Grace Centre for Newborn Intensive Care at The Children's Hospital at Westmead
Phone: (02) 9845 2715
Fax: (02) 9845 2251
Location: Level 3, Diagnostic Services Building
The Grace Centre for Newborn Intensive Care is a unique unit where a team of experienced and specifically trained doctors, nurses and allied health professionals care for babies - some less than one month old (neonate) - with complex medical conditions, serious cardiac, or surgical disorders.
The Grace Centre is not a maternity ward but a specialised unit providing dedicated treatment for premature newborns and critically-ill infants.
When a baby is transferred to Grace … it is literally the difference between life and death.
The Centre comprises specialised intensive neonatal care and high dependency units that deliver unique care tailored to the medical or surgical needs of the state’s sickest infants – some as young as 23 weeks gestation.
Some of the country’s most influential healthcare professionals work in the Grace Centre. Here these highly skilled doctors, together with qualified and expertly skilled nurses and allied health professionals, treat and care for more than 600 fragile babies each year.
Some babies are flown to the nursery within hours of birth for urgent life-saving care not available anywhere else in the state. These babies come from across New South Wales, the Australian Capital Territory and the Pacific Rim for complex medical conditions, serious cardiac and surgical disorders or complex diagnostic testing.
With access to the best consultants and staff across many medical and surgical disciplines as well as sophisticated equipment and the application of ground breaking research, these babies and their families are in the best place for a positive start in life and future.
Our Care … Your Trust
Our relationship with a family starts from the moment their baby is transferred to the Grace Centre – even earlier for some when the need for the baby’s admission is detected during pregnancy.
A family’s trust is our inspiration.
Passionate about our responsibility, every member of the Grace team is committed to the Centre’s vision to “Work with families to achieve the best for their child”.
Mindful of supporting each baby’s development our expert teams actively work to strengthen the relationship between parents and baby – teaching and encouraging them to actively participate, as early as is possible, in their baby’s care.
Focussing too on the wellbeing of parents, we provide continuous counselling and support. Our lactation specialists work with mothers to help with breast feeding and expressing. Social Workers support families during anxious and emotional moments and help with strategies to balance and cope with life in this complex environment. Our infant follow-up and developmental clinics provide continuous support with occupational therapy, physiotherapy and speech therapy services long after a baby leaves our Centre.
Today, as we continue to save more babies, we have sharpened our focus on collaborative research – determined to further improve the quality of these little lives. Input from families is critical and our parent advisory council provides vital consumer advocacy within the Grace Centre.
Caring for critcally ill newborn babies
Every member of the Grace Centre is proud to maintain the Grace name.
Originally from the Grace Bros Staff Aid to Charities, it symbolises a strong connection with our community – caring hands extended from those committed to service. We are proud to uphold this connection with our history as we continue to deliver the very best of care, while pursuing innovation through multidisciplinary research.
We are delighted to enjoy an internationally recognised reputation for our expertise and excellence in neonatal care, however the real reward is the inspiration we receive from the trust that families bestow on us.
While we remain focussed on ensuring our babies go home as healthy as possible, today, we are equally committed to pursuing research that can guarantee the best chance of a bright future.
Today, our promise is to constantly strive to further our knowledge and challenge clinical and educational practices so that we can continuously improve our treatment and care of newborns.
The Grace Centre works collaboratively with all the neonatal intensive care units within NSW and the ACT accepting referrals from across this Perinatal Services Network. Its close location to Westmead Adult Hospital’s high risk birth unit enables women whose babies have been identified with birth defects, to be referred for delivery and early transfer to the Grace Centre.
When a baby is diagnosed before birth with a condition requiring an operation, we offer parents a tour of the intensive care unit to meet some of the staff. A card given during the tour offers a contact number to call which the expectant parents are welcome to call at any time.
While the neonatal period is defined as the first 28 days of life, the Grace Centre also cares for older babies, particularly those born prematurely, who may have serious health conditions.
