Understanding Neonatal Intensive Care Unit (NICU)

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Understanding Neonatal Intensive Care Unit (NICU)

Witnessing the power and beauty of a tiny life is awe-inspiring. Every new mom aspires this experience of delivering a healthy baby to be a smooth one but sometimes things don’t go as planned; babies can be born prematurely, with a serious health condition or can become gravely ill after delivery. Hence, when parenting a preemie, learning all about the neonatal intensive care unit (NICU) and what NICU levels mean can help you feel more aware and in charge of your baby’s care.

Neonatal refers to the first 28 days of life. A neonatal intensive care unit (NICU) is an intensive care unit of a hospital that is staffed and equipped for the care of premature, ill newborn babies or neonates. It is typically directed by one or more neonatologists and staffed by nurses, nurse practitioners, pharmacists, physician assistants, resident physicians, respiratory therapists and dietitians. Not all NICUs are created equal when considering all the factors in the choice of what hospital to birth a baby. The NICU level defines the level of expertise, which differs between hospitals. You may think that the NICU is just for preemies, but many are full-term babies, from healthy pregnancies, that unexpectedly have a condition that needs immediate attention.

India has 4-tier system based on weight and gestational age of neonate

Level I care

Neonates weighing more than 1800 grams or having a 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 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 a 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 a gestational maturity of fewer 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.

Level IV care: Highest Level of Neonatal Care

Level 4 NICUs provided the highest level, the most acute care. These nurseries are in a hospital that can provide surgical repair of complex congenital or acquired conditions. The facilities have a full range of pediatric medical and surgical subspecialties as well as pediatric anesthesiologists on site.

Usually, level 3 and 4 are exchangeable.

Choose a Hospital with a Higher Level NICU
When your baby is need of neonatal care, you want to have that specialized care available immediately and avoid the difficult and dangerous transfer situation. Here is why you want to deliver your baby at a higher level NICU (Level 3 or 4).

  • In facilities that see the most complex cases, there is a better likelihood of identifying the risk factors and applying the best strategies.
  • Higher level NICUs employ the most experienced nursing staff. This nurse (or team of nurses) cares for your baby 24/7.
  • Even when the pregnancy is full-term, going smoothly, and not considered high-risk, there are many conditions that affect babies when they are born. Heart defects are the most common birth defect, most often undetected in vitro, and can require the most advanced medical treatment.
  • Unless you are at a higher level NICU, parents find themselves trying to figure out what to do from the hospital bed when a situation arises. Timing becomes critical and you end up relying on the medical professionals in that facility to advise you, diagnose and decide if a transfer is warranted.
  • If a NICU at the desired facility is full and a transfer is needed, the transfer situation becomes difficult. The infant may end up waiting for a bed to become available or may need to transfer to a facility even further away.
  • Transfers can become complicated by competition between hospitals and economic pressure on the hospital to keep costs low. Unless the transfer is clearly warranted, you may end up in a situation where the transfer is needed, but not granted.
  • If an infant is transferred to another facility, the mother is likely to still be admitted to the original hospital, just having given birth. This creates emotional issues for the parents and makes breastfeeding the baby and bonding impossible.

Last words…

The best way to find out what Level NICU is at your hospital is to call them or know from the obstetrician. There are very few things less stressful than having a baby in the NICU, regardless of what level facility in which they are staying. Learning a little bit about the various levels of intensive care nurseries and which type your baby is in may help make the experience less intimidating and allow you to focus your efforts on your baby’s progress and care.

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