A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an

intensive care unit An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive care medicine. An inten ...

(ICU) specializing in the care of ill or

premature Premature may refer to: * ''Premature'' (2014 film), an American comedy film * ''Premature'' (2019 film), an American romantic drama film * '' PREMature'', a 2015 British television drama miniseries See also * Premature aging, of an organism * ...

newborn

infants In common terminology, a baby is the very young offspring of adult human beings, while infant (from the Latin word ''infans'', meaning 'baby' or 'child') is a formal or specialised synonym. The terms may also be used to refer to juveniles of ...

. The NICU is divided into several areas, including a critical care area for babies who require close monitoring and intervention, an intermediate care area for infants who are stable but still require specialized care, and a step down unit where babies who are ready to leave the hospital can receive additional care before being discharged. Neonatal refers to the first 28 days of life. Neonatal care, as known as specialized nurseries or intensive care, has been around since the 1960s. The first American newborn intensive care unit, designed by

Louis Gluck Louis Gluck (1924–1997) was an American neonatologist who made many important contributions to the care of newborns, and who is considered "the father of neonatology." Career overview Gluck designed the modern neonatal intensive care unit ( ...

, was opened in October 1960 at

Yale New Haven Hospital Yale New Haven Hospital (YNHH) is a 1,541-bed hospital located in New Haven, Connecticut. It is the second-largest hospital in the United States and one of the largest in the world. It is the primary teaching hospital for the Yale School of Med ...

. An NICU is typically

directed Direct may refer to: Mathematics * Directed set, in order theory * Direct limit of (pre), sheaves * Direct sum of modules, a construction in abstract algebra which combines several vector spaces Computing * Direct access (disambiguation), a ...

by one or more

neonatologists Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a hospital-based specialty and is usually practised in neonatal intensive care units (NICUs). The ...

and staffed by

resident Resident may refer to: People and functions * Resident minister, a representative of a government in a foreign country * Resident (medicine), a stage of postgraduate medical training * Resident (pharmacy), a stage of postgraduate pharmaceut ...

physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...

nurse Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alle ...

nurse practitioner A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, prescribe medications an ...

pharmacists A pharmacist, also known as a chemist in English in the Commonwealth of Nations, Commonwealth English, is a healthcare professional who is knowledgeable about preparation, mechanism of action, clinical usage and legislation of medications in ...

physician assistants A physician assistant or physician associate (PA) is a type of non-physician practitioner. While these job titles are used internationally, there is significant variation in training and scope of practice from country to country, and sometimes b ...

respiratory therapists A respiratory therapist is a specialized healthcare professional, healthcare practitioner trained in Intensive care medicine, critical care and cardio-pulmonary medicine in order to work therapeutically with people who have acute critical condit ...

, and

dietitian A dietitian, medical dietitian, or dietician is an expert in identifying and treating disease-related malnutrition and in conducting medical nutrition therapy, for example designing an enteral tube feeding regimen or mitigating the effects of ...

s. Many other

ancillary {{Short pages monitor Equipment in the NICU">neonatology.org --> Equipment in the NICU
Created 1/25/2002 / Last modified 6/9/2002. Retrieved on September 2, 2009 Incubators may be described as

bassinet A bassinet, bassinette, or cradle is a bed specifically for babies from birth to about four months. Bassinets are generally designed to work with fixed legs or caster wheels, while cradles are generally designed to provide a rocking or glidi ...

s enclosed in plastic, with climate control equipment designed to keep them warm and limit their exposure to germs. * Maintaining

fluid balance Fluid balance is an aspect of the homeostasis of organisms in which the amount of water in the organism needs to be controlled, via osmoregulation and behavior, such that the concentrations of electrolytes (salts in solution) in the various body ...

by providing fluid and keeping a high air humidity to prevent too great a loss from skin and respiratory evaporation.Humidity control tool for neonatal incubator
1998: Abdiche M; Farges G; Delanaud S; Bach V; Villon P; Libert J P, Medical & biological engineering & computing 1998;36(2):241-5. A ''transport incubator'' is an incubator in a transportable form, and is used when a sick or premature baby is moved, e.g., from one hospital to another, as from a

community hospital A community hospital can be purely a nominal designation or have a more specific meaning. When specific, it refers to a hospital that is accessible to the general public and provides a general or specific medical care which is usually short-term, i ...

to a larger medical facility with a proper neonatal intensive-care unit. It usually has a miniature

ventilator A ventilator is a type of breathing apparatus, a class of medical technology that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathi ...

, cardio-respiratory monitor, IV pump,

pulse oximeter Pulse oximetry is a noninvasive method for monitoring blood oxygen saturation. Peripheral oxygen saturation (SpO2) readings are typically within 2% accuracy (within 4% accuracy in 95% of cases) of the more accurate (and invasive) reading of art ...

