Admission of Term Infants to Neonatal Intensive Care Unit from Nursery

Jin Seok Park; Kee Hyun Cho; Heui Seung Jo; Sung-Il Cho; Gyu Young Chae; Moon Kyu Kim; Kyu Hyung Lee

doi:10.14734/kjp.2014.25.4.246

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Park, Cho, Jo, Cho, Chae, Kim, and Lee: Admission of Term Infants to Neonatal Intensive Care Unit from Nursery

Original Article

Korean J Perinatol 2014;25(4):246-256.

Published online: 21 December 2014

DOI: https://doi.org/10.14734/kjp.2014.25.4.246

Admission of Term Infants to Neonatal Intensive Care Unit from Nursery

Jin Seok Park, M.D.¹, Kee Hyun Cho, M.D.¹, Heui Seung Jo, M.D.¹, Sung-Il Cho, M.D.², Gyu Young Chae, M.D.¹, Moon Kyu Kim, M.D.¹, Kyu Hyung Lee, M.D.¹

¹Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea

²Graduate School of Public Health, Seoul National University, Seoul, Korea

Received 27 August 201427 September 2014 Accepted 29 September 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We evaluated the clinical characteristics of term infants admitted to the neonatal intensive care unit (NICU) from nursery.

Methods

This is a study of NICU-admitted infants who were born ≥37 weeks of gestation at the Bungdang CHA Hospital between January 2012 and August 2013 (n=161). The infants were divided into 3 groups. The “nursery room (NR) group” (n=97) comprised admissions from the nursery following a late deterioration in condition. The “delivery room (DR) group” (n=64) comprised infants who required admission to the NICU immediately after delivery. In addition, healthy term infants who were selected as the “Term group” (n=95).

Results

The NR group had a higher incidence of respiratory distress syndrome than DR group (28.9% vs. 14.1%, P=0.029). Compared with the Term group, the NR group had increased incidence of prolonged (>18 h) premature rupture of membranes (PROM) (6.2% vs. 0.0%, P=0.029). By logistic regression analysis, comparing NR group and Term group, a 1 min Apgar score ≤7 points {odds ratio (OR) and 95% confidence intervals (CI) 3.1 (1.0-9.1)}, a requirement of O2 at birth 2.6 (1.2-5.9) and abnormalities detected on an antenatal sonogram 3.3 (1.4-7.8) were associated with an increased risk of admission to NICU.

Conclusion

Risk factors for NICU admission from nursery in term infants included prolonged PROM, a 1 min Apgar score of ≤7 points, a requirement of O₂ at birth, and abnormalities on antenatal sonograms. Term infants with these risk factors should be carefully observed in the early neonatal period.

Keywords: Term birth, Neonatal intensive care unit, Patient admission, Risk factors

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Fig. 1.

The relationship between abnormal finding of prenatal ultrasonography and congenital anomalies (See the Table. 4). A: The cases of Abnormal findings of prenatal ultrasonography. B: The cases of Both of abnormal findings of prenatal ultrasonography and congenital anomaly 1-3. B': The cases of Both of abnormal findings of prenatal ultrasonography and congenital anomaly 6-13. C: The cases of revealed Congenital anomaly after birth 4,5,14-20. a : The cases of abnormal prenatal ultrasonography in newborns without congenital anomaly. c : The cases of congenital anomaly in newborns with normal prenatal ultrasonography.

Table 1.