There are two Units providing different levels of care within the Grace Centre:
- Neonatal Intensive Care Unit, (NICU) for the most seriously ill babies (we have nine ventilator beds);
- High-dependency Unit, (HDU) for babies who do not need to be in the NICU but still need complex care, close monitoring and observation (we have 13 high dependency beds)
All babies treated in our neonatal intensive care unit are critically ill and usually need one or more of the following treatments:
- A surgical operation
- Support for their breathing with a breathing machine due to prematurity, pneumonia, or surgery
- Diagnostic tests involving complex imaging with x-rays, ultrasounds, and other technological techniques
- Special studies of body chemistry and cell biology
Seriously ill neonates requiring intensive care are often ventilated, which means that a machine is helping them to breathe. These babies are monitored around the clock for any changes in their vital signs. Premature and critically ill babies are vulnerable and need extra monitoring for serious health problems.
We know that there are lots of monitors, leads and tubes and sometimes it is hard for parents to know how to help, but in Grace, parents play a vital role and are actively encouraged to assist in providing care.
The Newborn Individualised Developmental Care and Assessment Program (NIDCAP)
In the Grace Centre we are committed to providing care that acknowledges that every experience endured by a newborn baby, especially in the busy environment of a NICU, can have an impact on their growing brain and body. We have deliberately designed our model of care to be developmentally supportive by taking into account the potential long-term implications of these experiences, including delayed breast feeding, consistently absent mother figure, repeated painful stimuli and lack of circadian rhythms.
As the only provider of NIDCAP training in Australia, the Grace Centre is leading the way in neonatal developmental care. Currently we have several NIDCAP certified professionals who lead the developmental team in meeting the needs of sick and premature infants and their families. Regular rounds enable the families to discuss their baby’s development, behavioural cues and participate in goal-setting for their newborn within the family.
Parent's Guide to The Grace Centre for Newborn Care
Click here for a copy of the Parent's Guide to the Grace Centre.
When a baby is diagnosed before birth with a condition requiring an operation, we offer parents a tour of the intensive care unit to meet some of the staff. A card given during the tour offers a contact number to call which the expectant parents are welcome to call at any time.
Skin-to-skin contact – or Kangaroo Mother Care
A baby’s wellbeing can be greatly helped through skin-to-skin contact. In Grace, as soon as possible we help parents to hold their baby against bare skin. This is soothing for the baby, helps each baby’s development and sleep and has also been shown to reduce infections, encourage feeding and promote bonding.
It helps develop the relationship between the baby and parents.
Grace "graduates"... when it is time to go home
When a Grace "graduate" is ready to go home, we know it can be both a happy and stressful time for families. Going home is a joyful celebration of a new and exciting, sometimes challenging, chapter in the lives of babies we have come to know so well.
When discharge time comes, we work closely with our families to ensure that they are well prepared and can confidently and comfortably care for their baby at home. This includes careful instruction on how to use specialist equipment and, if required, how to prepare and give medications.
We’ve also developed a booklet called "Going Home" which helps parents get ready and serves as a resource when they get home. The information in "Going Home" is not specific to individual patient management but is intended to complement the advice provided by Grace staff.
The booklet contains lots of useful advice and suggestions and includes helpful tips, tools and things to remember. Things like:
- having your infant car seat fitted by a qualified professional before discharge day
- knowing that after leaving the busy environment of Grace, it may take some weeks to settle your baby into a good sleeping routine
- always washing your hands and making sure visitors do the same before holding the baby, and other ways to keep your baby safe and reduce the risk of infection
- how to sterilise bottles and make up your baby’s feed - whether expressing or bottle feeding
- avoiding large crowds for one to two months after discharge, especially during the cold/flu season
- techniques to prevent cot death, Sudden Infant Death Syndrome (SIDS)
- what to do if baby gets sick
There’s information and descriptions about feeding and settling, communication, play and development, a list of useful contacts, as well as some important advice about ‘self-care’ for parents, including:
- take it one day at a time and try to plan for periods of sleep and rest
- use exercise to relieve stress and tension; even walking helps
- eat a balanced diet. Limit junk food. Drink plenty of water
- don’t try and do too much, avoid doing non-essential household jobs
Grace Development Clinic
With the increasing complexity of conditions being treated in the Grace Centre combined with improving survival rates, a demand for follow-up support and community care has emerged. Although the average length of stay for a baby admitted to the Grace Centre is 12 days; ongoing care and support continues long after discharge. Of the 600 babies who receive intensive care in the Grace Centre each year, almost 400 will return for appointments at our Follow-up Clinic.
