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NICU guideline identifier

Admission to Newborn Services from home

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The following guidelines cover admissions to the Newborn Service for babies who have been delivered at home, have been discharged early or recently from NICU/PIN, and in whom problems arise.

Referrals may be from CED consultants or Postnatal Midwives and must be communicated via the level 2 consultant or registrar. GPs are expected to direct their referrals via CED.

This includes infants going directly to the postnatal wards with their mother as well as those being admitted to level 2 NICU.

Eligible ages

  • <7 days old - infants should be admitted under the care of Newborn Services to either NICU or the postnatal ward, unless they fulfil exclusion criteria. This includes infants born at home. 
  • Infants recently discharged (<48 hours) from NICU or the postnatal wards - some infants may be considered for readmission (if no evidence of acquired community infection). 

Eligible conditions

Babies can be admitted under the care of Newborn Services if their primary problem requires neonatal expertise. Examples include:

  • Low birthweight (including recent NICU/PIN discharge, if appropriate)
  • Early onset respiratory distress (1st 48 hours)
  • Seizures in the first 72 hours
  • Jaundice requiring treatment
  • Congenital malformations requiring assessment or treatment
  • Feeding difficulties requiring observation, maternal assistance, or NG feeding. These infants should preferentially be admitted to the postnatal ward so that the mother and baby dyad is preserved.

Exclusions

  • Infants with definite cardiac disease should be referred to the Paediatric Cardiology Service at Starship Hospital.
  • Infants with surgical problems (e.g. bilious vomiting, bowel obstruction) that will not require intensive care support and who can be admitted to Starship surgical ward.
  • Infants with suspected or definite infectious diseases in whom isolation is a priority (e.g. bronchiolitis, gastroenteritis, HSV, term infants presenting with apnoea) should be admitted under the General Paediatric Service at Starship Hospital.

Special considerations

  • Some infants may initially be assessed in NICU (assessment room), prior to a decision about admission and destination.
  • Some infants may be admitted to the postnatal wards as boarder babies when their mothers are admitted with complications after delivery. Ordinarily, these babies will not require medical care. In the event that they require medical attention, the neonatal team will assess them in the first instance. If they require care that cannot be provided on the postnatal ward with their mother, they should generally be referred to the Starship General Paediatric Service.

Isolation

Ideally, infants who have been home should be separated from other infants in NICU and the postnatal wards. This may be via:

  • Nursing in incubators, or
  • Use of a single or isolation room (if infectious aetiology is thought possible)

There will be times when, due to workload or occupancy, admission under Newborn Services will not be feasible. In these circumstances, referral should be made to the General Paediatric Service at Starship Hospital.

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Document Control

  • Date last published: 10 October 2018
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years