1. Term Admissions to NICU ST Michaels Hospital, Bristol
Corenna Bowers ANNP

2. Network Report for UHB Based on 2016 badger net admissions
6.3% local term live births were admitted to NICU
Regionally 5.5% admitted
National aim <5%

3. Issues Raised
Report considered that some admissions could have been cared for on transitional care or post natal ward
Hypoglycaemia – 27 (83%)
Respiratory – 22 (18%)
Monitoring – 9 (64%)
Suspected HIE – 10 (31%)
Suspected infection – 5 (83%)

4. Audit of Unexpected Term Admissions
Some of the numbers in the Network report did not “ring true”
No NICU feel for our unexpected admission but no one thought we were admitting babies for hypoglycaemia or jaundice unnecessarily
However there was a feeling we may admit a high number of babies for very short term respiratory support – could these be prevented

5. Process
Retrospective audit admissions using admission book 01/04/17 – 01/07/17
Ongoing prospective audit until 31/03/18
Badger and phillips notes reviewed

6. Results 234 babies admitted Asphyxia 42 bilious vomits 20
Hypoglycaemia 11
Jaundice 18
Monitoring 30
Respiratory
110
Social 3

7. Respiratory
110 babies admitted with primary respiratory issues 13/110 did not require respiratory support
27/42 asphyxia babies also received respiratory support
101 babies received CPAP
26 babies intubated and ventilated

9. Asphyxia 41/42 babies with possible asphyxia had 6hrs CFM monitoring
1/42 was reviewed by registrar and felt not to meet criteria for passive cooling and was sent back to mother on CDS
8/42 received therapeutic hypothermia

10. Jaundice
All babies admitted with jaundice were at or close to exchange line
All recieved triple phototherapy
16/18 received IV fluids,
1/18 required exchange transfusion

11. Hypoglycaemia
All babies admitted with hypoglycaemia required IV fluids
6/11 had blood glucose <2, 4 had blood glucose 2 and 1 had blood glucose 2.1

12. Implemented Actions Attend one of our simulation sessions
Development of new guideline : Respiratory Support and Monitoring for Newborsn >/= 37 weeks
Attend one of our simulation sessions
Access the e-learning package:
Updating hypoglycaemia and Jaundice guidelines

14. Ongoing Monitoring 2018

16. Other Issues
Completion of Admission Badger – primary reason for admission – education junior medical team
Exclusion/Inclusion pre-booked admissions
Relatively high number HIE most only 6hrs CFM
Classification readmissions from home