Background The NICU admission rate for term babies in the UK was 6% of all term births (2011). Some admissions may be avoidable reflecting poor standards and quality of care. Reducing the admissions may reduce costs.
Aims To review the admission and management of term (37+0–42+6) neonates in a tertiary neonatal unit.
Methods Retrospective data was collected from medical records of full term neonates (1/1/2013–30/6/2013) on antenatal, delivery and postnatal management including delivery mode, complications, diagnosis, treatment and outcome.
Results Of total 286 admitted babies, 109 were full term (mean gestation 38+5 weeks, birth weight 3.36 kg, length of stay 4 days). 46 were female and 63 were male. 63 were born by instrumental or caesarean delivery.
42 had meconium stained liquor, fetal distress or sepsis risk factors. 85 were admitted from labour ward or theatre and 24 from postnatal ward.
Initial diagnosis was respiratory distress (50), hypoglycaemia (12), hypothermia (6), malformations (11) and poor condition at birth (19). Most babies with respiratory distress, hypoglycaemia and hypothermia were admitted from labour ward or theatre. Final diagnosis was congenital pneumonia or clinical sepsis in 28.
74 needed antibiotics. 13 were ventilated. 82 had either xray, EEG, ECG, Echo, CT, MRI or ultrasound. 27 had invasive procedures. All 109 survived. 26 needed follow up.
Conclusions Respiratory morbidity, hypoglycaemia, hypothermia and suspected sepsis were the commonest causes of unexpected term neonatal admissions requiring significant investigations, invasive procedures and treatment.
Quality improvement projects need to focus on these areas to minimise unnecessary admissions.
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