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Special Care Nursery · Gosford · K7

Welcome to the
Special Care Nursery.

Find your feet quickly: how the unit runs, where to find things, and what to do when it gets busy or uncertain. Read straight through, or jump to a section below.

Unit: K7, Level 7Handover: 0800 & 1600>1000 babies / year
Calling for help in an emergency

You are never expected to manage an emergency alone - escalate early, it is always the right call.

First, call your team
  1. Call the registrar or fellow - your first call for any concern.
  2. Call the consultant on call for more senior input.
For immediate assistance
  1. Call 2222 and ask for a "neonatal emergency" so the right team comes.
  2. If you need more help, call 2222 and ask for "advanced neonatal resuscitation" - this also brings a neonatal nurse.
Day one

Your first shift

A quick checklist to get you going.

Before your first ward shift, collect your ID / swipe card from security on Level 3 (outside ED).
You'll usually have an orientation day; if you don't, arrive in time for the 0800 handover in the Lorraine Love Room (in D4), and sort your access and logins (eMR / PowerChart).
Introduce yourself to the nurse in charge and the team.
Walk the unit - the resus trolley, equipment, and where things live.
Find the patient list on NICUS (the neonatal patient-list system; the nursing staff can help direct you), and get to know the babies.
Check how to call for help and escalate (see the box above).
Ask what your role is for the shift - and never hesitate to ask questions.
Finding your feet

Getting started

Welcome to Gosford Special Care Nursery. The Level 4 neonatal unit cares for preterm and term infants who require additional support, monitoring and early stabilisation. We work as a collaborative team alongside families, obstetrics and tertiary neonatal services to provide safe and compassionate care.

The team

Roles

  • Consultant Paediatrician - overall clinical oversight; the primary escalation point.
  • Neonatal fellow - a fellow is designated to the SCN each week (approximately 0800-1630) and can help with questions, review babies and attend births. When the fellow is in clinic or otherwise offsite, the consultant covers this role.
  • Registrar or SRMO - day-to-day management, admissions and family communication under senior guidance.
  • General paediatric registrar - your contact for acute paediatric advice and after-hours escalation, alongside the on-call consultant.
  • NUM / shift coordinator - unit flow, staffing, operations.
  • Nursing team - experienced neonatal clinicians; key partners in recognising early deterioration.

Meet the paediatric team →

The rhythm

How the unit works

  • Ward rounds are consultant-led - present clearly: respiratory support, feeding, escalation.
  • Documentation and jobs occur during or just after rounds.
  • After hours you are supported by the on-call consultant - early phone discussion is encouraged.
  • Working together: families are part of the care team; escalation and asking for help are safe practice.
You are not alone. Early discussion and asking for help are always encouraged - you are never expected to manage challenging situations alone.

Shifts

These may change depending on staffing - confirm against the current roster.

ShiftHours
Neo07:30 - 16:00
Neo 1007:30 - 18:00
Neo 1208:00 - 20:30
Neo (weekend)08:00 - 18:00
Neo EW12:00 - 22:00
Neo E15:30 - 23:30
Neo E 1013:30 - 23:30
Find your feet

Where everything is

The Special Care Nursery (K7) is your home base. The birth suite, maternity and paediatric ward are close by - you will move between them.

AreaWhere
Special Care NurseryK7 - your home base
Birth suiteK5 - instrumental & emergency births
MaternityJ7 - postnatal reviews
Paediatric wardD4 - main entrance, turn left, follow the corridor (colourful stickers on your left)
TheatresLevel 5 - follow the registrar
Tertiary referralCHW / SCH or JHH - depends on the specialty and the patient's address
The service

Clinical scope

Gosford Neonatal Unit (K7) is a Level 4 unit admitting over 1000 babies a year. It cares for neonates from 32 weeks gestation and above, including respiratory support (CPAP), chest drains for pneumothorax, and UVC (umbilical venous catheter) insertion for hypoglycaemia. Sicker and more preterm babies can be stabilised here and retrieved to a NICU by NETS (the Newborn & paediatric Emergency Transport Service).

The SCN has

  • 15 funded beds (22 physical), in pods and single rooms
  • 4-bed pods for respiratory support / higher observation
  • A procedure room for resus and stabilisation before retrieval
  • A clinic room
  • Parent overnight rooms, a lounge and an interview room
Credentialing & training

  • Neonatal resuscitation training begins in orientation, then continues with hands-on experience and supervision.
  • Everyone should get to attend NeoSim during their time - a full day of education on neonatal resuscitation and management.
The clinical work

Common things you'll see

Respiratory distress

The approach: recognise it, stabilise, and work through the differential.

