Background and aim Term infants represent a significant percentage of NICU admissions and are major contributors to workload. We audited all admissions to our unit over a year to identify potentially avoidable admissions and common avoidable factors.
Methods Retrospective review of admissions >36 weeks gestation Oct 2005–Oct 2006. Gestational age, birth weight, mode of delivery, Apgar score and need for resuscitation, source and reason for admission, temperature, blood sugar and any relevant preadmission events were assessed. Final diagnoses, outcome and length of stay were noted. Case notes review of potential avoidable admissions were carried out.
Results 419 (49%) admissions to the NICU/SCBU were >36 weeks gestation. 88 were deemed potentially avoidable. Case notes review of 88 infants identified 46 of these (10.9%) were potentially avoidable admissions (no evidence of sepsis, early response to basic supportive measures only). Within this cohort reasons for admission were hypoglycaemia in 31/46, (67%); hypothermia in 14/46, (30%); poor feeding with excessive weight loss and hypernatremia in 3/46, (6.5%), and critical hyperbilirubinaemia in 1/46, (2%).
Conclusion Term/near term admissions comprise about half of the NICU workload. In our study 11% of admissions were potentially avoidable. Early review and better management of hypothermia and hypoglycaemia particularly in known risk groups such as those <2.5 kg may reduce admissions. Improving documentation of early management plans and care given to newborns during their stay in the delivery suite may reduce costs of the neonatal unit significantly although it is difficult to identify factors determining admission retrospectively.