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NICU guideline identifier

Surgical neonates - pathway for provision and location of intensive care

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Location of Intensive Care

All surgical neonates who require intensive care in the neonatal period will be looked after before and after surgery in NICU.

The exceptions to this are:

  • Infants with congenital diaphragmatic hernia
    • Delivery will be attended by the Neonatal Team and they will be stabilised in NICU and then transferred as soon as practicable to PICU for ongoing management. 
    • This will generally be after vascular lines have been inserted and radiographs taken, and we would anticipate that babies move to PICU within 1-2 hours of birth.
  • Infants with a paediatric surgical problem (e.g. bowel anomaly) whose predominant problem is congenital heart disease will be transferred to PICU.
  • Infants with airway problems will be managed in PICU.
  • Infants with abdominal wall defects who develop an abdominal compartment syndrome with renal impairment will be transferred to PICU.

Surgical flow chart

These guidelines will need to be flexible. There will be times when one or other unit is full and requires assistance. In addition, some infants with conditions which would normally require admission to PICU may be initially managed in NICU if they are premature.

Infants older than 7 days or with acute infections

  • Infants older than 7 days who have been discharged home and present with a condition requiring surgery will be admitted to ward 24B and receive their intensive care support in PICU. 
  • Babies who clearly have acute infections will be admitted to PICU or 24B in preference to NICU. 
  • If babies who have been in NICU are transferred to ward 24B and subsequently require further intensive care, they will be admitted to PICU if they have been discharged from NICU for more than 72 hours. 

Referral processes

  • Referral to the surgical service for urgent consultation or where there are concerns about the clinical condition of the infant will continue to be neonatal specialist to surgical specialist. 
  • Non-urgent referrals (for example, inguinal hernias awaiting elective repair) may be referred from NICU registrar or Nurse Specialist to surgical registrar. 

Ward 24B High Dependency Unit

Placement of surgical neonates requiring high dependency care will continue on the surgical ward. However, the Neonatal Team will consult as needed and advise over medical management. 

Post-operative surgical review

  • The surgical team involved in the surgical care will regularly visit the NICU in the post-operative period until the baby no longer requires surgical involvement or until the baby is transferred out of NICU. 
  • Infants born at Middlemore Hospital who require surgical procedures will be looked after post-operatively in the ACH NICU (some infants may be transferred to the ACH NICU prior to surgery if indicated). Once these infants no longer need surgical review, they will be transferred back to Middlemore NICU

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Document Control

  • Date last published: 30 November 2004
  • Document type: Clinical Guideline
  • Services responsible: Neonatology, Paediatric Surgery
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years