Jaundice

Hour-specific nomograms, phototherapy, and spotting pathological jaundice.

Hypoglycaemia

At-risk babies, thresholds, and management.

Sepsis

Early/late-onset, screening and empirical antibiotics.

Respiratory conditions

RDS, TTN, MAS, PPHN, air leak and more.

All conditions

Browse every system on the Neonatal Learning Hub.

Feeding & fluids:
  • We always prioritise breast milk.
  • In brief: preterm or unwell babies usually start at 60 mL/kg/day.
  • In certain circumstances term infants may start at 30 mL/kg/day.
  • Feeds are increased daily by 20 or 30 mL/kg/day (e.g. 60 → 80 → 100 → 120 → 140 → 160, or 60 → 90 → 120 → 150).
  • If using IV fluids, start with 10% glucose on the first day of life, then change to 10% glucose with 0.22% sodium chloride at 24 hours of life.
  • These parameters change based on the infant's condition and clinician choice.
The day

A typical day

07:30
Start of day
08:00
Handover
Mid-am
Ward round
After
Jobs
Afternoon
Reviews
Eve / night
Stay ahead
07:30

Start of day

  • Check in with SCN; introduce yourself to the In Charge Nurse or NUM.
  • Print patient lists and review current concerns.
  • Identify unwell infants, anticipated admissions and planned births.
08:00

Morning handover

  • Paediatric ward handover in D4.
  • Note new admissions, overnight concerns and infants needing early review.
Mid-morning

Ward round

  • Consultant- or fellow-led, in SCN.
  • Present clearly: respiratory support, feeding, growth, escalation.
  • Be ready to leave for births or urgent reviews.
After round

Jobs

  • Complete ward round jobs promptly.
  • Prioritise consults, investigations, discharge planning.
  • Keep documentation, charts and escalation plans updated.
Afternoon

Reviews & follow-up

  • Continue jobs, discharge planning and reviews as staffing allows.
  • Tuesday & Thursday afternoons: follow up the blue investigations folder (see the note below).
  • When short-staffed, may assist the PARC (paediatric review clinic) or follow-up calls - clarify early.
Evening & night

Stay ahead

  • Review respiratory or metabolic concerns early.
  • Escalate early to the on-call consultant for any change or uncertainty.
  • Maintain clear documentation for safe handover.
NAP reviews (non-admitted patients): babies seen after discharge - they come in on set days you arrange, or parents can ring the In Charge within the first 2 weeks of life if they are worried. Some reviews are nurse-led, some need a medical review. If you ask a baby to come back in, put a sticker in the diary in the fishbowl so the team knows.
The blue investigations folder (fishbowl): put a photocopy of every imaging or investigation request in the blue folder at the time it is due (for example, a breech baby needs a hip USS at 6 weeks corrected). Following these up is an SCN SRMO job - work through the folder each week, mainly on Tuesday and Thursday afternoons.
Team culture: where workload allows, the team aims for a brief coffee break together after ward round - to check in and plan the day.
At birth

Births

Who attends a birth depends on the anticipated acuity - it escalates from the SRMO up to the paediatrician.

RoleAttends
SRMOAnticipated / lower-risk
  • Instrumental (forceps / ventouse)
  • Elective LSCS
  • IUGR (<3rd centile, <36 wks)
  • 34-36 wks or >42 wks
  • Scalp pH <7.20 or non-reassuring CTG
  • Twins or triplets
  • Midwife / obstetrician concern
  • Maternal opiate <4 h, prolonged ROM
  • Maternal sepsis / chorioamnionitis
RegistrarWhen resuscitation may be needed
  • Severe compromise (pH <7.0 or terminal / sinusoidal CTG)
  • Meconium-stained liquor
  • Failed instrumental
  • <34 wks (twins <35 wks, triplets)
  • Major known abnormality (hydrops, TOF)
  • Shoulder dystocia, antepartum haemorrhage
  • LSCS under GA, category 1 LSCS
  • If the SRMO is unavailable
PaediatricianHighest acuity
  • Full resuscitation under way (intubation, CPR or adrenaline)
  • APGAR <4 with no recovery
  • Known significant abnormality (e.g. CDH)
  • Any birth <32 wks
Resuscitation record: if you attend a birth and provide any resuscitation - defined as applying a mask to the face - you must complete the NSW resuscitation record form.