Demographics and clinical characteristics of pregnancies and deliveries

	NR group (N=97)	DR group (N=64)	Term group (N=95)	P^a	P^†
Maternal Age (yr)	33.1±4.5	31.2±5.7	32.0±4.2	0.017^‡	0.07
Paternal Age (yr)	36.6±5.5	33.6±6.7	35.4±5.2	0.003^‡	0.138
Cesarean section (%)	42 (43.3)	40 (62.5)	29 (30.5)	0.017^‡	0.067
Without labor (elective) (%)	27 (27.8)	16 (25.0)	17 (17.9)	0.691	0.101
Emergency (%)	15(15.5)	24(37.5)	12 (12.6)	0.001^‡	0.572
IVF pregnancy (%)	6 (6.2)	12 (18.8)	9 (9.5)	0.013^‡	0.396
Twin pregnancy (%)	5 (5.2)	9 (14.1)	3 (3.2)	0.050^‡	0.489
Antenatal Admission (%)	16(16.5)	16(25)	13(13.7)	0.186	0.587
Maternal hypertension (%)	1(4.7)	3(1.0)	2(2.1)	0.145	0.548
Gestational diabetes (%)	11 (11.3)	9 (14.1)	7 (7.4)	0.608	0.345
Thyroid disease (%)	7 (7.2)	4 (6.3)	9 (9.5)	0.812	0.572
PROM ≥18hr (%)	6 (6.2)	2 (3.1)	0 (0.0)	0.382	0.029^‡
Antenatal admission due to prelabor (%)	10(10.3)	11(17.2)	9(9.5)	0.205	0.846
Mother ICU admission after delivery (%)	4 (4.1)	5 (7.8)	0 (0.0)	0.319	0.121

^* Comparison of nursery room group and delivery room group

^† Comparison of nursery room group and term group

^‡ P<0.05

Abbreviations : NR, nursery room; DR, delivery room; PROM, premature rupture of membranes; ICU, intensive care unit

Table 2.

Demographics and clinical characteristics of neonatal characteristics

	NR group (N=97)	DR group (N=64)	Term group (N=95)	P^*	P^†
Male (%)	47 (48.5)	30 (46.9)	41 (43.2)	0.844	0.462
Gestational age (weeks)	38⁺⁵±1⁺¹	38⁺⁰±1⁺¹	38⁺⁶±1⁺¹	0.006^‡	0.553
37⁺⁰- 37⁺⁶ (%)	22 (22.7)	26 (40.6)	17 (17.9)	0.019^‡	0.826
38⁺⁰- 38⁺⁶ (%)	25 (25.8)	21 (32.8)	28 (29.5)
39⁺⁰- 39⁺⁶ (%)	29 (29.9)	7 (10.9)	28 (29.5)
40⁺⁰- 40⁺⁶ (%)	19 (19.6)	9 (14.1)	18 (18.9)
≥41⁺⁰ (%)	2 (2.1)	1 (1.6)	4 (4.2)
Birth weight (g)	3,150±420	2,830±700	3,210±400	0.002^‡	0.256
1,500-1,999 g (%)	0 (0.0)	11 (17.2)	0 (0.0)	<0.0001^‡	0.183
2,000-2,499 g (%)	9 (9.3)	11 (17.2)	3 (3.2)
2,500-2,999 g (%)	27 (27.8)	14 (21.9)	28 (29.5)
3,000-3,499 g (%)	39 (40.2)	20 (31.3)	45 (47.4)
3,500-3,999 g (%)	21 (21.6)	6 (9.4)	15 (15.8)
≥4,000g (%)	1 (1.0)	2 (3.1)	4 (4.2)
SGA (%)	3 (3.1)	16 (25)	1 (1.1)	0.000^‡	0.322
Meconium stained (%)	24 (24.7)	15 (23.4)	19 (20.0)	0.852	0.431
Apgar score 1min	7.7±0.4	6.1±1.6	7.9±0.2	<0.0001^‡	<0.0001^‡
Apgar score 1min ≤7	25 (25.8%)	50 (78.1%)	6 (6.3%)	<0.0001^‡	<0.0001^‡
Apgar score 5min	9.0±0.2	7.4±1.4	9.0±0.1	0.000^‡	0.181
O₂ need at birth (%)	39 (40.2)	54 (84.4)	15 (15.8)	0.000^‡	<0.0001^‡
Abnormal finding of prenatal ultrasonography (%)^∮	20 (31.3%)	26 (26.8%)	9 (9.5%)	0.541	0.043^‡
Congenital anomaly (%)	5 (5.2)	15 (23.4)	0	0.003^‡	-
Hospital stay (day)	9.0±3.7	13.8±14.9	-	0.015^‡	-
Mortality (%)	0 (0.0%)	1 (1.6%)	0	0.398	-

^* Comparison of nursery room group and delivery room group

^† Comparison of nursery room group and term group

^‡ P<0.05

^∮ Thicken nuchal fold, echogenic bowel, ventriculomegaly, echogenic focus in the heart and fetal cardiac anomay, choloid plexus cyst, single umbilical artery, enlarged cisterna magna, pyelectasis, mass lesion Abbreviations : NR, nursery room; DR, delivery room; SGA, small for gestational age

Table 3.

