Newborns - High
Neonatology refers to the care of newborn infants due to
premature birth, low birth weight, birth defects, heart trouble, lung problems,
or other life-threatening conditions. University of Iowa Children’s Hospital
is home to Iowa's Level IV NICU—the highest level recognized by the American
Academy of Pediatrics. This means that our NICU is equipped to care for the
tiniest and most critically ill babies, offering the greatest range of neonatal
services and support. In fact, we care for more babies, and more complex
conditions, than any other NICU in Iowa.
Our survival rates for babies
born at 23, 24, and 25 weeks are significantly higher than survival rates for
extremely premature infants born at other U.S. hospitals, placing UI Children’s
Hospital among the top neonatal intensive care providers anywhere.
Few parents consider the possibility that their baby might need
special medical care after birth. Even fewer think about which neonatal
intensive care unit (NICU) might care for their baby.
One out of nine
mothers do not carry to full term (37 or more weeks), and roughly 100,000
babies end up in an NICU each year. We hope that your pregnancy and delivery go
smoothly, but if the unexpected should occur, here are 15 facts you
need to consider:
indicates you can expect better results in NICUs that treat larger numbers of
babies because they have the experience, equipment, research, and processes to
assure the best care possible.
- The NICU at UI Children's Hospital
is Iowa's largest, caring for 800 babies on average each year.
the NICU was established in 1974, we have cared for approximately 30,000
premature or sick babies.
Ask your hospital for
their NICU outcomes data over the past several years showing survival
statistics, including gestational age.
- The survival rate among all
babies cared for in the UI Children's Hospital NICU is more than 95%, which
ranks among the best of any NICU in the country.
- Our survival rates
for babies born at 23, 24, and 25 weeks are significantly higher than survival
rates for extremely premature infants born at other U.S. hospitals (averaged
from 2006 through 2012):
- at 23 weeks = 68%
- at 24 weeks =
- at 25 weeks = 91%
NICU should have trained pediatric specialists in-house to respond immediately
to your baby's needs.
- The NICU at UI Children's Hospital has 13
board-certified neonatologists with 249 years of combined experience, the
largest and most highly trained NICU team in Iowa.
- UI Children's
Hospital is the only hospital in Iowa nationally ranked by U.S. News &
World Report for pediatric care, and every possible pediatric specialty is
- Care providers are present in the UI Children's
Hospital NICU at all times to address any questions parents may have about the
care of their baby.
A neonatologist is a pediatrician with additional
training in newborn intensive care, and is an expert in the care of critically
ill infants. However, babies in the NICU need advanced care provided by a team
of pediatric experts.
- UI Children's Hospital uses an NICU
multidisciplinary care team to insure the most rapid progress and favorable
outcomes for the infants in its care.
- The team members who work
closely with our neonatologists have ready information to analyze the full
scope of a baby's medical and developmental progress and act on it
appropriately. Those team members, all trained in the specific needs of
infants, include nurses, respiratory therapists, nutritionists, social workers,
pharmacists, lab technicians, and physical therapists.
- As part of
Iowa's only comprehensive children's hospital, our NICU has immediate access to
the expertise of every possible pediatric specialist 24 hours a day.
Our neonatologists work closely
with obstetricians in offering prenatal consultation and attend all high-risk
deliveries. UI Hospitals and Clinics is home to 6 high-risk OBs.
- Moms who deliver their babies at UI Hospitals and Clinics have peace of
mind knowing that NICU care is literally down the hall. No matter what,
families stay together under one roof and never need to be transferred to
another hospital for more advanced care.
- 65% of babies cared for in
our NICU were delivered here, while 35% are transferred from other hospitals in
Iowa and nearby states.
All NICUs care for babies who need special help, but
different NICUs offer different levels of care. The first hour of life is often
called "the golden hour," because it's so important to a baby's future. The
level of care that a baby receives in the first hour of life will determine how
that baby does for the rest of its life. There are many studies that show that
babies born at the highest level center have a much better outcome. If you're
going to have a premature baby, you want to have that baby at the highest level
center available. UI Children's Hospital is Iowa's Level 4 NICU – the highest
- Level 1: Level 1 nurseries care for healthy,
full-term babies. They are able to stabilize babies born near term to get them
ready to transfer to facilities that offer special care.
- Level 2:
Level 2 NICUs (special care nursery) can care for babies born around 32 weeks
gestational age or greater and for full-term babies who need close monitoring
or IV antibiotics after birth. Special care nurseries can treat babies with
some health problems of prematurity, such as jaundice and trouble eating or
- Level 3: Level 3 NICUs can provide intensive care for
babies born at all gestational ages. The definition of a Level 3 NICU may vary
in different states or hospitals, but all Level 3 NICUs can care for babies
born at more than 28 weeks, can provide respiratory support for babies who are
having trouble breathing, and can deliver IV fluids to babies who cannot take
- Level 4: A level 4 NICU is an intensive care unit that
can care for babies as young as 22 to 24 weeks gestational age. Level 4 NICUs
can provide sophisticated types of respiratory support for very sick babies,
and offer a wide variety of neonatal surgeries.
Close monitoring of blood
gases and other tests that require frequent collection of small samples of the
baby's blood often can be decreased or obtained less frequently, depending on
the baby's risk factors and condition. Less frequent testing means less stress
and more uninterrupted sleep for the baby.
