Reducing Term Neonate Admissions to the Intensive and High Dependency Care Neonatal Unit

Background: NHS England launched an initiative to change practice through keeping mothers and babies together and reduce term admissions to the neonatal unit^{(1, 2)}. This avoids the effects of infant and maternal separation and reduces costs in admissions. Four conditions focused on were respiratory distress, jaundice, hypoglycemia and asphyxia.

Across our Tertiary Neonatal Centre* there are approximately 1500 admissions to the Neonatal unit each year; one third are term gestation. After adjusting for cardiac and surgical admissions, the remaining majority fall into the above four areas.

Hypothermia was previously identified as a preventable contributor to hypoglycemia and from each case being subject to a root cause analysis, our admission rates have reduced in this area.

Ongoing weekly multidisciplinary team meetings between Obstetrics, Neonatology, Transitional Care and Risk Management review all term admissions. Data now shows respiratory distress accounts for a significant amount of potentially avoidable admissions.

Objective: To reduce respiratory admissions to the Neonatal Unit through guideline and poster dissemination on obstetric wards.

Method: A guideline and poster have been developed aiding the approach to the assessment of babies immediately after birth focusing on their respiratory status.

Weekly MDT meetings continue to review all avoidable admissions and to categorize each admission into the ATAIN ⁽¹⁾categories described above.

Results: Between 35 and 40 term admissions are identified using our data systems each month and each case has a “deep dive” into each section of care- antenatal, delivery, resuscitation and postnatal care to look at avoidable factors.

Results show that 61% of term admission are due to respiratory distress, 18% for hypoglycemia and only 3% for hypothermia. Ongoing surveillance with implementation of the flowchart continues.

Conclusion: Infants with respiratory distress can create significant anxiety for parents, midwifes and junior doctors. Through creation of a reference standard of clinical care and management unnecessary admissions should be avoided.