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

intensive care unit 220px, 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 intensi ...

(ICU) specializing in the care of ill or premature newborn

infants An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...

. 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, 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 owned and operated by the Yale New Haven Health System. YNHH includes the 168-bed Smilow Cancer Hospital at Yale New Haven, the 201-bed Yale New Hav ...

. NICU is typically

directed Director may refer to: Literature * ''Director'' (magazine), a British magazine * ''The Director'' (novel), a 1971 novel by Henry Denker * ''The Director'' (play), a 2000 play by Nancy Hasty Music * Director (band), an Irish rock band * ''D ...

by one or more neonatologists and staffed by resident

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

nurse Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health ...

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, formulate and prescribe ...

pharmacists A pharmacist, also known as a chemist (Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instructi ...

, physician assistants, respiratory therapists, 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 bassinets 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 variou ...

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 piece 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 breathing insufficiently. Ventilators ...

, cardio-respiratory monitor, IV pump,

pulse oximeter Pulse oximetry is a noninvasive method for monitoring a person's 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 ...

, and oxygen supply built into its frame.

Pain management

Many parents with newborns in the NICU have expressed that they would like to learn more about what types of pain their infants are feeling and how they can help relieve that pain. Parents want to know more about things such as; what caused their child's pain, if the pain that we feel is different than what they feel, how to possibly prevent and notice the pain, and how they could help their child through the pain they were struggling with. Another main worry that was mentioned was the long-term effects of their pain. Would it mentally affect the child in the future, or even affect the relationship they have with their parents?

Relieving pain

There are multiple ways to manage pain for infants. If the mother is able to help, holding the infant in kangaroo position or breastfeeding can help calm the baby before a procedure is done. Other simple things that can help ease pain 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. MotherKMC

Patient populations

Common diagnoses and pathologies in the NICU include: *

Anemia Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, ...

Apnea Apnea, BrE: apnoea, is the temporal 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 airways are (patency), there may ...

Bradycardia Bradycardia (also sinus bradycardia) is a slow resting heart rate, commonly under 60 beats per minute (BPM) as determined by an electrocardiogram. It is considered to be a normal heart rate during sleep, in young and healthy or elderly adults, ...

Bronchopulmonary dysplasia Bronchopulmonary dysplasia (BPD; part of the spectrum of chronic lung disease of infancy) is a chronic lung disease in which premature infants, usually those who were treated with supplemental oxygen, require long-term oxygen. The alveoli that are ...

(BPD) *

Hydrocephalus Hydrocephalus is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain. This typically causes increased pressure inside the skull. Older people may have headaches, double vision, poor balance, urinary in ...

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 ...

(IVH) *

Jaundice Jaundice, also known as icterus, is a yellowish or 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 abnormal heme met ...

Necrotizing enterocolitis Necrotizing enterocolitis (NEC) is a devastating intestinal disease that affects premature or very low birth weight infants.Gephart S.M., Quinn M. A call to action to fight for equity and end necrotizing enterocolitis disparities. ''Adv. Neonata ...

(NEC) *

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

(PDA) * Periventricular leukomalacia (PVL) *

Infant respiratory distress syndrome Infantile respiratory distress syndrome (IRDS), also called respiratory distress syndrome of newborn, or increasingly surfactant deficiency disorder (SDD), and previously called hyaline membrane disease (HMD), is a syndrome in premature infants c ...

(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 due t ...

(ROP) * Neonatal sepsis *

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

(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 an American professional association of pediatricians, headquartered in Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C. Background The Academy was found ...

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

India

India has 3-tier system based on weight and gestational age of neonate.

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 de ...

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.

United Kingdom

The terminology used in the

United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the European mainland, continental mainland. It comprises England, Scotlan ...

can be confusing because 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 known as supplemental oxygen, is the use of oxygen as medical treatment. Acute indications for therapy include hypoxemia (low blood oxygen levels), carbon monoxide toxicity and cluster headache. It may also be prophylactic ...

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

to treat infection and

phototherapy Light therapy, also called phototherapy or bright light therapy is intentional daily exposure to direct sunlight or similar-intensity artificial light in order to treat medical disorders, especially seasonal affective disorder (SAD) and circadi ...

for

jaundice Jaundice, also known as icterus, is a yellowish or 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 abnormal heme met ...

. 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) 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 companies. The person receives a nutritional m ...

and

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 ...

(CPAP). Confusingly, 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, neonatal surgery and inhaled

nitric oxide Nitric oxide (nitrogen oxide 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 denoted by a dot in its ...

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, officially the NHS Commissioning Board, 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 side of th ...

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.

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 Pediatric updated their policy statement delineating the different levels of neonatal care. One major difference in the 2012 updated policy statement from the AAP compared to the 2004 policy statement 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 preg ...

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 An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used t ...

care. Required provider types for well newborn nurseries include

pediatricians Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until th ...

, family physicians, 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

. 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 neonatologists and

neonatal nurse practitioner A neonatal nurse practitioner (NNP) is an advanced practice registered nurse (APRN) with at least 2 years experience as a bedside registered nurse in a Level III NICU, who is prepared to practice across the continuum, providing primary, acute ...

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.

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

Neonatal Nurse Practitioner
{{Authority control Neonatology Intensive care medicine Hospital departments Nursing Infancy