Diabetes in pregnancy: are we providing the best care ... - HQIP

Neonatal care of term babies
12.3 The babies in the neonatal enquiry
In the 119 babies selected for neonatal enquiry, two sets of medical records were not available and fi ve
babies had no documented location of care. Amongst the remaining 112 babies with data available on their
care in the fi rst three days of life, 70 babies were nursed initially with their mothers (61 on the postnatal
ward, fi ve in a transitional care unit and four on the labour ward or maternal high dependency unit). By
day three, nearly half of these 70 babies had been discharged from hospital. Six babies, who were initially
nursed with their mother, were later admitted to a neonatal unit.
Forty two babies were admitted directly to a neonatal unit after delivery. By day three, one third of these
42 babies were still on the unit while two thirds had returned to be with their mothers on the postnatal ward.
Two babies were later readmitted to the neonatal unit.
12.4 Avoidable admissions
Current national guidance is that babies of women with diabetes should be admitted to a neonatal unit only
if there is a specifi c medical indication. 5-7 As already mentioned, in 2002, a third of units routinely admitted
babies of women with diabetes to the neonatal unit. 1 The CEMACH descriptive study also found that
30% of term babies were admitted to a neonatal unit 2 , a threefold increase over the neonatal admission
rate in the general maternity population in the UK. 4 This is concerning, as separation of mother and baby
after birth may affect a number of important processes such as early establishment of breastfeeding,
temperature control and emotional bonding.
12.4.1 Enquiry fi ndings
The three main indications for admission to a neonatal unit were a hospital policy of routine admission of
healthy babies of mothers with diabetes; non-symptomatic hypoglycaemia in a healthy baby; and a clinical
need for admission such as poor feeding and respiratory problems.
Table 12.1
Reasons for admission of babies of mothers with diabetes to a neonatal unit
Babies admitted to a neonatal unit
n (%)
(N=42)
Hospital policy (infant of mother with diabetes) 12 (29)
Non symptomatic hypoglycaemia in a well baby 11 (26)
Baby clinically needing admission: 18 (43)
Hypothermia (with hypoglycaemia) 6
Poor feeding (with hypoglycaemia) 3
Macrosomia (otherwise well baby) 3
Respiratory diffi culties 5
Other medical condition (cardiac) 1
Not known 1 (0)
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