairly urgent, requiring re-admittance of your baby to NICU for something called phototherapy. We will manage all of this for you.

This is another area of care where experience matters, espcially in recognising the signs of infection early. Delays in recognising a baby is not well, leading to treatment delays, can lead to more serious complications, including sepsis, which may be life-threatening. Your baby has a rapidly developing immune system but it’s also facing exposure to many bacteria and other pathogens that it has been protected from in utero, including bacteria like Group B Streptococcus commonly found in the birth canal. We take great care to assess any risk factors for a newborn infection, so that we can minimise risks ahead of birth and manage the approriate use of antibiotics and follow up afterwards too, where necessary. If this is an area that you wish to explore further, we recommend reading the excellent guide from our colleagues in Cambridge UK on Infection in Newborn Babies.

Neonatal seizures are sudden, abnormal electrical activities in a newborn’s brain, causing jerking or twitching movements, and are the result of a lack of oxygen and blood to the brain, called hypoxic ischemic encephalopathy (HIE). These are rare but can be extremely frightening to parents, and indeed to paediatricians not used to treating them too. Expert care, rapidly delivered, is crucial because seizures can indicate underlying problems that need immediate treatment to prevent brain damage and other complications. That’s especially important in Cayman, because tackling issues early can help prevent needing to transfer infacts overseas. We hold a particular expertise in this area, with Medical Director and Consultant Neonatologist, Dr Sara Watkin, having been NICU Chief of Service in one of the foremost UK centre’s for prevention and treatment of newborn brain injury – UCLH London – also one of the leading NICU’s for introducing therapeutic hypothermia or cooling.