What Is a Neonatal Intensive Care Unit (NICU): Q&A with Dr. Lauren Priolo

What is a Neonatal Intensive Care Unit (NICU) and what are the different types/levels? 

<iframe src="https://support.doctorpodcasting.com/client/audio-player/solhealth/item/64143" seamless scrolling="no" border="0" frameborder="0" width="800" height="200" ></iframe>

A Neonatal Intensive Care Unit or NICU is a unit in some hospitals that is equipped to provide critical care services to newborns. Elliot Hospital has a NICU, but not all hospitals that deliver infants do.   

There are different types of NICUs which are often referred to as levels.  

Level I: All hospitals that deliver infants will have a Level I nursery. These are “well-baby” nurseries that provide routine newborn care after birth.  

Level II: Level II is often referred to as a special care nursery. These nurseries are equipped to take care of some premature infants but are limited by the gestational age of the infant. These gestational age guidelines vary. Most will care for infants born at 32-33 weeks gestational age and above. Special care nurseries treat infants who are moderately sick or have difficulty with breathing or maintaining blood sugar levels or body temperature. If an infant has breathing difficulty that does not appear to improve in a short-term time frame or has more complex medical needs, then the infant would require a higher level of intensive care.   

Level III: Elliot Hospital has the only level III NICU in southern NH and is one of only two in New Hampshire. A Level III NICU is equipped to take care of infants born at any gestational age and birth weight. We can provide advanced breathing support to infants with different modes of ventilation or breathing machines and specialized respiratory medicines, and we have a multidisciplinary team available to care for each infant. As a Level III NICU, we work with pediatric surgeons, pediatric anesthesiologists, pediatric gastroenterologists, neurologists, ophthalmologists, and radiologists. We also have a neonatal follow-up program, where certain infants are followed post-NICU discharge by a team of nutritionists, physical and occupational therapists, and neonatologists to follow their development. The Elliot Hospital NICU also has a neonatal transport team which is available to transport infants from community hospitals who need a higher level of service. In fact, 20-25% of babies treated in our NICU are transported to our hospital.  

The Elliot NICU also has a specialized treatment called therapeutic hypothermia which can be initiated by the transport team at the community hospitals and in the Elliot NICU.  Therapeutic hypothermia is used to lower an infant’s body temperature to protect brain development in those infants who show evidence of decreased oxygen or blood flow around the time of birth.  

Level IV: This is the highest level of neonatal intensive care. This level is found in universities or large academic center hospitals. A Level IV NICU can also provide specialized heart surgery, heart bypass, known as ECMO, and further specialty support for more complex or critical conditions.  

What are some common conditions or reasons newborns are admitted to the NICU? 

Prematurity, breathing difficulty, and low blood sugar commonly lead to admission. All infants who are born at a gestational age of less than 35 weeks are admitted to the NICU. When infants are born prematurely, they require close monitoring and, depending on the degree of prematurity, will require medications or therapies to support their body systems while they continue to grow and mature. Sometimes infants born at term or a few weeks prior to their due date require NICU care, most commonly for delays in the transition that all infants go through at birth. Some require breathing help or breathing support. Others require IV fluids to help keep their blood sugar within a normal range, and some infants require help maintaining their body temperature. Some infants might need help learning how to eat by bottle or breastfeed. 

What are some of the most challenging aspects of caring for premature or critically ill newborns in the NICU? 

The most challenging aspects are monitoring everything about the infant, such as bloodwork, physical exam, vital signs, x-ray or imaging studies, and continuously assessing how the infant is doing, what the next steps are, and planning for what could happen if something changes. Sometimes, despite optimized care and vigilant monitoring of infants, unexpected changes can happen, which require creating a new care plan for the infant. 

Who are the typical team members, and what are their roles in the NICU? 

There is a large multidisciplinary team working together to care for infants in the Elliot Hospital NICU.   

Neonatologists: These are specialized physicians overseeing all aspects of care and management of each infant and work with the team to create the care plan for each infant.   

Neonatal nurse practitioners and physician assistants: These specialized providers work closely with neonatologists and the entire team to provide care to infants in the NICU and when infants are being delivered if needed. Neonatal nurses provide bedside care to infants, assess infants routinely throughout the day, and provide families one-on-one education while their infants are in the NICU.   

Respiratory therapists: These providers are trained to assess how an infant is breathing and implement and monitor specialized breathing machines and equipment.  

Physical therapists and occupational therapists: These therapists specialize in providing developmental care and support to infants and provide techniques such as infant massage to help infants grow and develop comfortably.  

Speech therapists: These are the feeding specialists in the NICU who work together with nurses to assess and help support those infants that have difficulty taking feeds by bottle.  

Lactation consultants: These specialists focus on supporting mothers in breastfeeding and pumping.  

Social workers: Social workers are available for all families when an infant is admitted to the NICU. They provide support and assistance in areas such as finance and insurance and emotional support for families.  

In addition, behind the scenes are pharmacists who are available to ensure the correct medication and dosing is always prescribed, nutritionists who assess the needs of each infant and work to optimize nutritional intake, and pediatric radiologists who are available to interpret the imaging studies such as x-rays, ultrasounds, and MRIs that some infants might require. Elliot Hospital also has the support of pediatric surgeons and anesthesiologists for those infants who might require surgical care, pediatric gastroenterologists, pediatric neurologists, ophthalmologists, and pulmonologists. 

What makes The Elliot’s NICU special?  

I think what makes the Elliot NICU so special is the team of specialists providing care here. The multidisciplinary team is committed to providing the highest quality of care close to home in southern NH. We care for over 600 babies per year. 

What can parents expect when their infant is in the NICU?  

For most families, admission to the NICU was not part of their birth plans. The equipment, sounds of the monitors, and multiple different faces of the team of care providers can all seem very overwhelming. When an infant is first admitted to the NICU, a lot of different things are happening at once to provide needed care. The providers are always available and will teach parents what everything is and why things are being done. The priority of the NICU team is to provide exceptional care to each infant in addition to making sure parents are aware and understanding of the care plan for their infant. Our goal is always to keep infants with their parents, and we take separating infants from their parents to admit to the NICU seriously. If an infant is admitted to the NICU, a thorough assessment of medical needs and what is in the infant’s best interest is always done.  

What advice would you give to expectant parents who may be anxious about the possibility of their newborn needing NICU care? 

Fear of the unknown and lack of control of the situation are common for parents in the NICU.  Be assured that the NICU team is always doing everything possible to help their infant and that most infants go home from the NICU as healthy, happy infants and do well. The NICU stay might be longer than anticipated by parents, and there is an understandable desire for parents to have their infants at home. The NICU team is always working to get infants home as soon as the infant is safely ready. The NICU team’s goal is to partner with parents and involve parents in the care of their newborn. We are always here to answer questions and hear any concerns parents might have.