15 Questions You Should Ask about Neonatal Intensive Care Units
Few parents consider the possibility that their baby might be premature or 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 important questions to ask:
1. How many babies are cared for in the NICU each year?
Research 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.
- UI Children's Hospital is home to Iowa's largest NICU, with 69 beds, caring for 800 babies on average each year.
- Since the NICU was established in 1974, we have cared for approximately 30,000 premature or sick babies.
2. Does the hospital provide you with outcomes and statistics?
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 babies born at other U.S. hospitals (averaged from 2006 through 2013):
- at 23 weeks = 71%
- at 24 weeks = 86%
- at 25 weeks = 90%
- at 26 weeks = 90%
- at 27 weeks = 97%
3. Are pediatric experts available in the NICU 24 hours a day?
A NICU should have trained pediatric medical and surgical 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 available 24/7.
- 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.
4. Does the NICU have a team of specially trained experts?
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.
5. Does the hospital have a high-risk OB team?
Our neonatologists work closely with obstetricians in offering prenatal consultation and attend all high-risk deliveries. UI Hospitals and Clinics is home to eight maternal fetal medicine physicians who specialize in the care and management of high-risk pregnancies.
- Moms who deliver their babies at UI Hospitals and Clinics have peace of mind knowing that NICU care is literally across 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.
6. Do all NICUs have the same capabilities?
All NICUs care for babies who need special help, but different NICUs offer different levels of care. The first hour of life for a very low birth weight baby is often called "the golden hour," because it's so important to a premature 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 home to a Level IV NICU – the highest designation possible, according to standards specified by the American Academy of Pediatrics.
7. Are the appropriate programs in place to eliminate unnecessary tests?
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.
- Children's Hospital 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.
8. How are the nutritional needs of babies in the NICU met?
Make sure that pediatric nutritionists are part of the NICU care team and that their practice reflects the latest understanding of infant nutrition.
- 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.
9. How are breathing (respiratory) problems managed?
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 premature babies
- 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.
10. What is the environment in the NICU like?
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. Twins or triplets may share a room.
11. Are resources available to support parents?
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
12. Are overnight stays for parents welcome and convenient?
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.
13. Is the NICU actively involved in research and education?
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 patients.
- 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.
14. How do families prepare to go home?
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 home.
- The UI Children's Hospital team works closely with the family's local doctor to see that any remaining medical concerns are addressed.
- UI Children's Hospital specialty trained nurses, called 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.
15. Is there a plan in place for regular follow-up care?
Members of the NICU team should be involved in the developmental follow up of NICU graduates well beyond the first months at home.
- 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 development.
- 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.