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Neonatal intensive care unit
A neonatal intensive care unit, also called
a newborn intensive care unit or NICU, is a unit of a hospital
specializing in the care of ill or premature newborn infants.
NICUs were developed in the 1950s and 1960s
by pediatricians to provide better temperature support, isolation
from infection risk, specialized feeding, and access to specialized
equipment and resources. Infants are cared for in incubators
or "open warmers." Nearly all are attached to various
types of monitors. Some require respiratory support ranging
from extra oxygen (by head hood or nasal cannula) to continuous
positive airway pressure (CPAP) or mechanical ventilation. Public
access is limited, and staff and visitors are required to wear
gowns, gloves, and/or masks to reduce infection transmission.
Nearly all children's hospitals have NICUs, but they can be
found in large general hospitals as well.
A NICU is typically directed by one or more
neonatologists and staffed by nurses, nurse practitioners, resident
physicians, and respiratory therapists. Many other ancillary
services are necessary for a top-level NICU. Other physicians,
especially those with "organ-defined" specialties
often assist in the care of these infants.
Besides prematurity and extreme low birth weight,
common diseases cared for in a NICU include perinatal asphyxia,
major birth defects, sepsis, neonatal jaundice, and respiratory
distress syndrome due to immaturity of the lungs. Complications
of extreme prematurity may include intracranial hemorrhage,
chronic bronchopulmonary dysplasia (see Infant respiratory distress
syndrome), or retinopathy of prematurity. An infant may spend
a day of observation in a NICU or may spend many months there.
Neonatology and NICUs have greatly increased
the survival of very low birth weight and extremely premature
infants. In the era before NICUs, infants of birth weight less
than 1400 grams (3 lbs, usually about 30 weeks gestation) rarely
survived. Today, infants of 500 grams at 26 weeks have a fair
chance of survival.
The NICU environment provides challenges as
well as benefits. Stressors for the infants can include continual
light, a high level of noise, separation from their mothers,
reduced physical contact, painful procedures, and interference
with the opportunity to breastfeed. A NICU can be stressful
for the staff as well. A special aspect of NICU stress for both
parents and staff is that infants may survive, but with damage
to the brain or eyes.
NICU rotations are essential aspects of pediatric
and obstetric residency programs, but NICU experience is encouraged
by other specialty residencies, such as family practice, surgery,
and emergency medicine.