What Happens During a Neonatal Ward Round?
If your baby is admitted to a neonatal unit, you will probably hear the words “ward round” quite often.
You might notice a group of doctors, nurses and other healthcare professionals moving from one baby to another, discussing things like feeds, breathing support, blood results, weight and medications.
When you’re new to the neonatal environment, this can feel quite overwhelming. There may be medical terminology you’ve never heard before, lots of numbers being discussed and several people standing around your baby’s cot or incubator.
You might find yourself wondering:
What are they talking about? What decisions are being made? Can I ask questions? Am I supposed to be involved?
So, let’s talk about what actually happens during a neonatal ward round and, importantly, where you as a parent fit into it.
What is a neonatal ward round?
A ward round is when the neonatal team comes together to review each baby’s progress and discuss their ongoing care.
The team will look at how your baby has been since the previous review, discuss any changes or concerns and agree on a plan for what happens next.
For one baby, that might mean increasing their milk feeds. For another, it could mean reducing their breathing support, reviewing medication or arranging a blood test or scan.
And sometimes, nothing needs to change at all.
In neonatal care, babies often simply need time to grow, recover and become stronger. So hearing that the plan is to continue exactly as you are isn’t necessarily a bad thing.
Who might be at the ward round?
The people you see during a ward round will vary depending on the neonatal unit, your baby’s needs and the day.
You may see a consultant neonatologist or paediatrician, other doctors, advanced neonatal nurse practitioners and the nurse looking after your baby.
Other members of the wider neonatal team, such as pharmacists, dietitians, speach and language therapists, physiotherapists and occupational therapists may also be involved.
There may also be students or other healthcare professionals observing or learning within the unit.
It can feel like a lot of people suddenly gathering around your baby, but everyone is there for the same reason: to review how your baby is doing and decide what they need next.
What do we actually discuss?
During the ward round, the team builds a picture of how your baby has been doing.
Depending on your baby and the reason they are receiving neonatal care, we might discuss their:
Breathing and oxygen requirements
Heart rate and other observations
Feeds and how well they are tolerating them
Weight and growth
Fluids
Medications
Blood results
Urine and stools
Recent scans or investigations
Any significant events, such as apnoeas, bradycardias or desaturations
Not every baby will need all of these things discussed every day.
The nurse caring for your baby has a particularly important role during the ward round. Nurses are at the bedside 24 hours a day, caring for your baby closely throughout every shift. After you as their parent, we are often the people who get to know your baby best, their usual behaviours, how they respond to handling, how they tolerate their feeds, what settles them and the small changes that may not always be obvious from looking at observations or test results alone.
Communication between nurses is therefore incredibly important. At every handover, we pass on detailed information about how your baby has been, any changes we have noticed, how they have responded to their care and any concerns that need to be followed up. This information then helps the nurse caring for your baby contribute to the ward round and give the wider medical team a clearer picture of how your baby has been over the previous hours.
The numbers and results are important, but so is knowing the baby behind them. That continuity of observation is one of the most valuable things the bedside nurse brings to the ward round.
What decisions might be made?
Once everyone has shared the relevant information, the team will make a plan for your baby.
That plan will be individual to them.
It could include increasing their milk feeds, reducing their oxygen or breathing support, changing medication, arranging an investigation or simply continuing with the current care and reviewing them again later.
In neonatal care, progress isn't always about doing more.
Sometimes the safest and most appropriate plan is simply to give your baby more time.
Why are there so many numbers and medical words?
If you listen to a ward round, you may hear what feels like an endless stream of numbers.
Oxygen percentages. Feed volumes. Weight changes. Blood results. Medication doses.
You may also hear abbreviations and medical terminology that you've never come across before.
Please don't feel that you're expected to understand all of it.
Healthcare professionals use these words every day. Parents don't.
If you don't understand something, you are allowed to ask what it means. There is nothing wrong with asking someone to explain something again or to explain it in a simpler way.
Can parents be there?
Parents are an important part of their baby's care.
Exactly how ward rounds work can vary between neonatal units, particularly because confidential information about other babies and families may be discussed as the team moves around the unit.
If you're unsure whether you can be present for your baby's ward round, ask the nurse looking after them how it works in your unit.
If you are able to be there, don't feel that you have to stand quietly and simply listen.
This is your baby. You can ask questions.
What can I ask during the ward round?
Sometimes it is difficult to know what to ask, particularly when everything is new and you're trying to process a lot of information.
Some simple questions can help:
“What is the plan for today?”
“Has anything changed since yesterday?”
“Are you happy with my baby's progress?”
“What needs to happen before their breathing support can be reduced?”
“When might their feeds increase?”
“Are there any tests or scans planned?”
“What are we waiting for before the next step?”
And if somebody says something you don't understand, one of the most useful questions can simply be:
“Can you explain what that means?”
You don't need to know the medical terminology to be involved in your baby's care.
What if I think of a question afterwards?
You don't have to remember everything during the ward round.
Having a baby in neonatal care can be overwhelming. You may be tired, worried and trying to absorb a huge amount of new information all at once.
It's completely understandable to walk away and suddenly think, “I wish I'd asked that.”
Speak to the nurse looking after your baby. If they can't answer your question themselves, they can help you find the right person to speak to.
Some parents also find it helpful to keep a note on their phone or a small notebook beside them and write down questions as they think of them.
That way, when the team comes around, you don't have to rely on remembering everything in the moment.
You are part of your baby's team too
This is perhaps the most important thing I want parents to take away from this article.
As neonatal professionals, we may know the medical side of your baby's care, but you know your baby.
You may notice that they seem more tired than usual. You might notice a difference during feeds, know what settles them or simply feel that something isn't quite right.
Those observations matter.
Ward rounds aren't only about blood results, oxygen levels, feed volumes and numbers on a monitor.
They're about your baby as a whole.
So ask questions. Tell us what you've noticed. Ask us to explain something again if you didn't understand it the first time.
You are not expected to become an expert in neonatal medicine.
You are already the expert in being your baby's parent.
And you are an important part of their neonatal journey.
This article is for general information and education only and does not replace advice from your baby's healthcare team. Practices and policies may differ between neonatal units.
