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Home  Healthcare Articles  Neonatal intensive care unit

   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.

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