The Grace Development Clinic is a specialist clinic – available by referral only – for babies after they graduate from the Grace Centre. Babies referred to the Grace Development Clinic include those who have significant neurological problems eg from seizures, meningitis, lack of oxygen to the brain, bleeding into the brain (haemorrhage), or who have cardiac disorders, have undergone surgery, have severe breathing abnormalities, or have metabolic disorders that may cause a risk to their development.
Because these babies have complex medical conditions, a developmental program is started during admission and the specialist team involved in our Follow-up Clinic will make arrangements for continued support after discharge. After discharge infants are seen at three months corrected age, one year and three years, with appointments in between as necessary.
The Grace Development Clinic focuses on neuro-developmental assessments, early detection and referral to early intervention, and ongoing support designed to help these babies reach their developmental potential.
At three months of age, the occupational therapist and physiotherapist administer a General Movements (video) Assessment, and a Bayley Assessment, in conjunction with the medical examination. At 12 months and three years, another Bayley Assessment and medical examination is performed by the team and infants can be referred for a speech therapy assessment if necessary.
The care program tailored for each child provides significant tools that benefit the family and infant.
For families who don’t live locally, our specialist team will make contact with the baby’s local NICU, GP and/or paediatrician and will link the family with community health services including Occupational Therapy, Physiotherapy, Speech Therapy, Early Intervention programs or other diagnostic services closer to home. The developmental program devised is continuously refined in line with progress until the child reaches the age of three. At this time, as appropriate, the child can be linked to more age-specific developmental programs, if not done so already.
Although not all babies admitted to Grace Centre require referral to the Grace Development Clinic, if the assessments conducted by our specialist team indicate a need for developmental intervention, the team will link families into early intervention services before the infant is discharged from hospital.
It is important that all babies are supported to reach their developmental potential.
 The Bayley Scales of Infant Development (BSID) are used to describe the current developmental functioning of infants and to assist in diagnosis and treatment planning for infants with developmental delays or disabilities. The test is intended to measure a child's level of development in three domains: cognitive, motor, and language.
Collaborating in care
The Grace Centre shares a close working relationship with all specialty departments in the Hospital and Network. The Grace Centre has and will continue to collaborate and consult with every team across the Network to ensure the very best of care is provided to these precious infants.
For example, collaboration with our colleagues in the other intensive care unit (Paediatric Intensive Care Unit) and the Heart Centre for Children is critical especially when treating babies with cardiac conditions who often during their admission need the joint care and expertise of all these specialities.
Our relationship with the surgical team is vital and has dramatically improved patient survival and enhanced the long-term developmental outcomes of critically ill neonates.
Our relationship with other departments has led to collaborative neonatal research that has improved, and continues to enhance, clinical practices in the neonatal intensive care environment. Some examples of such collaborations include:
- DAISy (Development After Infant Surgery) – a world-first study involving more than 780 babies and their families, surgeons and other healthcare professionals that proved that children who undergo any type of major surgery are at risk of developmental problems at one year of age. Recommendations have lead to enrolment of all high risk infants in multi-disciplinary clinics, early identification of issues and initiation of early intervention strategies. We are continuing to assess these children, now at 8-9 years which will provide essential information on development and educational skills to our current parents.
- Working with respiratory specialists to look at why some babies stop or have difficulty breathing and the impact this has on development of their nervous system.
- Partnering with our colleagues in the Heart Centre as well as other facilities in NSW, Queensland and Western Australia to help understand whether delayed cord-clamping in pre-term babies (of less than 30 weeks gestation), affects blood circulation.
We are proud of our internal and external collaborative partnerships, including those with the Australian and New Zealand Neonatal Network, as well as those with our famlies and the wider community. The commitment to these partnerships and the dedication to success ensured by these associations adds strength to the promise of brighter futures for critically ill babies.
You can learn more about our successful collaborations at our neonatal research group (hyperlink) section.
Training and Education
The Leadership team in the Grace Centre is committed to maintaining the Centre’s international reputation for providing leading edge training to doctors from medical facilities around the world as well as nurses and allied health professionals passionate about pursuing this vital field of clinical care.
