Characteristics of Term Neonates Admitted to the Neonatal Intensive Care Unit: A Single-center Experience

Year 2021, Volume: 22 Issue: 3, 309 - 316, 30.12.2021

Ayşe Anık , Abdullah Barış Akcan , Deniz İlgün Gürel Gizem Ergin , Münevver Kaynak Türkmen

https://doi.org/10.4274/meandros.galenos.2021.98271

Cited By: 1

Abstract

Objective: Considerable research has been reported about the problems of preterm neonates admitted to the neonatal intensive care unit (NICU); however, the number of studies examining the problems of term neonates is limited. Thus, this study examined the problems of term neonates admitted to the NICU.
Materials and Methods: The demographic and clinical characteristics of mothers and term neonates admitted to the NICU between January 1, 2015, and December 31, 2020, were retrospectively examined from the medical records. Neonates with major congenital anomalies, diagnosed with genetic syndromes, or referred to another hospital for any reason were excluded from the study. Categorical variables are expressed as n and percentage (%) and numerical variables as median (25th-75th percentile) values.
Results: In total, 1,221 term neonates were enrolled, of which 349 (28.6%) were referred from other centers. The mean gestational age of the infant was 38 weeks (37-39) and the median birth weight was 3.560 g (3,210-3,672). The most common reason for admission to hospital was respiratory distress (n=399, 32.7%), followed by neonatal jaundice (n=370, 30.3%), infections (n=181, 14.8%), hypoxic-ischemic encephalopathy (HIE) (n=98, 8%), hypoglycemia (n=40, 3.3%), small for gestational age (n=25, 2%), poor feeding (n=16, 1.3%), and others (n=92, 7.6%). The median length of hospital stay was 5 (3-8) days. The mortality rate was calculated as 1.1%. Mortality occurred in seven neonates due to infection during the study and in seven due to HIE.
Conclusion: Term neonates represent a significant proportion of patients admitted to the NICU. In light of admission causes, various antenatal practices may help reduce the admission frequency of these neonates.

