Paediatric Clinical Guideline

Emergency

1.8 Care of the Next Infant Scheme

Short Title: / Care of the Next Infant
Full Title: / Guideline for the use of the Care of the Next Infant Scheme for infants and children.
Date of production/Last revision: / February 2007
Explicit definition of patient group to which it applies: / This guideline applies to all children under the age of 2 years.
Name of contact author / Dr Stephanie Smith, Consultant Paediatrician
Ext: 64041
Revision Date / February 2010
This guideline has been registered with the Trust. However, clinical guidelines are 'guidelines' only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

Care of the Next Infant Scheme (CONI and CONI plus)

Background

The programme was set up by the Foundation for the Study of Infant Deaths to support parents in caring for a subsequent child following a “sudden infant death”.

There is evidence that informed professional support in the first few months of the new child’s life can help alleviate anxiety and be of value in ensuring appropriate care of the new baby.

The Care of the Next Infant (CONI) Scheme

The decision to offer a family a place on the CONI or CONI Plus schemes is consultant led and managed by the CONI co-ordinator (Liaison Health Visitor)

Parents are offered a structured system of care involving parents, midwife, health visitor, general practitioner and paediatrician during subsequent pregnancies. A variety of support measures are available and these are selected by the parents with the advice of the paediatrician and CONI local co-ordinator (an experienced health visitor).

1.Initially there is a weekly home visit by a member of the community team

+/- any combination of the following

2.Apnoea monitor

3.Weighing scales and weight chart

4.Room thermometer

5.Symptom diaries

6. Follow-up with designated paediatrician

Apnoea Alarms

Any baby entered into the programme should be supplied with an apnoea alarm (if desired) as soon as possible after delivery unless already provided to the family antenatally. These can be obtained from:

  • Children’s Short Stay Unit at QMC (0115 924 9924 ext 69040)
  • Neonatal Unit at NCH (0115 969 1169 ext 55214).

The paediatric consultant or a paediatric SPR will be responsible for supplying and demonstrating these. There is a checklist available for this process:

  1. Consultant approval
  2. Parents / carers seen by paediatric specialist registrar or consultant or nominated health professional. Resuscitation technique demonstrated and parents encouraged to practice
  3. Indemnity form filled in correctly including alarm serial number and GP details, with a proposed date for return established
  4. Five sensors and one roll of tape issued
  5. Functioning and setting up of alarm demonstrated

As infants become more mobile the alarm can be changed to an apnoea mattress – this change usually takes place at around 6 months of age if parents are still using the programme.

Resuscitation

Parents should be forewarned about false alarms and be aware of resuscitation procedures. The following is on the back of the CONI information for parent’s leaflet.

* This ratio is for those with “a duty to respond” and parents should be warned that the emergency services may advise the adult ration of 30:2

Follow-Up

The designated paediatrician will see the family intermittently from the post-natal ward until approximately 3 months past the age of the previous baby’s death (or longer if desired). Most of the follow-up is by the community team but at times they, or the parents, may request urgent assessment of the baby.

Remember these parents have had a baby die – they are not over-reacting if they seek medical attention. There should be a low threshold for admission. Experience has shown that they do not seek help inappropriately.

Inform their designated consultant +/- CONI co-ordinator of any hospital attendances.

CONI-PLUS Scheme

Fortunately there are fewer babies coming onto the CONI scheme because of the fall in the number of sudden infant deaths.

The programme is now available to families with previous infant deaths from other causes or babies who have had an apparent life-threatening event (ALTE). Inclusion in this programme will be a consultant decision. It involves pre-determined Health Visitor contact +/- elements of CONI scheme as desired.

Useful Numbers:

CONI & CONI - plus
Co-ordinators
Liaison Health Visitors / Sue Threakall
Jan Cloke
Marian Lenaghan / QMC 63417
Designated Consultants
for CONI / Dr Stephanie Smith / QMC 64042
Dr Louise Wells / QMC 64042
Dr Damian Wood / QMC 64041

Other paediatric Consultants and Neonatal consultants at the CityHospital and at QMC may also access the CONI and CONI plus schemes but need to remember the necessity of the hospital follow-up as part of the package.

Helpful Leaflet


Title
Care of the Next Infant Scheme
Guideline Number / Version / Distribution
1.8 / Final / All wards QMC and CHN
Author / Document Derivation
Dr Damian Wood
Consultant Paediatrician
Dr Stephanie Smith
Consultant Emergency Paediatrician
First Issued / Latest Version Date / Review Date
February 2007 / February 2010
Ratified By / Date
Paediatric Clinical Guidelines Meeting / March 2007
Audit / Induction Programme / Amendments

Stephanie SmithPage 1 of 6February 2007