- The NICU team at UI
Children's Hospital is constantly developing and refining guidelines to limit
blood sampling and the amount of blood needed for each test.
- The UI
Children's Hospital NICU has a laboratory in the NICU that allows blood gases
to be tested quickly. A small baby has lungs that are very fragile, so it's
critical to be able to make changes immediately.
Make sure that pediatric nutritionists are part of
the NICU care team and that their practice reflects the latest understanding of
- The NICU care team at UI Children's Hospital
includes nutritionists who specialize in the nutritional needs of infants. They
advocate for the best nutritional resources for your infant, which includes
breast milk. Our doctors have been leaders in the field of infant nutrition for
over 75 years.
- Breast milk is by far the best nutrition for premature
babies. Because of that, we have a milk bank at the University of Iowa, the
only milk bank in Iowa, and provide milk to some of the other NICUs in the
state. Breast milk has been shown to increase the IQ of babies, and their
ultimate neurologic outcome. It's been shown to decrease the risk of a very
serious bowel infection.
- Doctors who specialize in the pediatric
digestive system are available to be sure that nutrition is optimized for an
infant's specific condition.
Asking the right questions is critical: Are all the
latest respiratory therapies available? Are infants in the care of respiratory
therapists who specialize in the treatment of infants?
- The UI
Children's Hospital NICU is equipped with high-frequency ventilation, nitric
oxide, and extracorporeal membrane oxygenation (ECMO). These therapies aren't
available in every NICU, 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 will be
needed for critically ill, full-term babies. In addition, high-frequency
ventilation reduces the risks of ventilator-induced lung injury in small
- Neonatologists and specially trained respiratory
therapists at UI Children's Hospital are at the forefront of these leading
infant breathing therapies. They are actively engaged in teaching other doctors
and therapists around the world in perfecting these techniques.
Research shows that the littlest patients do better
when noise is minimized and direct light is reduced. Every NICU patient at UI
Children's Hospital is cared for in a private room, which allows for complete
control of lighting and noise exposure.
A long-term NICU stay can
be difficult for parents and families. Counseling and other social support
services should be readily available.
- At UI Children's Hospital we
care for families, as well as babies. Our services for parents and siblings
include counseling, peer support groups, a resource library, and on-line
information tailored to a family's needs.
- We promote family-centered
care, inviting parents to participate in the care of their baby and allowing
family visitation, including siblings, around the clock
The presence of families is extremely important.
Babies know their parents. It's important that moms and dads can touch, talk
to, and read to their baby.
- UI Children's Hospital offers parents
the opportunity to stay in a patient guest house within the hospital that are
close, quite, and comfortable.
- Also, within walking distance of the
hospital, families can use the comfortable, inexpensive accommodations provided
by the Iowa City Ronald McDonald House.
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 UI Children's
Hospital NICU is involved in cutting-edge 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
and to develop and test other new treatments that offer benefit for our
- The most advanced care is available in hospitals that are
affiliated with medical schools (also known as an academic medical center),
such as UI Children's Hospital. Our doctors are involved in the research that
leads to improved methods of care, so the newest cutting-edge treatments are
available first in University NICUs.
- Neonatologists at academic
medical centers write textbooks and provide both the initial training and
continuing education of other neonatologists.
A NICU should involve your local
pediatrician or family physician in planning for your baby's discharge. Parents
should also receive thorough training and an explanation of what to expect at
- The UI Children's Hospital team works closely with the
family's local doctor to see that any remaining medical concerns are
- UI Children's Hospital specialty trained nurses, ca
- lled discharge planners, provide education to the parents of all NICU
infants. We know that training makes a big difference in a family's ability to
cope with the demands of a fragile infant. After discharge, we also call every
family to ensure the transition from hospital to home has gone smoothly.
Members of the NICU team should be involved in the
developmental follow up of NICU graduates well beyond the first months at
- UI Children's Hospital NICU graduates are enrolled in the
Iowa High-Risk Infant Follow-Up Program, a series of periodic examinations
during the first several years of life to monitor the child's growth and
- Our most fragile infants are followed in our clinic by a
neonatologist of the family's choice and a nurse practitioner.
- We also
have a Continuity-of-Care team that works to coordinate medical care after
discharge, if necessary.
- In addition, UI Children's Hospital team
members work closely with the child's local doctor to see that any remaining
medical concerns are addressed.
Tundi was having a normal pregnancy - until she went into
labor at only 20 weeks.
Noelle was born eight weeks before her due date and
12 weeks after her mother's water first broke.
Sarah appeared to be having a normal pregnancy.
Then, at 26 weeks, she woke with the telltale signs of preeclampsia.
born four weeks early and needed specialized pediatric surgery immediately.
A routine ultrasound at 20
weeks brought alarming news for Brynn’s parents.
Halfway through Sarah
Tillberg’s pregnancy, it became clear something was seriously wrong.
Born 15 weeks
premature, twins Ty and Lindsay were fighters from the very beginning.
Mason spent his first
10 weeks receiving life-saving care in the NICU.
A routine ultrasound at
week 10 of Andrea's pregnancy brought startling news:
When prenatal tests
showed that Julie’s unborn baby was hydrocephalic, the NICU team began to plan
for Jack’s birth.
Weighing only 1 pound, 1 ounce at birth, Alexis was
not much bigger than a block of butter.
Parents of NICU graduates offer their words of wisdom to