What is a Neonatal Intensive Care Unit?
The different levels of the NICU
A neonatal intensive care unit (NICU) is a special area of the hospital that provides additional care for premature infants or infants that are having a difficult time adjusting to life outside of the womb. The NICU has advanced technology, procedures, and healthcare professionals in place to provide specialized care to the tiniest of patients.
Descriptions are paraphrased from Barfield (2012).
Level I: Commonly referred to as “well baby nurseries.” This level provides care for stable-term newborn infants to infants who are born 35–37 week gestation and who remain physiologically stable. They also have the capability to stabilize and prepare to transfer patients < 35 weeks gestation.
Level ll: Commonly referred to as “special care nurseries.” This level can provide care for infants born ≥32 weeks gestation and weighing ≥1500 grams who have minor physiologic immaturities or who are moderately ill. These infants are expected to recover rapidly. They can also provide care for infants who require mechanical ventilation or continuous positive airway pressure (CPAP) for only a brief duration (i.e., less than 24 hrs).
Level lll: The most common understanding of a “NICU.” This level can provide comprehensive care for infants born <32 weeks gestation and weighing <1500 grams. They also have the ability to provide a full range of respiratory support that may include conventional and/or high-frequency ventilation
Level lV: Considered a “regional NICU.” This is the highest level of care an infant can receive in a hospital and the capability to provide a surgical repair of complex congenital or acquired conditions. In addition, they maintain a full range of pediatric medical subspecialists, pediatric surgical subspecialists, and pediatric anesthesiologists at the site.
Why do babies need to be in the NICU?
There is a wide range of reasons that an infant may need to be admitted to the NICU. When a baby is born, they go through a significant amount of physiological changes, like learning how to breathe, regulate their temperature, learn how to eat, and fight off illness. These tasks can be challenging by themself and are only exacerbated by being born prematurely. Issues with mothers or complications that occur during delivery can also cause infants to be admitted to the NICU.
Examples provided by Standford Medicine (2023).
Maternal Factors: Being younger than age 16 or older than age 40, Drug or alcohol use, Diabetes, High blood pressure (hypertension), Multiple pregnancies (i.e. twins, triplets, or more), or premature rupture of membranes.
Delivery Factors: Poor positioning of infant (i.e. breech), fetal distress, forceps or vacuum-assisted births, compromisation of the umbilical cord, or meconium passed in utero.
Infant Factors: Premature (i.e. < 37 weeks gestational age), low birth weight, respiratory distress, hypoglycemia, infections, or birth defects.
The Care Team
Because the patient population in the NICU is so specialized, the care team needs to have a wide variety of specialists in place. The most common healthcare professionals on the care team are neonatologists, neonatal nurse practitioners (NNP), respiratory therapists (RT), occupational therapists (OT), and neonatal registered nurses (RN). Additional people you can find in the NICU are lactation consultants, social workers, pharmacists, chaplains, and dieticians.
Descriptions paraphrased from Stanford Medicine (2023).
Neonatologist: A medical doctor with extra training focused on the diagnosis and care of premature/sick infants. Often they are considered the head of the care team, supervising all specialties listed below while creating a care plan for patients.
NNP: This is a registered nurse who has gone back to school to seek an advanced practice degree. Often they are present in the NICU 24/7, performing procedures and directing patient care.
RT: A therapist that specializes in providing patients with respiratory support. Overseeing intubation, ventilator, and continuous pulmonary airway pressure (CPAP) care. Helping support nurses in the use of breathing machines and oxygen delivery.
OT: These types of therapists support infant development. Working on positioning, feeding, and appropriate neurodevelopmental care of premature and sick infants. Work closely with nurses in developing care plans to make patients successful.
Neonatal RN: A registered nurse who works specifically with newborn babies, typically in their first month of life. Most often, these infants face specific challenges right after birth, including birth defects, heart problems, prematurity, and more.
References
Stanford Medicine. (2023). The Neonatal Intensive Care Unit (NICU). Stanford Medicine Children's Health - Lucile Packard Children's Hospital Stanford. Retrieved from https://www.stanfordchildrens.org/en/topic/default?id=the-neonatal-intensive-care-unit-nicu-90-P02389
Barfield, Wanda., et al. (2012). Levels of Neonatal Care. Pediatrics. 130 (3): 587–597. 10.1542/peds.2012-1999