Neonatal Intensive Care Unit

While the overwhelming majority of pregnancies result in the birth of healthy babies without complications, childbirth is still an inherently risky process, and things can sometimes go wrong. Modern medicine has sharply reduced the rate of infant mortality in the developed world, but in some cases newborn babies need to be placed in a Neonatal Intensive Care Unit (NICU). This treatment is routine for infants that have been born prematurely or suffer from some sort of congenital illness or condition. In other cases, a baby may need to be placed in a neonatal ICU after suffering some sort of injury during birth, or sometimes for observation due to some unusual symptoms, signs, or prenatally diagnosed findings.

Staffing and Equipment in a Neonatal Intensive Care Unit

An NICU is typically run by a neonatologist (a physician specializing in the care of newborns) who directs a staff comprising other neonatology physicians, registered nurses, neonatal respiratory therapists, pharmacists, dieticians, social workers, and sometimes nurse practitioners, resident physicians and neonatal fellows.

Neonatal ICUs typically are equipped with state-of-the-art incubators. An incubator is a device used to maintain a safe, warm, germ-free, oxygen-rich environment for a fragile newborn. An incubator can provide supplemental oxygen by a variety of means, which is especially important for infants suffering from perinatal asphyxia or respiratory distress syndrome (see below for detailed descriptions of these conditions). An incubator also protects the infant from infection and allows doctors to monitor its breathing, heart function, temperature, and brain activity.

An NICU is a very high level intensive care unit. Babies born as early as 2324 weeks and weighing under two pounds at birth have been able to survive due to excellent NICU care with hospital stays sometimes as long as three to four months or longer. This requires an extraordinary support system and a specialized team with 24 hour-a-day availability.

Possible Reasons Why a Baby Might Need Neonatal Intensive Care

There are myriad reasons a baby might require neonatal intensive care; this list should not be considered exhaustive; rather, it should be taken as a reference guide to explain some of the reasons this drastic medical step must sometimes be taken.

  • Premature Birth: This is the most common reason for a baby to be admitted to an NICU. Usually babies born after 36 weeks avoid the NICU, but 35 weekers and under often end up there.
  • Neonatal sepsis: A newborn’s life can be endangered by the presence of a bacterial infection in the bloodstream, such as pneumonia or meningitis. Sometimes this is suspected at birth because the mother showed signs of infection prior to delivery. Sometimes a baby that seems normal is admitted to NICU for a septic work-up only. This is a combination of tests, antibiotics, and observation, sometimes just for a few days if all the tests return as negative.
  • Multiple Births: Twins and higher order multiples sometimes encounter developmental problems in the womb, and the more babies in the womb, the earlier the delivery. More than 50 percent of all twins are born prematurely and underweight, and the figures are even more severe for multiple births involving large numbers of babies.
  • Perinatal asphyxia: This condition occurs when the baby is deprived of oxygen at some point during the birthing process. This can happen because the umbilical cord has become wrapped around the baby’s neck, or it can result from a sudden drop in the mother’s blood pressure. Perinatal asphyxia ordinarily occurs in only two out of every 1,000 births, but the figures are higher for premature babies.
  • Jaundice: Newborns presenting the yellow complexion characteristic of jaundice will sometimes require immediate neonatal intensive care to prevent kernicterus, a brain condition that can potentially result in severe brain damage. Jaundice is a common condition in newborns and the majority are safely treated without a stay in the NICU, but in severe cases they may need intensive care, such as for a procedure called an exchange transfusion (replacing the baby’s jaundiced blood with blood-bank donor blood).
  • Infant respiratory distress syndrome (IRDS) occurs mostly in premature infants. the earlier the birth, the more likely this condition will be present, and the more severe it is likely to be, especially in premies born prior to 32 weeks. The NICU provides expert respiratory support, care, and monitoring for this condition.
  • Hydrocephalus or intraventricular hemorrhage: Respectively, the accumulation of abnormal amounts of cerebrospinal fluid in the brain’s cavities, and bleeding in those cavities. This can be a complication of extreme prematurity or a birth defect.

Levels of NICU Care

Neonatal ICUs are differentiated by levels of care, which differ from one country to another. In the United States, there are four levels among NICUs, and each level is able to provide a greater degree of more specialized care than the level below it.

  • Level I is called a well newborn nursery. These NICUs are able to provide postnatal care to healthy newborns and can generally care for infants born at 35 to 37 weeks. They are able to stabilize infants born more prematurely or with more serious conditions, but these infants must soon be moved to a facility that is better equipped to care for them.
  • Level II: Level II units are called special care nurseries. Special care nurseries are better able to provide the respiratory assistance many premature infants require.
  • Level III: A level III neonatal intensive care unit is required to have a pediatric surgeon on its staff.
  • Level IV: A level IV regional NICU subject to the same requirements as a level III facility, but must also employ certain pediatric surgical sub-specialists. These facilities provide the highest level of neonatal intensive care available.

Neonatal ICUs are equipped with transport incubators, which are transportable versions of the machines used to protect infants from environmental hazards. These transport incubators are used when it is necessary to move an infant to a facility that offers a higher level of neonatal intensive care.

What to Expect

Depending on the reason your baby has been placed in neonatal intensive care, he or she may be able to go home with you in a day or two. In some cases, however, your baby may need to spend weeks—or even months—in NICU. Your doctor will be able to tell you what to expect in your baby’s case.

Questions to Ask Your Doctor About Neonatal Intensive Care

  • Why is my baby in the NICU? Is his condition serious?
  • Can I visit and handle my baby while she is in the NICU, or is she too fragile?
  • How soon can I take my baby home?
  • Is it likely my baby will need to be moved to a higher-level NICU?


This page was last updated on 06/2017

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