Major respiratory diseases

	NR group (N=97) (%)	DR group (N=64) (%)	P
Respiratory distress syndrome	28 (28.9)	9 (14.1)	0.029^*
Transient tachypnea of newborn	13 (13.4)	6 (9.4)	0.438
Meconium aspiration syndrome	12 (12.4)	4 (6.3)	0.284
Extrapulmonary air leak	8 (8.2)	2 (3.1)	0.318
Congenital pneumonia	3 (3.1)	1 (1.6)	1.000
PPHN^†	4 (4.1)	3 (4.7)	1.000

^* P<0.05

^† Associated with respiratory disease Abbreviations : NR, nursery room; DR, delivery room; PPHN, persistent pulmonary hypertension of newborn

Table 4.

Clinical characteristics of the congenital anomaly

Case	Congenital Anomaly	Pediction of Prenatal Ultrasonography	GA	BW	Gender
NR group
1	Indeterminate sex	Yes	39⁺⁵	3,100	Female
2	Adrenal mass	Yes	39⁺⁵	3,710	Female
3	ASD, VSD, R/o CoA	Yes	40⁺¹	2,590	Male
4	Lipomeningomyelocele	No	39⁺⁰	3,060	Female
5	Hemangioma DR group	No	40⁺⁰	3,090	Male
6	AVSD	Yes	37⁺²	2,160^*	Female
7	Indeterminate sex	Yes	38⁺²	3,135	Female
8	R/o CoA, PDA	Yes	38⁺²	2,880	Female
9	R/o CoA, PDA	Yes	39⁺⁴	3,375	Male
10	TOF	Yes	39⁺⁰	3,825	Male
11	Hand agenesis	Yes	40⁺⁰	2,950	Female
12	Corpus callosum dysgenesis	Yes	38⁺⁶	1,880^*	Female
13	Turner syndrome	Yes	37⁺⁰	1,980^*	Female
14	Robin syndrome	No	38⁺⁶	2,970	Male
15	Imperforated anus	No	40⁺⁴	3,030	Male
16	de Lange syndrome	No	37⁺⁴	2,330	Male
17	Multiple deformity with hypertonia^†	No	37⁺⁵	3,420	Female
18	Charge syndrome	No	37⁺⁴	2,010	Female
19	Microtia	No	38⁺⁴	3,550	Female
20	Treacher collins syndrome	No	38⁺²	3,190	Male

^* Small for gestational age

^† Death

Abbreviations : GA, gestational age (weeks); BW, birth weight(g); ASD, atrial septal defect; VSD, ventricular septal defect; CoA, coarctation of the Aorta; AVSD, atrioventricular septal defect; PDA, patent ductus arteriosus; TOF, tetralogy of fallot

Table 5.

Effects of variables on admission of neonatal intensive care unit form nursery

	Odds ratio	95% Confidence interval	P
With PROM>18hr
Apgar score 1min	3.1	1.0-9.1	0.040^*
O₂ need at birth (%)	2.6	1.2-5.9	0.017^*
Abnormal finding of
Prenatal ultrasonography (%)	3.3	1.4-7.8	0.008^*
Without PROM>18hr
Apgar score 1min	3.0	1.0-8.8	0.047^*
O₂ need at birth (%)	2.4	1.1-5.1	0.031^*
Abnormal finding of
Prenatal ultrasonography (%)	3.4	1.4-7.9	0.005^*

^* P<0.05 Abbreviations : PROM, premature rupture of the membranes

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