Requirement for SCBU admission in babies born at 35 and 36 weeks gestation. Nicola Cochrane (5th year medical student and Dr Gemma Sullivan, ST6 paediatrics)

Aims

The aim of this project was to investigate what percentage of babies born at two defined gestational periods (35+0 until 35+6 weeks and 36+0 until 36+6 weeks) in a district general hospital were admitted to the special care baby unit (SCBU) and also to get an understanding of what the reasons for admission were. This information is important for obstetric teams in the planning delivery of late preterm infants.

Methods

The maternity department in the Royal Alexandra Hospital (RAH) in Paisley, Greater Glasgow and Clyde, keeps written records of all births in delivery books. The most recent book available for use includes births up to and including 12th September 2013. These books were manually searched and the details of any babies born between 35+0 and 36+6 were entered into a spreadsheet until we had 100 babies born at 35 weeks and 100 born at 36. The following details were collected:

  • Maternal CHI number (community health index)
  • Maternal surname
  • Gestation
  • Date of birth
  • Whether labour was induced or spontaneous
  • Mode of delivery
  • Birth weight
  • Gender of infant

Once the spreadsheets were complete with 100 entries for each gestation the books were re checked again in case any entries had been missed.

This information was then used to identify the baby details. There were two methods use to do this. Firstly maternal surname and baby’s date of birth were used to search on portal. In approximately 50% of cases, this identified the baby. The difficulties in identifying babies may be because they had a different surname to their mother. As our aim was to establish how many of the 100 babies in each group were admitted to SCBU we also searched the admission books from SCBU for the time period of our study and were able to cross reference those babies who were admitted with our data. The SCBU books only use maternal surname for new admissions so this record should be accurate.

For the infants we could identify on portal, we searched their record to establish if they had been admitted to SCBU, and if so what for. We were also able to gather CHI numbers and admission details for all babies admitted through the SCBU admission books. We therefore now updated our spreadsheet to include the following information:

  • Baby CHI number
  • Admitted to SCBU? (yes or no)
  • Reason for admission

Results

In the 35 week gestation group, 58 out of 100 babies had a SCBU admission. In the 36 week group, 24 babies had an admission (see figure 1).

Figure 1: Admissions to SCBU

Figures 2 and 3 show the reasons for admission of these babies. In both gestational groups respiratory distress was the commonest reason for admission with hypoglycaemia next most common.

Figure 2: reasons for admission at 35 weeks

Figure 3: Reasons for admission in babies born at 36 weeks

Discussion

Our data show that over half of babies born at 35 weeks and almost a quarter of those born at 36 weeks gestation were admitted to the special care unit. This places quite a demand on the neonatal unit and can cause a dilemma for the obstetrician if there is a need to deliver a late preterm pregnancy and no SCBU cots available.

The most common reason for admission, accounting for around half of all admissions, was respiratory distress. This would be a completely reasonable and expected reason for admission for pre term infants. However, a significant proportion of these admissions were for reasons that could in some cases be avoidable – jaundice, hypothermia and hypoglycaemia. Ensuring that protocols such as hypothermia bundles and early feeding are implemented on the post-natal wards could reduce the need for SCBU care in these late pre-terms. An alternative approach is the introduction of transitional care –these babies could receive medical input, perhaps seen daily by the neonatal ward round, but remain resident with their mother. This would have obvious financial benefits as well as the reduced maternal psychological impact.