Guidelines for the
by Moira Malarkey, Carl
Kuschel, and Simon Rowley
Back to the Parent-Infant Nursery (PIN)
See also the PIN Registrar Guideline
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.
- 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.
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.
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.
In general, an infant is ready for
- 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.