Introduction
Few expectant parents consider the possibility that their baby might need
special medical care after birth. Even fewer think about what neonatal intensive
care unit (NICU) their baby might be sent to if such care is needed. If your
pregnancy is high-risk and you learn that your baby may need special care,
you might consider where your baby should receive that care. What you learn
may affect your decision about where to deliver your baby, or to which NICU
your baby should be transferred after birth if intensive care is needed. One
out of nine expectant mothers does not carry to full term (37 or more weeks).
Approximately four percent of babies -- roughly 100,000 babies annually --
end up in an NICU. With statistics like these, expectant parents need to know
even before the birth of their child what to look for in an NICU.
Although it seems difficult to do, expectant parents should ask their doctor
what will happen if something goes wrong. The most important question may well
be what NICU your baby will be admitted to. Neonatologists are the physicians
with the most training and expertise in the care of critically ill infants.
A neonatologist is a pediatrician with additional training in newborn intensive
care. You should ask whether neonatologists are readily available around the
clock at the NICU you are considering?
In general, the most advanced care is available in hospitals that are affiliated
with medical schools, such as the University of Iowa Children's Hospital at the University
of Iowa Hospitals and Clinics. Most such hospitals offer a full range of services
to meet the needs of women with high-risk pregnancies and their babies. To
learn more about the specific services provided by an NICU, consider the following
questions.
Number of babies treated
What is the total number of premature or critically-ill babies cared for in
a typical year? What are the results, and how do these compare to other hospitals?
Volume of experience is not the only important consideration, but in general,
you can expect better results in NICUs that treat larger numbers of babies.
In addition, larger programs tend to have a greater depth of resources. The
NICU at the University of Iowa Children's Hospital treats approximately 600 babies per
year. Recent survival figures for babies born very prematurely and treated
at the University of Iowa Children's Hospital are shown below, along with the percentage
of survivors who are "intact," i.e. free of major handicap (cerebral palsy,
mental retardation, blindness, or deafness).
Outcomes of Very Premature Infants at the University of Iowa Children's Hospital, 1998-2002
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Completed weeks of gestation
(from last menstrual period)
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23
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24
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25
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26
|
27
|
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Survival (%)
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69
|
77
|
74
|
95
|
97
|
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Survivors free of major handicap* (%)
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71
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88
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90
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91
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92
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*Handicap-free survival data based on infants born
1995-1998.
These figures are shown below as a graph.
Round-the-clock care
Are there dedicated neonatologists available 24-hours a day?
Nutritional care
How are the nutritional needs of your infant addressed during his or her stay?
Is there a nutritionist with specialized expertise in the nutritional support
of NICU patients? Does the nutritionist make rounds and review the nutritional
care of each baby? Is breastfeeding encouraged, even for very sick or premature
babies? Are certified lactation consultants available? Do they have experience
providing support to the mothers of critically ill and premature babies? Are
pediatric gastroenterologists available for consultation if needed
Respiratory care
Are all the latest respiratory therapies available? Because respiratory problems
are the most common problem faced in the NICU, this is critical. Some NICUs
do not have high-frequency ventilation, nitric oxide (a special inhaled gas
that is still considered experimental, though it is widely available in many
NICUs), or ECMO (extracorporeal membrane oxygenation), and the time it takes
to transfer the baby to a center that provides these therapies may delay treatment.
Recent research has shown that high-frequency ventilation and nitric oxide,
used in combination, can reduce the likelihood that more dangerous and expensive
treatments such as ECMO will be needed for critically ill full-term babies.
In addition, high-frequency ventilation reduces the risks of ventilator-induced
lung injury in small premature babies.
Noise and light control
Are efforts made to minimize the effects of sound and light on NICU patients?
Recent studies have shown that the littlest patients do better when noise is
minimized and when direct light is reduced.
Unnecessary tests
Are there guidelines and appropriate programs in place to eliminate unnecessary
tests? Constant monitoring of blood gases and other tests that require frequent
withdrawal of blood often can be decreased or obtained less frequently, depending
on the baby's risk factors and current condition. Fewer tests mean less stress
and more uninterrupted sleep for the baby.
Team approach
Is there a multidisciplinary approach to your infant's care? Are staff members
trained in providing individualized developmental assessment and care? To insure
the most rapid progress and most favorable outcomes, the Children's Hospital
of Iowa uses a team that includes all care providers, including a faculty neonatologist,
other physicians, nurse practitioners, staff nurses and nurse educators, respiratory
therapists, nutritionists, social workers, pharmacists, physical therapists,
and other experts, who can analyze the full scope of an infant's medical and
developmental progress, and address problems as they arise. Are specialists
of all types available for consultation?: pediatric surgeons, pediatric cardiologists,
pediatric heart surgeons, pediatric ophthalmologists (with expertise in the
diagnosis and treatment of retinopathy of prematurity), pediatric ear-nose-and-throat
surgeons, pediatric gastroenterologists, pediatric neurologists, pediatric
infectious disease specialists, pediatric orthopedic surgeons, pediatric endocrinologists,
pediatric urologists, pediatric geneticists, pediatric hematologists, pediatric
nephrologists, and developmental pediatricians. It is important that these
specialists and subspecialists be focused on the care of children. All of these
specialty services are available at the University of Iowa Children's Hospital.