Find out more about the Grace Centre’s training and education program at (hyperlink to Professionals page/Learn with Us section)
We are a ‘NIDCAP training centre in development’ and in 2018 will establish our own NIDCAP training program inviting applications from health professionals across Australia.
Some of the training opportunities offered by the Grace Centre include:
The Grace Centre provides training in neonatal intensive care for senior doctors (ie Fellows who are planning to practice as Neonatologists following their paediatric training), Registrars as part of their paediatric training as well as medical students. The unit is accredited with the Royal Australasian College of Physicians to deliver advanced training in neonatal medicine.The unit offers a rich experience in complex neonatal intensive care, the opportunity to participate in research projects and the opportunity to work with a wide group of other professionals in a unit that emphasizes the improvement of long term outcomes, developmental care and an ongoing collaboration with families and the wider community.
Staff on the unit also have access to an extensive education program offered throughout the Hospital/Network including the Diploma of Child Health.
Focussed on continuous improvement, the Grace Centre is committed to ongoing Professional Development and offers access to:
- a statewide training day –
- SIM Training – with access to state-of-the-art equipment to simulate 'real-time' incidences to facilitate learning in a safe environment
- career development mentorship program – where junior medical staff are assigned a supervisor for the duration of their placement on the unit
- Annual Susan Ryan Neonatal Seminar – a popular annual seminar held on the first Friday in August attracting participants from all nurseries in NSW and beyond, who welcome the opportunity to network, share and learn in a positive environment. Presentations about innovations in care and management of the surgical neonate are given by nurses, doctors and surgeons from The Children’s Hospital at Westmead.
- Extended Nursing Orientation Program – for newly employed nurses interested in a career in neonatal nursing and the surgical neonate. The program includes observation days, support with an experienced nurse and a team of clinical nurse educators who will facilitate an individual program for the new employee including assessment and competency.
- Newborn Care Neonatal Nursing Speciality Transition Program – a 12month program designed for nurses new to the neonatal surgical setting. The course consists of clinical support work based learning activities, clinical progression opportunities and assessable components. Successful completion of this course also offers credits to University of Technology Sydney and University of Tasmania.
- Nursing Study Days – several study days are offered for nurses on staff as well as external nurses addressing:
Surgical care – providing training in the optimal care of the baby with surgical needs
Developmental care – looking at the best way to care for families and babies in a holistic fashion
Premature care –providing training in evidence based care of the premature baby who has particular medical and nursing issues as compared with those babies born at term
- University Study – We encourage nurses to upgrade their qualifications through post-graduate studies in neonatal nursing at various Universities. This is offered at Graduate Diploma, Masters and PhD levels.
Neonatal Intensive Care RESEARCH
We are proud of our achievements in recent years that have seen the survival rate of babies in the Grace Centre increased to over 97 per cent. However, we are aware that not enough is known about the long term effects of serious illness, congenital heart disease and complex surgical interventions on these young lives.
The Grace Research Unit is a lead academic and clinical neonatal research unit with a commitment to multi-disciplinary research. The Centre successfully supports a Nursing clinical research program, Medical honours students, Registrar/Fellow college projects and Masters and PhD researchers.
Our researchers collaborate with colleagues in multiple departments within the Sydney Children’s Hospitals Network, nationally and internationally and present at national and international conferences.
As a centre of excellence for neonatal research, we are committed to research that will further our knowledge and challenge clinical and educational practices to improve the way we treat and care for newborns.
With the ultimate aim of ensuring that babies go home as healthy as possible and with the best chance of a bright future, members of the Grace Research Unit are actively engaged with:
- Cerebral Palsy Research Institute (Chair)
- International Multidisciplinary Prevention and Cure Team for Cerebral Palsy (IMPACT for CP) Steering Committee
- Newborn and paediatric Emergency Transport Service (NETS) Research Committee
- Postgraduate Research Students’ Conference Organising Committee
- SCHN Research Advisory Committee
- Scientific Advisory Committee
- Early Career Researchers Committee
The Cerebral Palsy Research Institute has recently joined the Grace Centre Research Unit as part of the Discipline of Paediatrics and Child Health at the University of Sydney – further building our capacity to improve the lives of young babies and their families.
