Guidelines for Routine Screening, Testing, Treatment and Follow-up
Neonatal Intensive Care Unit
Beth Israel Deaconess Medical Center
Newborn Screening
Criteria

All infants admitted to the NICU
Initial

Day 3 or D/C date (whichever comes first)
Follow-up

Day 14 or D/C date (whichever comes first)

Week 6 (if birth weight <1500 gms)

Week 10 (if birth weight <1500 gms)
Head Ultrasound
Criteria

All infants with gestational age <32 weeks (An ultrasound should be done at any gestational age at any time if thought to be
clinically indicated)
Initial

Day 7-10 (In the case of critically ill infants, when results of an earlier ultrasound may effect clinical management, an
ultrasound should be performed at the discretion of the clinician)
Follow-up (minimum if no abnormalities noted)

If no hemorrhage or germinal matrix hemorrhage
-If <28 weeks: week 4 and at 40 weeks postmenstrual age (or discharge if <40 weeks)
-If 28 0/7-316/7 weeks: week 4 or 40 weeks postmenstrual age (or discharge if <40 weeks)

If intraventricular (grade 2+) or intraparenchymal hemorrhage: follow-up at least weekly until stable (more frequently if
unstable post-hemorrhagic hydrocephalus and clinically indicated). Daily head circumference measurement should also be
performed in the case of ventricular dilatation.
Ophthalmologic Examination
Criteria

All infants with birth weight <1500 gms or gestational age <31 weeks

Infants <34 weeks with high illness severity (e.g. those who have had severe respiratory distress syndrome, hypotension
requiring pressor support, or surgery in the first several weeks of life).
Initial

If <27 weeks: week 6

If 27-286/7 weeks: week 5

If 29-306/7 weeks: week 4
Note:
-If the infant is transferred to another nursery prior to 4 weeks of age, recommend exam at the receiving hospital
-If the infant is discharged home prior to 4 weeks of age, examine prior to discharge
Follow-up (based on initial exam findings)

Immature retina Zone 1 or Zone 2, or low grade ROP: follow-up every 2 weeks

Immature retina Zone 3: follow-up in 3-10 weeks

Prethreshold ROP: follow-up at least weekly or more frequently per ophthalmologist recommendation

Regressing ROP: follow-up every 1-10 weeks depending on zone

Mature retinae: Follow up at 8 months corrected age is recommended as an outpatient
Audiology Screening
Criteria:

All infants to be discharged home from NICU
Timing:

Examine at 34 weeks gestation or greater
Note: This is a general guideline, and it does not represent a
professional standard of care governing providers' obligations to
patients. Care is revised to meet individual patient needs.
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Guidelines for Routine Screening, Testing, Treatment and Follow-up
Neonatal Intensive Care Unit
Beth Israel Deaconess Medical Center
Car Seat Testing
Criteria

All infants to be discharged home from NICU and born at less than 37 weeks or with other conditions that may compromise
respiratory status (e.g. airway anomalies and tracheostomy)
Timing

Examine prior to discharge home
Hepatitis B Vaccination
For Hepatitis B Negative Mothers (See Hepatitis B Immunoprophylaxis Guidelines from Red Book if maternal status is HB SAgpositive or unknown.)
Criteria

All infants to be discharged home from NICU
Initial

If weight >2000 gms and stable: vaccinate at birth or shortly thereafter

If weight >2000 and unstable: defer vaccination until their clinical condition has stablized.

If weight <2000 gm : vaccinate as early as 30 days or just prior to discharge if baby discharged at < 30 days
Follow-up (dose #2)

Vaccinate 1 month after initial vaccine dose – may be part of Pediarix: combination vaccine (DPT, Hep B and polio)
Synagis RSV Prophylaxis
Criteria

Synagis RSV prophylaxis should be considered from November through March for infants who meet any of the following
criteria:

gestational age at birth < 32 0/7 weeks

gestational age at birth 32 0/7 to 34 6/7 weeks and either attend childcare or live with siblings under five years of age

chronic lung disease

hemodynamically significant congenital heart disease

congenital abnormalities of the airway or neuromuscular disease (if born before 35 weeks gestation)
Occupational Therapy Consultation
Criteria

All infants meeting one of the following conditions:
-Birth at or below 28 weeks gestation
-Birth weight < 1000g
-Neurological insults including IVH, PVL, seizure d/o
-Genetic syndromes which affect quality of movement or state regulation
-Symptoms associated with Neonatal Abstinence Syndrome
-Orthopedic or musculo-skeletal impairments
-Born to parents with physical disabilities
-Brachial plexus injury (Erb's or Klumpke’s Palsy)
-Critically ill term infants
Social Security
Criteria

All infants meeting one of the following conditions:
-Birth weight < 1200 gms
-Birth weight 1200-2000 gms and at least 4 weeks small for gestational age (refer to growth curve)
-Any infant with serious handicapping conditions
Timing

Application completed during first week of life
Follow-up

Parent notifies SSI office of baby’s discharge via form letter.
Note: This is a general guideline, and it does not represent a
professional standard of care governing providers' obligations to
patients. Care is revised to meet individual patient needs.
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Version 11.20.09
Guidelines for Routine Screening, Testing, Treatment and Follow-up
Neonatal Intensive Care Unit
Beth Israel Deaconess Medical Center
Infant Follow Up Program
Criteria

All infants meeting one of the following conditions:
-Gestational age <28 weeks
-Birth weight <1000 gms
-Birth weight 1000 – 1499 gms and gestational age <32 weeks with one of the following:

Maternal age < 20

IVH (Grades 2-4)

PVL

Surgical NEC

ROP Stage II or greater

Psychosocial concerns
Timing

Referral completed prior to discharge
Neonatal Neurology Program
Criteria

All infants meeting one of the following conditions:
-Neurologic disorders (e.g. stroke, intracranial hemorrhage, and neonatal seizures)
-Neuromuscular disorders
-Birth weight <1500 gms with IVH (Grades 2-4) or PVL (referral to IFUP also)
Timing

Referral completed prior to discharge
Early Intervention Program (EIP)
Criteria

Infant meeting four or more of the following criteria:
-BW < 1200 gms
-GA < 32 weeks
-NICU admission > 5 days
-Apgar < 5 at 5 minutes
-IUGR or SGA (refer to growth curves)
-Chronic feeding difficulties
-Suspected central nervous system abnormality
-Abnormal muscle tone
-Maternal age <17 or 3 or more births at maternal age < 20
-Maternal education <10 years
-Parental chronic illness or disability affecting care giving
-Lack of family supports
-Inadequate food, shelter, and clothing, including homelessness
-Open or confirmed protective service investigation (“51-A”) or file closed by DSS in the last 3 months
-Substance abuse in the home
-Domestic violence in the home
Timing

Referral complete prior to discharge
Note: This is a general guideline, and it does not represent a
professional standard of care governing providers' obligations to
patients. Care is revised to meet individual patient needs.
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