Access to information
How accessible are the physicians for answering parents' questions? Are regular
updates provided to the parents? Are conferences with the key caregivers available
on request?
Parent support resources
What support services are available for parents? A long-term NICU stay can
be as hard on Mom and Dad as it is on the infant. Are counseling and other
social support services available? Are veteran parents available to provide
support and information? Is there a formal peer support program? Is there a
parent library? Do parents have access to the Internet while visiting their
baby in the NICU? These services are available at the Children's Hospital of
Iowa. Our group of veteran parents who provide support for new NICU parents
is called The Parent Connection.
Parent accommodations
Are there accommodations available within the hospital for parents who wish
to sleep near their baby? How close, how quiet, and how comfortable are these
accommodations? The University of Iowa Children's Hospital offers parents the opportunity
to stay as "attendants" in an unused patient room at no cost. The Iowa City
Ronald McDonald House also provides comfortable, inexpensive accommodations
for the parents and other family members of University of Iowa Children's Hospital patients.
Visiting policy
Do parents have unlimited visiting privileges? How are other visitors screened?
May siblings visit?
Preparation for release
How will the NICU prepare for the release of your baby? Will they involve
your pediatrician or family physician in planning for your baby's release,
and work with him or her to safeguard the baby after discharge from the hospital?
Do parents receive training and a thorough explanation of what to expect? Training
can make a big difference in a family's ability to cope with the demands of
a fragile infant.
Follow-up care
Are members of the NICU team involved in the care of the baby after discharge?
Is developmental follow-up available? At the University of Iowa Children's Hospital, most
NICU graduates are enrolled in the Iowa High-Risk Infant Follow-Up Program,
a free program consisting of periodic examinations during the first three years
of life to monitor the baby's growth and development. The most fragile infants
are followed in our clinic by a neonatologist of the family's choice and a
nurse practitioner. The University of Iowa Children's Hospital team works closely with
the child's physician to see that the remaining medical problems are gradually
overcome. Immunizations against respiratory virus infections are given to these
infants during winter virus season.
Research
What research is currently underway at the NICU chosen for your child? The
pace of improvements in medical care is rapid, and involvement in research
is a good indicator of whether your NICU is a leader in developing new and
improved treatments. The NICU at the University of Iowa Children's Hospital is involved
in research designed to reduce the premature infant's need for blood transfusions
and to provide safer transfusions when necessary. Other research projects are
underway to provide new insights into the best ways to nourish sick and premature
babies.
Summary
Approximately 600 babies are admitted each year to the Special Care Nurseries
(NICU and Intermediate Care Nursery) of the University of Iowa Children's Hospital. The
University of Iowa Children's Hospital is the primary pediatric teaching and research
hospital for the University of Iowa College of Medicine. Since the NICU was
begun in 1974, care has been provided to more than 15,000 babies. Approximately
60% of our babies are born at the University of Iowa Hospitals and Clinics.
The other 40% are transported from other hospitals throughout Iowa and nearby
states. The survival among all babies treated in the NICU is over 95%. The
University of Iowa Children's Hospital NICU is known worldwide for its expertise in advanced
respiratory care, particularly the use of high-frequency ventilation. Educational
programs and consultation are frequently provided to physicians and nurses
from throughout the U.S. and many other countries, including Austria, Portugal,
India, Korea, Russia, and Romania. The neonatologists at the Children's Hospital
of Iowa are all faculty members of the University of Iowa College of Medicine.
NICUs that are operated by university teaching hospitals often provide the
most advanced care available. Their physicians are involved in the research
that leads to improved methods of care, so the newest cutting-edge treatments
are available first in university NICUs. Moreover, the faculty neonatologists
at university hospitals write the textbooks and provide both the initial training
and continuing education of other neonatologists. In a university NICU, such
as the University of Iowa Children's Hospital, your child will benefit from the combined
expertise of a large number of faculty neonatologists (12 at CHI) who are personally
involved in the research that leads to improved treatments and in the training
of other neonatologists and pediatricians.
We hope this material gives you some idea of the questions you should ask
when evaluating the NICU where your baby might receive care if needed. You
should not hesitate to ask questions of the staff in the NICU you are assessing.
Ask to speak with the nurse manager or the medical director. If their unit
provides top-notch service, they will welcome your questions, will offer you
a tour of their facilities, and will put you in touch with members of their
parent support group or other veteran parents. We hope that your pregnancy
will end happily and that your baby will not need the services of an NICU.
But if you have found your way to this website, your are probably facing the
possibility that your baby will need the type of care provided by an NICU.
If so, this information will probably help you to ask the right questions and
make the right choices.
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