Examples of our ongoing or recently completed research include collaborating with the:
- Heart Centre for Children and A/Prof Nadine Kasparian in the development a psychological support program tailored to the needs of families dealing with a fetal or postnatal diagnosis and the subsequent care and development of a child affected by congenital heart disease (CHERISH study);
- Royal Children’s Hospital and Prof Rod Hunt who is leading the Newborn Electroencephalography and Seizures Trial (NEST) designed to assess the value of treating subclinical seizures in babies.
- Cerebral Palsy Research Foundation and Ms Cathy Morgan to investigate the use of environmental and goal oriented interventions to optimise motor learning for infants at risk of cerebral palsy
- Royal Children’s Hospital & Queen’s University, Belfast and Prof Linda Johnston to examine the social and emotional burden of having an infant with complex needs following neonatal surgery.
For information about the publications, presentations, ongoing studies, student projects, grants and awards involving our researchers see the Grace Research Unit's 2014 Research Report (hyperlink)
Video orientation for parents
Video on fundraising support
Staff - The Grace Team
Caring comes naturally
The Leadership Team in the Grace Centre for Newborn Intensive Care take their responsibility for the effective management and delivery of quality care and support in this critical care environment very seriously. In Grace, a unique trinity of co-Heads:
- Prof Nadia Badawi, AM – Neonatologist and Medical Director of Grace and Chair, Cerebral Palsy Alliance
- Ms Angela Casey - Nurse Manager (maternity leave)
- Ms Samantha Mihailovich – Acting Nurse Manager
- Dr Robert Halliday – Neonatologist
work together to lead a passionate, experienced and highly skilled multidisciplinary team – all focussed on their mission – to “Work with families to achieve the best for their child”.
Acknowledging the benefits of collaborative care in this complex environment, they continuously inspire innovative thinking, research, and engagement with families to ensure patients always receive the very best chance for a bright future.
Our staff are committed to providing the highest quality of treatment, care and support for babies in Grace as well as their families. This team of highly skilled professionals - many of whom also hold academic positions and titles - include:
Our Neonatologists are passionate and devoted paediatricians who are dedicated to saving the lives of critically ill newborns. These highly skilled doctors co-ordinate care and medically manage many babies who are critically ill, born with birth defects, born prematurely, or in need of urgent surgery. Medical problems in premature and newborn babies can create special challenges when important organs such as the heart, lungs, stomach and skin are not developed adequately to function without special help. Neonatologists have the special training needed to evaluate and treat these medical problems. Some of the nation’s leading neonatologists work in the Grace Centre and as leaders in their field they are actively involved in teaching junior medical staff (Fellows and Registrars) and imparting their knowledge to research programs. Their dedication and passion drives our team to constantly push boundaries to ensure healthy and positive futures for these tiny infants.
Our Researchers are represented from across all professional disciplines and bring together a broad range of expert knowledge, experience and care in this complex environment. Complementing the roles they perform in their individual specialties, these determined researchers are focused on constantly improving models of care to ensure quality of life for infants and their families.
Our Nurses are specifically trained and experts in caring for neonates and premature babies with complex needs. They are highly skilled in interpreting the silent signals and gestures of these critically ill infants and expertly guide parents in how to care for their baby. They formulate nursing care plans then implement and evaluate the effectiveness of treatment. They administer medications, perform complex procedures, work with sophisticated technology, and consult with a multidisciplinary healthcare team to co-ordinate all aspects of the baby’s care. Often the first point of comfort for infants in their care, our nurses also understand the fears and anxieties experienced by parents and provide emotional support and reassurance.
- Allied Health professionals provide an essential service to our patients and their parents. Our Physiotherapists help with handling and positioning advice, respiratory care and assessment of musculoskeletal, neuromuscular or genetic conditions. Premature babies often face challenges in feeding and gaining weight so our Speech Therapists work closely with babies to develop pleasurable experiences around feeding and provide stimulus that helps them learn to feed. Our Occupational Therapists (OTs) help each baby to bond, explore their environment and engage in care activities such as a nappy change. They also teach parents how to help their baby be comfortable and support his or her development and when parents can’t be with their baby, will keep them updated on progress. Our Allied Health team continue to provide care and support at Follow-up Clinics after discharge.
