Surgical management of neonates

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Surgical neonates requiring intensive care will be looked after before and after surgery in NICU. The exceptions will be:

• Children with 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 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.

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 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 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.

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.

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

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.