Guidelines for Admissions
to NICU, and Discharges and Transfers from NICU
|Reviewed by Carl Kuschel
Guidelines for Admission to Level 3
- Birthweight less than 1250g.
- Gestation less than 30 weeks. Some
infants born at 30-32 weeks may be admitted to Level 3 because of
- Requirement for intermittent positive
- Requirement for an exchange transfusion.
- Any other baby whose clinical condition is
such that they cannot be appropriately cared for in Level 2.
Guidelines for Admission to Level 2
- Low Birthweight -
Some babies between 2000 and 2500g may be able to go directly to the
This will depend upon the clinical assessment of the baby and whether the
postnatal ward is deemed likely to provide an appropriate level of care
- 36 weeks gestation or less.
For babies between 35 and 36 weeks gestation, criteria as in (1) apply.
- suspicion of infection together with clinical concern.
- Respiratory problems
(a) Apnoea or cyanotic episodes.
(b) Any respiratory distress causing
(c) Persisting signs of respiratory distress for more than
- Gastrointestinal problems
(a) Feeding problems severe enough to cause clinical concern.
Bile stained vomiting, or other signs suggesting bowel obstruction.
- Metabolic problems
Inability to maintain a serum glucose
concentration greater than or equal to 2.6mmol/L despite adequate
- CNS problems
(b) Moderate birth asphyxia, which may require monitoring for an initial
period to ensure problems do not ensue.
Congenital anomalies that may require
intervention unavailable on the postnatal wards, or an initial period of
observation, eg Pierre Robin Syndrome.
Problems requiring monitoring or
intervention unavailable on the postnatal wards.
Any baby that is causing concern to such
a degree that the attending doctor or NS-ANP feels that the baby
requires observation or treatment in Level 2. It is better for a baby to
be admitted unnecessarily than for a baby requiring admission to be left
on the ward.
- Social issues/terminal care
Such babies ideally be nursed on the ward
with parents, or at home. On occasions (after multidisciplinary
consultation) circumstances dictate that these babies require a period
of care on Level 2.
Discharge of Low
Infants that have been
born at very low birthweight or low birthweight, represent an at risk group of
children. Increasingly they are being discharged home at a weight less than
2.5kg. The following guidelines are suggested when considering discharge of such
- The baby has to be gaining weight -
it doesn't have to have reached any particular weight, however, as long as
there is weight gain.
- The baby has to be sucking all feeds.
If breast feeding is being established, it is not a prerequisite that the
baby is on full breast feeding prior to discharge, provided we are happy
that the baby is able to suck strongly.
However we must be sure that the mothers are aware of the need to continue
to monitor progress once further feeding changes are made at home, i.e. a
switch from complementing to fully breast feeding etc.
- The baby must be able to maintain his or her
temperature in a cot in a normal household environmental temperature.
This is particularly important when discharging low birthweight babies home
in the winter.
- Parents must be willing and happy
to take the baby home and to have demonstrated that they have adequate
This may be self-evident, particularly when there have been other children
in the family, although not always.
- Some basic information should be known about
the home environment and the community to which the infant is going,
i.e. if they are living in a remote area in a caravan, then one would be
less likely to effect a discharge home at a low birthweight.
- There should be adequate community follow
It may be appropriate to contact the general practitioner by telephone to
discuss follow up.
In remote areas details should be known about the availability of a Well
Child Service visiting.
The neonatal home care nurses will be able to provide some initial support
and follow up and to provide liaison for ongoing community follow up.
Discharges from NICU and PIN
Transfers from Level 3
- For transfers from Level 3 to
Level 2 or PIN a formal transfer should occur between Level 3 Registrar or
NS-ANP and the appropriate registrar or NS-ANP.
- Ideally the parents would have been told a few days in advance to
accustom to the transfer and possibly have looked around Level 2 or PIN.
- A transfer letter should be in the notes (and should also be sent to the
- The problem list should be up-to-date (as
should happen when a discharge/transfer summary is prepared)
For infants discharged from Level 2
- Babies transferred to PIN need
a formal letter if they have had a complicated course whilst in Level
2. If they have had a recent transfer summary from Level 3 to Level 2,
this may not be necessary.
- Babies who are transferred to PIN should
have an up-to-date problem summary in the notes.
- Babies transferred to other hospitals must not go without a registrar or
- Babies being transferred to towns outside the Auckland area should have a
formal letter prior to discharge.
All patients discharged from hospital must have:
- A full examination record on the
appropriate form (include age in days, weight, length, head circumference).
- A plan for
follow up clearly documented in the
- A record of any prescribed therapy.
- No baby is to be
discharged from Level 3, Level 2, or PIN without a letter.
- For babies who are being
discharged to the postnatal wards and where there are going to be delays
in generating a discharge letter, the baby can be discharged with out a
letter being available. However, it is the responsibility of the
resident team (registrar or NS-ANP) to ensure that a letter is completed
as soon as possible and is filed in the notes of the baby.
- PLEASE ENSURE that the discharge
letter contains the correct information.
- The database can only
use the information available within it.
- It provides a
structure for the letter, and makes an attempt at providing a
letter that is nearly complete. You need to check the letter
you have produced and edit it in Word.
- The quality of the letters
you sign your name to reflects on your abilities as well as the quality
of the care that the baby has received in NICU. PLEASE CHECK AND
EDIT THE LETTERS BEFORE YOU SIGN THEM AND SEND THEM OFF.