- Our Lactation Specialists are specially certified nurses who work individually with each mother to help with all aspects of feeding, including using a breast pump and solving breastfeeding or pumping problems. If a baby is not ready to feed from the breast or bottle our lactation specialists will explain techniques available to help feed each baby. This can include fluids and a nutrition mixture through a drip, or a tube (gastric) that carries milk into the baby’s stomach. Lactation specialists advise, guide and help with breast feeding and expressing and provide every support to help a mother successfully breastfeed while in hospital and continue when discharged home.
- Our Social Workers in the Grace Centre are expertly trained and highly experienced in assisting families who find themselves confronted with a baby in an intensive care environment. Focused on supporting the emotional wellbeing of each parent, social workers can help with antenatal support, assisting with baby’s medical needs, family relationship concerns and accessing support services in the community. These very special members of the team advocate for families and sadly, at times are there to provide grief and bereavement support to families – helping them through the heartache associated with the death of their newborn.
- Our Administrative Support officers work tirelessly to ensure that the clinical care provided to patients happens seamlessly and efficiently. Priority attention is given to organising patient admissions – including co-ordinating parent accommodation and organising visitor access – arranging patient transfers or discharge as well as follow-up appointments. The Administrative team help keep the Grace Centre functioning smoothly and assist clinical teams with filing to medical records, helping with pathology and pharmacy collections as well as ensuring the ward is stocked with adequate quantities of equipment and supplies.
Our team comprises more than one hundred and forty staff – every one of them committed to ensuring the very best of care is available for up to 22 babies in the unit at any one time. Medical and nursing staff are always rostered on the unit ensuring expert care is available every day. Other members of the team include:
- 3 x Clinical Fellows
- 5 x Clinical Registrars
- Amy Barker, Transitional Nurse Practitioner
- Dr Peter Barr OAM, Emeritus Neonatologist
- Catherine Brown, Nurse Unit Brown (NUM)
- Dr Kathryn Browning Carmo, Neonatologist
- Emma Carey, Nurse Unit Manager (NUM)
- Susan Clarke, Social Worker
- Kerry Everson, Secretary
- Natalie Fairbairn, Occupational Therapist and Research Officer
- Nadine Griffiths, Nurse Educator
- Emre Ihlan, Research Assistant
- Kristen James, Transitional Nurse Practitioner
- Michelle Juarez, Physiotherapist
- Caroline Karskens, Audit Officer
- Gabrielle Kerslake, Lactation Consultant
- Dr Alison Loughran-Fowlds, Neonatologist
- Bhavesh Mehta, Fellow
- Helen Mercieca, Lactation Consultant
- Bronwyn Parkinson, Nurse Unit Manager (NUM)
- Himanshu Popat, Staff Specialist
- Professor Kaye Spence AM, Clinical Nurse Consultant
- Jan Stewart, Research Nurse
- Dr Amit Trivedi, Neonatologist
- Associate Professor Karen Walker, Research Fellow
Grace Centre for Newborn Care Parent Advisory Council
Established in 2005, the Grace Centre for Newborn Care Parent Advisory Council offers a voice and advocacy role for families of babies treated on the unit. Recognising the important role that families play in our family-centred approach to care, membership to the Council offers them an opportunity to provide input, feedback and suggestions about existing policies, procedures and practices as well as views about new initiatives being considered for implementation in the unit.
Grace Centre staff or current members of the Council identify prospective members who undertake a recruitment process that addresses respect for diversity and differing opinions and the importance of confidentiality.
Membership is offered for a minimum of 12 months, although many representatives choose to continue on the Council for longer periods. New members serve a three month probationary period prior to membership being reviewed by the Council.
Members assist with the development of information and educational resources and can also volunteer to support our Grace Gala Ball including participation on the Gala Committee and helping raise awareness and support from corporate supporters.
Although communication is generally by email, the Council meets face-to-face quarterly, setting annual goals early in the calendar year, with extraordinary meetings conducted if required.
For more information about the Parent Advisory Council see the Terms of Reference and contact Caroline Karskens on (02) 98452712.