• Clinical condition requiring constant monitoring

  • <34 weeks’ gestation or birth weight <1700 g

• Unwell baby:
  • poor condition at birth requiring prolonged resuscitation for >10 min
  • respiratory distress or cyanosis
  • apnoeic or cyanotic attacks
  • signs of encephalopathy
  • jaundice needing intensive phototherapy or exchange transfusion
  • major congenital abnormality likely to threaten immediate survival
  • seizures
  • inability to tolerate enteral feeds with vomiting and/or abdominal distension
  • symptomatic hypoglycaemia or hypoglycaemia not responding to treatment (see Hypoglycaemia guideline)
• Neonatal abstinence syndrome requiring treatment (see Abstinence syndrome guideline)
• Short-term care while mother admitted to ITU

Procedure

• Manage immediate life-threatening clinical problems (e.g. airway, breathing, circulation and seizures)
• Show baby to parents and explain reason for admission to NNU
• Inform NNU nursing staff that you wish to admit a baby, reason for admission and clinical condition of baby
• Inform middle grade doctor and/or consultant
• Ensure baby name labels present before transfer
• On admission to NNU:
  • document relevant history and examination
  • complete any local problem sheets and investigation charts
  • measure birth weight and head circumference and plot on growth chart
  • measure admission temperature
  • measure blood pressure using non-invasive cuff
  • institute appropriate monitoring and treatment in conjunction with nursing and senior medical colleagues

Investigations

Babies <32 weeks/1500 g weight/unwell/ventilated

• FBC
• Blood glucose
• Blood gases
• Clotting screen if clinically indicated (see Coagulopathy guideline)
  • routine clotting screen in all babies <30 weeks’ gestation is not recommended
• If respiratory symptoms or support given, chest X-ray
• If umbilical lines in place, abdominal X-ray
• If suspicion of sepsis, blood culture and CRP before starting antibiotics and consider lumbar puncture (see Infection in first 72 hours of life guideline)

Other babies

• Decision depends on initial assessment and suspected clinical problem (e.g. infection, jaundice, hypoglycaemia etc.) see relevant guidelines

• Evaluation of baby, including full clinical examination
• Define appropriate management plan and procedures in consultation with middle grade doctor and perform as efficiently as possible to ensure baby is not disturbed unnecessarily
• Aim for examination and procedures to be completed within ≤1 hr of admission
• If no contraindications, unless already administered, give vitamin K (see Vitamin K guideline)
• If antibiotics indicated, give within 1 hr
• Senior clinician to update parents as soon as possible (certainly within 24 hr) and document discussion in notes and on BadgerNet

Respiratory support

• If required, this takes priority over other procedures
  • includes incubator oxygen, high-flow humidified oxygen, continuous positive airway pressure (CPAP) or mechanical ventilation

IV access

• If required, IV cannulation and/or umbilical venous catheterisation (UVC) – see appropriate guidelines in Practical procedures section

Use minimal handling

• Cardiorespiratory monitoring through skin electrodes. Do not use in babies <26 weeks’ gestation
• Pulse oximetry. Maintain SpO₂ as per gestation target values (see Oxygen saturation targets guideline)
• Transcutaneous probe for T_cPO₂/T_cPCO₂, if available (especially clinically unstable preterm) (see Transcutaneous CO₂ and O₂ guideline)
• Temperature
• Blood glucose (see Hypoglycaemia guideline)
• If ventilated, umbilical arterial catheterisation (UAC)/peripheral arterial line for monitoring arterial blood pressure and arterial blood gas – see appropriate guidelines in Practical procedures section

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

• Small for gestational age, 1.7–2 kg and no other clinical concerns
• Preterm 34–36 weeks’ gestation and no other clinical concerns
• Minor congenital abnormalities likely to affect feeding, e.g. cleft lip and palate
• Requiring support with feeding e.g. predicted to require NGT feeds
• Babies of substance abusing mothers (observe for signs of withdrawal)
• Receiving IV antibiotics