, and oxygen supply built into its frame. Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal membrane oxygenation Extracorporeal membrane oxygenation (ECMO) is a form of extracorporeal life support, providing prolonged cardiac and respiratory system, respiratory support to people whose human heart, heart and human lung, lungs are unable to provide an adequa ...

is used for babies with severe respiratory or cardiac problems. ECMO is typically a last resort when all other treatments have failed. It is an extreme procedure, but significantly improves the life of the newborn. Two different types of ECMO: * Venovenous ECMO: Used mostly for lung failure. The blood from the baby is taken from a vein, oxygenated outside the body, and put back through a different vein. * Venoarterial ECMO: Used for severe heart and lung failure. The blood is taken from a vein, oxygenated outside the body, and put back through an artery to support the heart and lung function.

Pain management

In one study, many parents with newborns in the NICU expressed that they would like to learn more about what types of pain their infants are feeling and how they can help relieve it. Another concern mentioned was potential long-term effects of pain.

Relieving pain

There are multiple ways to manage pain for infants. Holding the infant in kangaroo position or breastfeeding can help calm the baby before a procedure is done. Other methods include allowing the infant to suck on a gloved finger, gently binding the limbs in a flexed position, and creating a quiet and comfortable environment.

Patient populations

Common diagnoses and pathologies in the NICU include: *

Esophageal atresia Esophageal atresia is a congenital medical condition (birth defect) that affects the alimentary tract. It causes the esophagus to end in a blind-ended pouch rather than connecting normally to the stomach. It comprises a variety of congenital anat ...

Apnea Apnea (also spelled apnoea in British English) is the temporary cessation of breathing. During apnea, there is no movement of the muscles of inhalation, and the volume of the lungs initially remains unchanged. Depending on how blocked the ...

Bradycardia Bradycardia, also called bradyarrhythmia, is a resting heart rate under 60 beats per minute (BPM). While bradycardia can result from various pathological processes, it is commonly a physiological response to cardiovascular conditioning or due ...

Bronchopulmonary dysplasia Bronchopulmonary dysplasia (BPD; part of the spectrum of chronic lung disease of infancy) is a chronic lung disease which affects premature infants. Premature (preterm) infants who require treatment with supplemental oxygen or require long-term ox ...

(BPD) *

Hydrocephalus Hydrocephalus is a condition in which cerebrospinal fluid (CSF) builds up within the brain, which can cause pressure to increase in the skull. Symptoms may vary according to age. Headaches and double vision are common. Elderly adults with n ...

Intraventricular hemorrhage Intraventricular hemorrhage (IVH), also known as intraventricular bleeding, is a bleeding into the brain's ventricular system, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space. It can result from p ...

(IVH) *

Jaundice Jaundice, also known as icterus, is a yellowish or, less frequently, greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving ...

Necrotizing enterocolitis Necrotizing enterocolitis (NEC) is an intestinal disease that affects premature or very low birth weight infants. Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, vomiting of bile, multi-organ failure, and p ...

(NEC) *

Patent ductus arteriosus Patent ductus arteriosus (PDA) is a medical condition in which the ''ductus arteriosus'' fails to close after childbirth, birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs from the aorta, which has a h ...

(PDA) *

Periventricular leukomalacia Periventricular leukomalacia (PVL) is a form of white-matter brain injury, characterized by the necrosis (more often coagulation) of white matter near the lateral ventricles. It can affect newborns and (less commonly) fetuses; premature infants ...

(PVL) *

Infant respiratory distress syndrome Infant respiratory distress syndrome (IRDS), also known as surfactant deficiency disorder (SDD), and previously called hyaline membrane disease (HMD), is a syndrome in premature infants caused by developmental insufficiency of pulmonary surfacta ...

(RDS) *

Retinopathy of prematurity Retinopathy of prematurity (ROP), also called retrolental fibroplasia (RLF) and Terry syndrome, is a disease of the eye affecting prematurely born babies generally having received neonatal intensive care, in which oxygen therapy is used beca ...

(ROP) *

Neonatal sepsis Neonatal sepsis is a type of neonatal infection and specifically refers to the presence in a newborn baby of a bacterial blood stream infection (BSI) (such as meningitis, pneumonia, pyelonephritis, or gastroenteritis) in the setting of fever. Ol ...

Transient tachypnea of the newborn Transient tachypnea of the newborn is a respiratory problem that can be seen in the newborn shortly after delivery. It is caused by retained fetal lung fluid due to impaired clearance mechanisms. It is the most common cause of respiratory distress ...

(TTN)

Levels of care

The concept of designations for hospital facilities that care for newborn infants according to the level of complexity of care provided was first proposed in the United States in 1976. Levels in the United States are designated by the guidelines published by the

American Academy of Pediatrics The American Academy of Pediatrics (AAP) is the largest professional association of pediatricians in the United States. It is headquartered in Itasca, Illinois, and maintains an office in Washington, D.C. The AAP has published hundreds of poli ...

