- Indications for Admission to NICU.

Indications for Admission of neonates to Neonatal ICU.

• Prematurity ≤34 weeks' gestation 
• Low Birth Weight (LBW) <1800 gm
• Cardiopulmonary problems:

1. Central cyanosis 
2. Respiratory distress 
3. Apnea/Bradycardia 
4. Cardiac arrythmia
5. Meconium suctioned below the vocal cords 

• Neurologic problems: 

o Seizures
 o Impaired consciousness
 o Abnormal neonatal reflexes
 o Severe hypotonia 
o Low 5-minute Apgar score o signs of encephalopathy
 o poor condition at birth requiring prolonged resuscitation for >10 min

• Gastrointestinal and genitourinary problems: 

1. Delayed passage of meconium beyond 48 hrs 
2. Bile stained vomiting, or other signs suggesting bowel obstruction 
3. Feeding problems severe enough to cause clinical concern 
4. Abdominal masses 
5. Delayed passage of urine beyond 24 hrs 

• Hematologic problems: 

1. Pallor 
2. Polycythemia with venous hematocrit ≥65%, or 60-64% with clinical symptoms 
3. Petechiae and purpura 

• Hyperbilirubinemia requiring treatment 
• Neonatal infection (acquired or congenital)
• Metabolic problems: 

1. Hypoglycemia and IDM: inability to maintain a serum glucose concentration ≥45 mg/dl despite adequate feeding 
2. Dehydration 
3. Electrolyte disturbances 

• Congenital malformation: 

1.  Major malformations or minor malformations that need special care as: 
2. Chromosomal disorders (trisomies 13, 18, and 21) 
3. Pierre Robin syndrome 
4. Osteogenesis imperfecta 
5. Asphyxiating thoracic dystrophy 

•  Neonatal abstinence syndrome requiring treatment.

• Birth injuries

CRITERIA FOR ADMISSION TO TRANSITIONAL CARE UNIT

The following are common indications for admitting babies to transitional care unit (if available locally), refer to local guidelines for local variations

o   Small for gestational age, 1.7- 2 kg and no other clinical concerns

o   Preterm 34–36 weeks’ gestation and no other clinical concerns

o   Minor congenital abnormalities likely to affect feeding, e.g. cleft lip and palate

o   Requiring support with feeding e.g. predicted to require NGT feeds

o   Babies of substance abusing mothers (observe for signs of withdrawal)

o   Receiving IV antibiotics and positive blood culture.

o   Short-term care while mother admitted to ITU (intensive therapy unit)

o   Fetal acidemia

o   Heart murmur

 

Thnxx Dr Ibrahim