PC.59 Unexpected term admissions to the neonatal unit: Can the burden be reduced ?

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Abstract

Background and aim

Unexpected term admissions represent a significant percentage of NICU admissions and are major contributors to work load. We audited all infants admitted over 3 months with the aim to

Methods

Retrospective review of admissions >36+6/40 gestation between the 1st January 2013–31st March 2013. Gestational age, weight, mode of delivery, source and reason for admission were determined. Final diagnosis, management received and length of stay were noted.

Results

There were 161 admissions during the study period. 58(36%) were unexpected term admissions. The source of admissions was the postnatal ward in 31(54%). Babies admitted with potentially avoidable factors were poor feeding 5/58 (9%), hypoglycaemia 5/58(9%), hypothermia 1/58(2%), jaundice 2/58(3%). 38/58 (66%) of babies were admitted to SCBU. Treatment in SCBU consisted of supportive measures namely, antibiotics, nasogastric feeding, phototherapy, observation for NAS and routine care in 35(92%). Mean duration of stay was 4.7 days. Of the 19 infants admitted with respiratory distress only 4(21%) required respiratory support.

Conclusion

Our audit identified a recurring pattern of potentially avoidable admissions. A joint review panel run jointly by neonatal and maternity team to review these infants with a view to use targeted approach may potentially reduce the admission rate. A transitional care ward led by neonatally trained staff and providing additional services coupled with early robust management plans may further reduce the number of admissions and the costs of the neonatal unit.

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