Keywords

Term , newborn , intensive care unit , admission , indication

References

• 1. Lee HC, Bardach NS, Maselli JH, Gonzales R. Emergency department visits in the neonatal period in the United States. Pediatr Emerg Care 2014; 30: 315-8.
• 2. Aurangzeb B, Hameed A. Neonatal sepsis in hospital-born babies: bacterial isolates and antibiotic susceptibility patterns. J Coll Physicians Surg Pak 2003; 13: 629-32.
• 3. Battersby C, Michaelides S, Upton M, Rennie JM; Jaundice Working Group of the Atain (Avoiding Term Admissions Into Neonatal units) programme, led by the Patient Safety team in NHS Improvement. Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study. BMJ Open 2017; 7: e016050.
• 4. Rohininath T, O’Connell LA, Sheehan K, Corcoran D, Matthews TG, Clarke TA. Workload and short-term outcome of babies weighing 2,500 grams or more at birth admitted to the paediatric unit of the Rotunda Hospital. J Matern Fetal Neonatal Med 2005; 17: 139-43.
• 5. LeBlanc S, Haushalter J, Seashore C, Wood KS, Steiner MJ, Sutton AG. A Quality-Improvement Initiative to Reduce NICU Transfers for Neonates at Risk for Hypoglycemia. Pediatrics 2018; 141: e20171143.
• 6. Nirmala S. Small for gestational age. In: Gomella TL, Cunningham MD, Eyal FG, Tuttle D (Editors). Neonatology. Appleton Lange: Stamford, 2012: 23.
• 7. Whitsett JA RW, Warner BB, Wert SE, Pryhuber GS. Acute respiratory disorders. In: MacDonald MG MM, Seshia MMK editor. Avery’s Neonatology. 6th edition ed. Philadelphia, USA: Lippincott Williams and Wilkins; 2005. p. 569-76.
• 8. Fanaroff AA. Meconium aspiration syndrome: historical aspects. J Perinatol 2008; 28 Suppl 3: S3-7.
• 9. Committee on Fetus and Newborn, Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics 2011; 127: 575-9.
• 10. ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 348, November 2006: Umbilical cord blood gas and acid-base analysis. Obstet Gynecol 2006; 108: 1319-22.
• 11. Fishman SG, Gelber SE. Evidence for the clinical management of chorioamnionitis. Semin Fetal Neonatal Med 2012; 17: 46-50.
• 12. Haque KN. Definitions of bloodstream infection in the newborn. Pediatr Crit Care Med 2005; 6(3 Suppl): S45-9.
• 13. Çoban A, Türkmen MK, Gürsoy T. Turkish Neonatal Society guideline to the approach, follow-up, and treatment of neonatal jaundice. Turk Pediatri Ars 2018; 53(Suppl 1): S172-9.
• 14. Spain JE, Tuuli MG, Macones GA, Roehl KA, Odibo AO, Cahill AG. Risk factors for serious morbidity in term nonanomalous neonates. Am J Obstet Gynecol 2015; 212: 799.e1-7.
• 15. Harrison W, Goodman D. Epidemiologic Trends in Neonatal Intensive Care, 2007-2012. JAMA Pediatr 2015; 169: 855-62.
• 16. Yang X, Meng T. Admission of full-term infants to the neonatal intensive care unit: a 9.5-year review in a tertiary teaching hospital. J Matern Fetal Neonatal Med 2020; 33: 3003-9.
• 17. Ali SR, Ahmed S, Lohana H. Disease patterns and outcomes of neonatal admissions at a secondary care hospital in pakistan. Sultan Qaboos Univ Med J 2013; 13: 424-8.
• 18. Watkins WJ, Kotecha SJ, Kotecha S. All-Cause Mortality of Low Birthweight Infants in Infancy, Childhood, and Adolescence: Population Study of England and Wales. PLoS Med 2016; 13: e1002018.
• 19. Ito M, Tamura M, Namba F; Neonatal Research Network of Japan. Role of sex in morbidity and mortality of very premature neonates. Pediatr Int 2017; 59: 898-905.
• 20. Burgess AP, Katz J, Pessolano J, Ponterio J, Moretti M, Lakhi NA. Determination of antepartum and intrapartum risk factors associated with neonatal intensive care unit admission. J Perinat Med 2016; 44: 589-96.
• 21. Horowitz K, Feldman D, Stuart B, Borgida A, Ming Victor Fang Y, Herson V. Full-term neonatal intensive care unit admission in an urban community hospital: the role of respiratory morbidity. J Matern Fetal Neonatal Med 2011; 24: 1407-10.
• 22. Richardson BS, Czikk MJ, daSilva O, Natale R. The impact of labor at term on measures of neonatal outcome. Am J Obstet Gynecol 2005; 192: 219-26.
• 23. Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP, et al. Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010; 126: e1319-44.
• 24. Ersch J, Roth-Kleiner M, Baeckert P, Bucher HU. Increasing incidence of respiratory distress in neonates. Acta Paediatr 2007; 96: 1577-81.
• 25. Kaplan M, Bromiker R, Schimmel MS, Algur N, Hammerman C. Evaluation of discharge management in the prediction of hyperbilirubinemia: the Jerusalem experience. J Pediatr 2007; 150: 412-7.
• 26. Porter ML, Dennis BL. Hyperbilirubinemia in the term newborn. Am Fam Physician 2002; 65: 599-606.
• 27. Sundaram V, Kumar P, Dutta S, Mukhopadhyay K, Ray P, Gautam V, et al. Blood culture confirmed bacterial sepsis in neonates in a North Indian tertiary care center: changes over the last decade. Jpn J Infect Dis 2009; 62: 46-50.
• 28. Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev 2010; 86: 329-38.
• 29. Türk Neonatoloji Derneği Hipoksik İskemik Ensefalopati Çalışma Grubu. Türkiye’de yenidoğan yoğun bakım ünitelerinde izlenen hipoksikis kemik ensefalopatili olgular, risk faktörleri, insidans ve kısa dönem prognozları. Çocuk Sağlığı ve Hastalıkları Dergisi 2008; 51: 123-9.
• 30. Martinez-Biarge M, Diez-Sebastian J, Wusthoff CJ, Mercuri E, Cowan FM. Antepartum and intrapartum factors preceding neonatal hypoxic-ischemic encephalopathy. Pediatrics 2013; 132: e952-9.
• 31. Walsh CA, Robson M, McAuliffe FM. Mode of delivery at term and adverse neonatal outcomes. Obstet Gynecol 2013; 121: 122-8.
• 32. Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O’Sullivan F, Burton PR, et al. Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ 1998; 317: 1554-8.
• 33. Signore C, Klebanoff M. Neonatal morbidity and mortality after elective cesarean delivery. Clin Perinatol 2008; 35: 361-71.
• 34. Dawodu AH, Effiong CE. Neonatal mortality: effects of selective pediatric interventions. Pediatrics 1985; 75: 51-7.
• 35. Herrera CA, Silver RM. Perinatal Asphyxia from the Obstetric Standpoint: Diagnosis and Interventions. Clin Perinatol 2016; 43: 423-38.
• 36. Ziegler KA, Paul DA, Hoffman M, Locke R. Variation in NICU Admission Rates Without Identifiable Cause. Hosp Pediatr 2016; 6: 255-60.
• 37. Busse M, Stromgren K, Thorngate L, Thomas KA. Parents’ responses to stress in the neonatal intensive care unit. Crit Care Nurse 2013; 33: 52-9; quiz 60.