Admission criteria: Neonatal Unit & Transitional Care

Criteria for Admission to the Neonatal Unit

Prematurity

Gestation <34 weeks

Birthweight <1600g

Hypothermia – requiring incubator care

Around delivery

Peripartum compromise:

• Altered consciousness
• Requiring therapeutic hypothermia
• Neurological symptoms e.g. seizures

Chest compressions required during resuscitation

Respiratory

Persistent signs of respiratory distress

Recurrent or prolonged cyanotic episodes

Recurrent & prolonged apnoeic episodes

Cardiac

Persistent cyanosis

Infection

Suspected sepsis with clinical signs and/or  raised inflammatory markers.  Does not include babies with risk factors on NEWS monitoring

Sudden collapse on the postnatal wards

Metabolic

Hypoglycaemia - If feed intervals of less than 2 hourly or IV dextrose required

GI/Surgical

Jaundice:

• if quickly rising despite appropriate phototherapy
• likely to need exchange transfusion/ immunoglobulin
• antenatal concern of haemolysis, high antibody titres
• Anticipated to require double PT > 24 hours

Persistent / bilious vomiting, abdominal distension, Rectal bleeding

Congenital abnormalities

Babies identified antenatally as having a congenital condition requiring neonatal admission e.g. cardiac anomalies, open spina bifida, congenital diaphragmatic hernia etc.

Congenital abnormalities if physiologically unstable

Other

Babies requiring IV infusions

NAS requiring treatment > day 10 if not rapidly weaning if so consider TC particularly to assess parenting further.

Babies, whose mothers are no longer inpatients in the maternity ward, who cannot be discharged for any other indication. Includes babies for adoption

Criteria For Admission to a Transitional Care Unit (or equivalent)

Admission can be

• Direct from Labour Ward following Medical /ANNP assessment
• Step-down from the neonatal unit
• From home following assessment* 

NB.  Some variation will occur between units dependent on available facilities.

        Location of care will involve discussion and agreement with the families involved.

Gestation 34+0 - 35+6 weeks at birth if otherwise well

Birthweight >1600g at birth if otherwise well

Feeding support
Requirement for full or partial NG feeding ( e.g congenital anomaly or prematurity in line with criteria above ) or an inability to suck full feeds if otherwise medically well and maintaining temperature in a hot cot.

Hypoglycaemia controlled with feeding at least 2 hourly intervals by suck and/or via NG tube.

Weight loss requiring more intensive feeding support (including NG feeding)

Jaundice
Requiring double phototherapy( if level rising rapidly requires NNU admission)

Parenting assessment/social
Babies identified antenatally as requiring additional support to appropriately assess parenting skills
admit from LW if no other acute concerns

Neonatal Abstinence Syndrome
Babies requiring on-going treatment > day 10 (up to day 10 on PNW) if already weaning treatment and anticipated to stop within 5 days.

Step Down from NNU care
Corrected gestational age > 33+0 weeks and otherwise clinically well
Tolerating at least 3 hourly NG feeds
Rooming  in pre- discharge ( many units provide this directly within NNU rather than TC)

Criteria for babies with additional care requirements who are able to remain on the Postnatal Wards

NB.  Some variation will occur between units dependent on available facilities.

       Includes transfer back of babies to PNW after a brief period of observation in a NNU

Gestation 36+0 – 37+0 weeks if:

• No signs of respiratory distress ( if after a period of NNU observation, mild tachypnoea persists but baby is otherwise well,  transfer remains appropriate)
• Feeding adequate volumes
• Maintaining temperature using hot cot if required
• Maintaining normoglycaemia

Birthweight >1800g if:

• Feeding adequate volumes
• Maintaining temperature
• Maintaining normoglycaemia

Congenital abnormalities in otherwise well baby e.g:

• Cleft lip/palate if feeding well
• Trisomy 21 if feeding well

Resolving colour changes

Weight loss requiring feeding support in otherwise well baby

Jaundice:
otherwise well babies receiving single phototherapy

Additional monitoring
Baby undergoing observations on ‘NEWS’ chart
Well babies requiring antibiotics
Baby undergoing hypoglycaemia protocol

Hypothermia requiring care in a heated cot

Requiring monitoring & treatment for neonatal abstinence syndrome up to day 10 (local arrangements may apply)

Readmission to the Postnatal wards
Requires Medical/ANNP review at time of readmission

Jaundice in an otherwise well baby

Weight loss in an otherwise well baby requiring feeding support

Readmission to the Neonatal Unit

Jaundice:

• In unwell baby
• Likely to need exchange transfusion
• Unable to adequately feed

Suspected sepsis

Excessive weight loss/ poor feeding requiring NG feeding (re-admission to transitional care unit after medical assessment if well appropriate)

Cyanotic episodes

Readmission to Transitional Care (or equivalent)

Excessive weight loss/ poor feeding requiring NG feeding
(re-admission to transitional care unit only after medical/ANP  assessment)

Should be diverted to paediatric services

>14 days old (unless condition suitable for readmission to the postnatal wards or transitional care)

Signs of respiratory distress

Vomiting with loose stools

Requires immediate 999 Call
Sudden unexplained collapse at home