Full walkthrough: Attending a birth →

First steps

Admissions & notes

First, tell the team: notify the Team Leader early if admitting a baby to SCN.
Preparation

  • Review antenatal history and reason for admission.
  • Clarify gestation, birth events and anticipated concerns.
  • Confirm bed availability with the In Charge Nurse / Shift Coordinator.
  • Prepare equipment early if monitoring is anticipated.
Initial assessment

  • Structured clinical assessment on arrival.
  • Respiratory status, tone, perfusion, temperature, glucose risk.
  • Escalate early if unwell or uncertain.
Early communication

  • Introduce yourself to the bedside nurse; agree priorities.
  • Ensure senior awareness of significant admissions (<35 weeks, respiratory support, hypoglycaemia needing IV).
  • Discuss early if support or transfer may be needed.
Documentation

  • Commence admission documentation promptly.
  • Outline a clear initial plan and escalation considerations.
  • PowerChart admission template available (search the unit template).
Escalation

Communication & handover

Escalate early when there is

  • Clinical deterioration
  • Increasing respiratory support
  • Recurrent apnoea / bradycardia
  • Abnormal investigations
  • Uncertainty about management
  • Concern raised by nursing staff
Consultant or fellow should be aware of

  • All new admissions on respiratory support
  • Significant clinical change
  • Escalation of respiratory support
  • Intubation or CPR
  • Anticipated retrieval
  • Stable matters can wait for end of shift
Handover

0800 & 1600, D4

  • Highlight change since last review
  • Clarify active problems
  • Identify babies needing early review
  • Outline overnight escalation thresholds
  • Avoid repeating full admission history unless relevant
Consultant changeover

Fri PM & Mon AM

  • Clear summary of active problems
  • Anticipated trajectory; pending investigations
  • Babies at risk of deterioration or transfer
  • Babies predicted for discharge + follow-up
  • Update documentation and problem lists first
Families: update parents regularly and document significant discussions in the EMR.
Before birth

Antenatal

Antenatal counselling

  • Clear, consistent communication guides shared decision-making while recognising uncertainty and family values.
  • A structured approach supports safe, family-centred care across gestations and scenarios.
Extreme prematurity

  • Consider gestation, birth weight, sex, plurality, steroid exposure, growth, anomalies and anticipated condition at birth.
  • At the limits of viability, lead with the most senior clinician available - resuscitation options, expected course and areas of uncertainty.

Counselling tools & resources

Outcome estimators

For periviability counselling

Use them as a guide

Not a script

  • Estimates are population-level - individualise to the family and acknowledge uncertainty.
  • Leave the most difficult discussions to the most senior clinician available.
  • Document what was discussed and agreed.
When it gets busy

Emergencies

Neonatal resuscitation

The newborn algorithm, SpO2 targets, and when to escalate.

Unexpected preterm birth

Warmth, gentle support, and calling for help early.

NETS & retrieval

When and how to call, and what to do while you wait.

These are educational summaries. Always follow current ANZCOR Newborn Life Support guidance and your local emergency protocols.
Who to call

Contacts

Switchboard & paging

How to reach people

  • Switchboard: dial 43
  • Paging: dial 65, enter the pager number and press *, enter the callback number, then press *
Contact list

The live list is in Teams

  • The full pager and phone list - consultants, medical, SCN, birth suite, postnatal, imaging, pathology and allied health - lives in the unit's Teams contact list.
  • Ask the nurse in charge to point you to it on your first shift.
Direct numbers and named staff are kept in the unit's Teams contact list, not on this page.
Reference

Tools & links

Stabilisation & retrieval

  • NETS - referral, advice and clinical resources (song sheets - quick-reference guides). Call 1300 36 2500.
  • NETS clinical calculator - drug doses and fluid calculations.
Resuscitation

Prematurity counselling

Calculators

Formulary & guidelines

  • ANMF - Australian Neonatal Medicines Formulary (neonatal drug dosing).
  • ASID guidelines - perinatal and neonatal infection management.
Who to consult

  • Most subspecialties: Children's Hospital at Westmead (CHW).
  • Endocrine: paediatric endocrine is onsite on Tuesdays; otherwise consult John Hunter Children's Hospital (JHCH).
  • ENT and plastics: local team.
  • Consultmed - specialist advice and referrals.
  • For a question, email the relevant consultant; if you have concerns, call the on-call consultant.

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