(AAP). In Britain, the guidelines are issued by the British Association of Perinatal Medicine (BAPM), and in Canada, they are maintained by the

Canadian Paediatric Society The Canadian Paediatric Society (CPS) is a national association of paediatricians. As a voluntary professional association, the CPS represents more than 3,000 paediatricians, paediatric subspecialists, paediatric residents, and other people who ...

. Neonatal care is split into categories or levels of care. These levels apply to the type of care needed and are determined by the governing body of the area.

United States

The definition of a neonatal intensive-care unit (NICU) according to the National Center for Statistics is a "hospital facility or unit staffed and equipped to provide continuous mechanical ventilatory support for a newborn infant". In 2012, the American Academy of Pediatrics updated their policy statement delineating the different levels of neonatal care. One major difference in the updated 2012 AAP policy statement compared to the 2004 version is the removal of subspeciality nurseries for levels II and III with the addition of a level IV NICU. The four distinct levels of neonatal care defined in the most recent policy statement from the AAP are: # Level I, Well newborn nursery # Level II, Special care nursery # Level III, Neonatal intensive-care unit (NICU) # Level IV, Regional neonatal intensive-care unit (Regional NICU)

Level I (well newborn nursery)

Level I units are typically referred to as the well baby nursery. Well newborn nurseries have the capability to provide neonatal resuscitation at every delivery; evaluate and provide postnatal care to healthy newborn infants; stabilize and provide care for infants born at 35 to 37 weeks'

gestation Gestation is the period of development during the carrying of an embryo, and later fetus, inside viviparous animals (the embryo develops within the parent). It is typical for mammals, but also occurs for some non-mammals. Mammals during pregn ...

who remain physiologically stable; and stabilize newborn infants who are ill and those born less than 35 weeks' gestation until transfer to a facility that can provide the appropriate level of

neonatal In common terminology, a baby is the very young offspring of adult human beings, while infant (from the Latin word ''infans'', meaning 'baby' or 'child') is a formal or specialised synonym. The terms may also be used to refer to Juvenile (orga ...

care. Required provider types for well newborn nurseries include

pediatricians Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, pediatrics covers many of their yout ...

family physicians Family medicine is a medical specialty that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is ...

, nurse practitioners, and other advanced practice registered nurses.

Level II (special care nursery)

Previously, Level II units were subdivided into 2 categories (level IIA & level IIB) on the basis of their ability to provide assisted ventilation including

continuous positive airway pressure Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The a ...

. Level II units are also known as special care nurseries and have all of the capabilities of a level I nursery. In addition to providing level I neonatal care, Level II units are able to: * Provide care for infants born ≥32-week gestation and weighing ≥1500 g who have physiologic immaturity or who are moderately ill with problems that are expected to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis * Provide care for infants who are feeding and growing stronger or convalescing after intensive care * Provide mechanical ventilation for a brief duration (<24 h) or continuous positive airway pressure * Stabilize infants born before 32-week gestation and weighing less than 1500 g until transfer to a neonatal intensive-care facility * Level II nurseries are required to be managed and staffed by a pediatrician, however many Level II special care nurseries are staffed by

and neonatal nurse practitioners.

Level III (neonatal intensive-care unit)

The 2004 AAP guidelines subdivided Level III units into 3 categories (level IIIA, IIIB & IIIC). Level III units are required to have pediatric surgeons in addition to care providers required for level II (pediatric hospitalists, neonatologists, and neonatal nurse practitioners) and level I (pediatricians, family physicians, nurse practitioners, and other advanced practice registered nurses). Also, required provider types that must either be on site or at a closely related institution by prearranged consultative agreement include pediatric medical subspecialists, pediatric anesthesiologists, and pediatric ophthalmologists. In addition to providing the care and having the capabilities of level I and level II nurseries, level III neonatal intensive-care units are able to: * Provide sustained life support * Provide comprehensive care for infants born <32 wks gestation and weighing <1500 g * Provide comprehensive care for infants born at all gestational ages and birth weights with critical illness * Provide prompt and readily available access to a full range of pediatric medical subspecialists, pediatric surgical specialists, pediatric anesthesiologists, and pediatric ophthalmologists * Provide a full range of respiratory support that may include conventional and/or high-frequency ventilation and inhaled nitric oxide * Perform advanced imaging, with interpretation on an urgent basis, including computed tomography, MRI, and echocardiography

Level IV (regional NICU)

The highest level of neonatal care provided occurs at regional NICUs, or Level IV neonatal intensive-care units. Level IV units are required to have pediatric surgical subspecialists in addition to the care providers required for Level III units. Regional NICUs have all of the capabilities of Level I, II, and III units. In addition to providing the highest level of care, level IV NICUs: * Are located within an institution with the capability to provide surgical repair of complex congenital or acquired conditions * Maintain a full range of pediatric medical subspecialists, pediatric surgical subspecialists, and pediatric anesthesiologists at the site * Facilitate transport and provide outreach education.

