Purpose

• The PIN environment should be quiet, intimate, and provide privacy and comfort but also provide company for parents to support each other.
• There is an expectation that parents will actively participate in the discharge planning process.
• Staff in the Newborn Service are there to support parenting with the emphasis on encouraging the family/whanau to stay and carry out many of the baby’s cares.
• An important aim is to be able to "demedicalise" the baby before discharge home in an environment that is safe.

Admission Criteria

• PIN is not an observation unit for acute babies.  Babies will not be admitted directly to the Neonatal Service via PIN, unless transferred in from another neonatal unit and requiring only the level of care provided in PIN.

Absolute Admission Criteria:

• >1200g (and preferably >1400g)
• ≥32 weeks gestation (corrected)
• on full oral feeds

Relative Criteria for Admission to PIN:

Infants who have "greater than usual" medical needs can still be considered for PIN (if staffing allows):

• On low flow oxygen
• On antibiotics
• Long line antibiotics (if staffing appropriate)
• Top up transfusions (if staffing appropriate)

Contraindications to Admission to PIN:

• ADAPT babies.  These babies should either be nursed on the postnatal wards with the mother, or on NICU.
• Babies who are expected to be in PIN for less than 48 hours and whose mother is still on the postnatal ward should not be admitted as they may directly to the ward

Medical and Nursing Staffing

• The infants will be under the Level 2 Specialist Team.
• A Registrar will be assigned to spend one week on PIN.

• Click here to access the PIN Registrar guidelines
• The specialist is available to review babies or meet with parents as requested by the Registrar/FLN or family/whanau on other days.

• There will be a Family Liaison Nurse in PIN Monday to Friday.  The FLN will co-ordinate discharge planning with the multidisciplinary team.
• When patient numbers are high it is important to try to maintain the special purpose and ambience of PIN.

Handover

• There will be a list on the whiteboard in NICU of babies coming up to readiness for transfer to PIN. The decision is made by the Specialist, FLN and CCN each day.
• It is expected that all babies being transferred will have a handover written in the case notes pending the letter.
  • Complicated infants who are transferred directly from Level 3 require a formal transfer letter and a consultant handover.
  • Infants who have been in Level 2 following an admission to Level 3 do not require a further letter if they have had an uncomplicated course and a letter of transfer from Level 3 to Level 2.
  • Complicated infants who have been cared for primarily in Level 2 also require a formal transfer letter.

Discharge Criteria

In general, an infant is ready for discharge when

• They are able to maintain their temperature in a cot,
• They have had 24 hours of full sucking feeds OR 3-4 breast feeds during the day,
• They are medically stable, and
• The family/whanau are adequately prepared for discharge and follow-up through Newborn Home Care Nursing service or transfer to a well health provider has been arranged.
• Most babies will achieve these criteria at 36 weeks corrected gestational age or greater.