- Indications for Admission to NICU.

Indications for Admission of neonates to Neonatal ICU.

• 1.  Clinical condition requiring constant monitoring:

        <34 weeks’ gestation or birth weight <1700 gm.

  2.  Cardiopulmonary problems:

  o   Cyanotic attacks.

  o   Respiratory distress

  o   Apnea/Bradycardia

  3.  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   Suspected perinatal asphyxia (especially if cord pH <7.0 or base deficit < – 15).

  o   poor condition at birth requiring prolonged resuscitation for >10 min

  4.  Gastrointestinal and genitourinary problems:

  o   Delayed passage of meconium beyond 48 hrs

  o   Bile stained vomiting, or other signs suggesting bowel obstruction

  o   Feeding problems severe enough to cause clinical concern

  o   Abdominal masses

  o   Delayed passage of urine beyond 24 hrs

  5.  Hematologic problems:

  o   Pallor

  o   Polycythemia with venous hematocrit ≥65%, or 60-64% with clinical symptoms.

  o   Petechiae and purpura

  6.  Hyperbilirubinemia requiring treatment.

  7.  Neonatal infection (acquired or congenital).

  8.  Neonatal abstinence syndrome requiring treatment.

  9.  Metabolic problems:

  o   Symptomatic hypoglycemia or hypoglycemia not responding to treatment.

  o   Dehydration.

  o   Electrolyte disturbances.

  10. Congenital malformation:

  o   Major malformations or minor malformations that need special care as:

  ü Chromosomal disorders (trisomies 13, 18, and 21)

  ü Pierre Robin syndrome

  ü Osteogenesis imperfecta

  ü Asphyxiating thoracic dystrophy

  11. Birth injuries.

  12. Pre or post operative care of major surgical procedures case.

  13. Others: e.g hydrops

  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   Inability to tolerate full enteral feeding or 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

  o   Unknown babies.