Guidelines for admission to neonatal unit and the immediate management

Avoid unnecessary separation of mother and baby to protect maternal bonding. All babies admitted to the NNU must have a newborn infant physical examination (NIPE) within 72 hours of birth and again once they reach 34+0 weeks corrected age.

Criteria for Admission:

• Gestational age <34 weeks or a birth weight <1700 g.

• Clinical conditions requiring constant monitoring.

• Unwell babies, such as those requiring prolonged resuscitation (>10 min), those with respiratory distress, cyanosis, apnoea, or signs of encephalopathy.

• Babies with seizures, major congenital abnormalities, or jaundice requiring intensive phototherapy or exchange transfusion.

• Inability to tolerate enteral feeds accompanied by vomiting or abdominal distension.

• Symptomatic hypoglycaemia or hypoglycaemia not responding to standard treatment.

Immediate management of life-threatening clinical problems regarding airway, breathing, circulation, and seizures must take priority. The admitting team must explain the reason for NNU admission to the parents and show them the baby.

• Document a relevant history and physical examination.• Measure and plot birth weight and head circumference on growth charts.• Measure admission temperature and non-invasive blood pressure.• Immediate Management and InvestigationsFor babies who are <32 weeks, <1500 g, or ventilated, standard investigations include CBC, blood glucose, and blood gases. If sepsis is suspected, a blood culture and CRP should be obtained before starting antibiotics, which should be administered within one hour if indicated. Vitamin K should also be administered unless already given. Respiratory support, including oxygen or ventilation, takes priority over other procedures.

The unit utilizes minimal handling during monitoring. Standard monitoring includes:• Cardiorespiratory monitoring via skin electrodes (not used for babies <26 weeks).• Pulse oximetry to maintain target SpO2 levels based on gestation.• Temperature and blood glucose monitoring.