Guidelines on Admission to Newborn Services
(either NICU level 2 or Postnatal Ward) from Home
|Reviewed by Simon Rowley
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.
- <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
- 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
- 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.
- • 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.
- 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.
- 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
- 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