United Kingdom

Different criteria are used to designate special and intensive neonatal care locally and nationally.

Level 1 Neonatal Units

Also known as Special Care Baby Units (SCBU), these look after babies who need more care than healthy newborns but are relatively stable and mature. SCBU might provide tube-feeding,

oxygen therapy Oxygen therapy, also referred to as supplemental oxygen, is the use of oxygen as medical treatment. Supplemental oxygen can also refer to the use of oxygen enriched air at altitude. Acute indications for therapy include hypoxemia (low blood o ...

antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...

to treat infection and

phototherapy Light therapy, also called phototherapy or bright light therapy is the exposure to direct sunlight or artificial light at controlled wavelengths in order to treat a variety of medical disorders, including seasonal affective disorder (SAD), circ ...

for

jaundice Jaundice, also known as icterus, is a yellowish or, less frequently, greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving ...

. In a SCBU, a nurse can be assigned up to four babies to care for.

Level 2 Neonatal Units

Also known as Local Neonatal Units, these can look after babies who need more advanced support such as

parenteral nutrition Parenteral nutrition (PN), or intravenous feeding, is the feeding of nutritional products to a person intravenously, bypassing the usual process of eating and digestion. The products are made by pharmaceutical compounding entities or standard ph ...

and

(CPAP). They may also look after babies who need short-term intensive care such as mechanical ventilation. Babies who will need longer-term or more elaborate intensive care, for example extremely preterm infants, are usually transferred to a Level 3 unit. Babies in a Level 2 unit may be classified for nursing purposes as Special Care, High Dependency (HDU), in which a nurse will be assigned up to two babies, or Intensive care, where nursing is one-to-one, or sometimes even two-to-one.

Level 3 Neonatal Units

Also known as Neonatal Intensive Care Units (NICU) – although Level 2 units may also have their own NICU. These look after the smallest, most premature and most unwell babies and often serve a large geographical region. Therapies such as prolonged mechanical ventilation,

therapeutic hypothermia Targeted temperature management (TTM), previously known as therapeutic hypothermia or protective hypothermia, is an active treatment that tries to achieve and maintain a specific body temperature in a person for a specific duration of time in an ...

, neonatal

surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

and inhaled

nitric oxide Nitric oxide (nitrogen oxide, nitrogen monooxide, or nitrogen monoxide) is a colorless gas with the formula . It is one of the principal oxides of nitrogen. Nitric oxide is a free radical: it has an unpaired electron, which is sometimes den ...

are usually provided in Level 3 Units, although not every unit has access to all therapies. Some babies being cared for in Level 3 units will require less intensive treatment and will be looked after in HDU or SCBU nurseries on the same site.

NHS England NHS England, formally the NHS Commissioning Board for England, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning si ...

recommended in December 2019 that these units should care for at least 100 babies weighing less than 1.5 kg, and usually perform more than 2,000 intensive care days per year.

India

India has a three-tier system based on weight and gestational age of the neonate.Singh, Meharban (2010). ''Care of the Newborn''. pp. 4-5.

Level I care

Neonates weighing more than 1800 grams or having gestational maturity of 34 weeks or more are categorized under level I care. The care consists of basic care at birth, provision of warmth, maintaining

asepsis Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...

and promotion of breastfeeding. This type of care can be given at home, subcenter and primary health centre.

Level II care

Neonates weighing 1200–1800 grams or having gestational maturity of 30–34 weeks are categorized under level II care and are looked after by trained nurses and pediatricians. The equipment and facilities used for this level of care include equipment for resuscitation, maintenance of thermoneutral environment, intravenous infusion, gavage feeding, phototherapy and exchange blood transfusion. This type of care can be given at first referral units, district hospitals, teaching institutions and nursing homes.

Level III care

Neonates weighing less than 1200 grams or having gestational maturity of less than 30 weeks are categorized under level III care. The care is provided at apex institutions and regional perinatal centers equipped with centralized oxygen and suction facilities, servo-controlled incubators, vital signs monitors, transcutaneous monitors, ventilators, infusion pumps etc. This type of care is provided by skilled nurses and neonatologists.

References

External links

Life in the NICU: what parents can expect

NeonatalICU.com - Expecting a Preterm Infant in the NICU

Equipment used in the NICU – interactive parent friendly information

Association of Women's Health, Obstetric and Neonatal Nurses

The Academy of Neonatal Nursing

{{Authority control Neonatology Intensive care medicine Hospital departments Nursing Infancy