Big Near-Term and Sick Newborns are the Majority of the NICU Admissions

Even though people associate the (NICU) Neonatal Intensive Care Unit with premature babies, near-term babies, the fact is that those babies who are closer to term (40 weeks) are often the ones most frequently admitted.

We get this all the time when I mention my daughter was in the NICU. "Oh, she was a preemie?" "No. She was a Sick Newborn."

Definitions

Near-term infant - a newborn closer to term (40 weeks), often between 34 and 36 weeks or born roughly four or five weeks before his or her estimated due date.

Late preterm infant - Near-term infant

Premature baby - a newborn born before 34 weeks

Sick Newborn - Newborns that are near term or term infants who require Intensive Care intervention for a variety of problems or diseases.

Some near-term or sick newborns experience complications from oxygen deprivation during delivery or wet lungs after a Cesarean section.

Big NICU Babies
According to an article on near-term babies, Dr. Kenneth Herrman, neonatologist and medical director of newborn services at Deaconess Women's Hospital at Riley Hospital for Children in Evansville, IL:

The big babies, closer to term, are the majority, and they stay for the shortest amount of time.

If you would walk through the nursery on any particular day, you would have the impression the NICU is filled with premature babies because they stay a disproportionately longer amount of time.

Our daughter was not a preemie, she was a sick newborn diagnosed with PPHN, or Persistent Pulmonary Hypertension of the Newborn. She required supportive ventilation on a respirator because of high pressure in the lungs and ended up in the NICU.

Combing the Internet for Resources on Sick Newborns
It took me several days after our daughter was hospitalize in the NICU to find online resources for parents of sick newborns since most of the online resources, organizations and online groups are for parents of preemies. This was extremely frustrating for someone used to finding information quickly online.

Thankfully I stumble upon the helpful resources about Sick Newborns written by neonatologist, Dr. Jane E. Brazy and her colleagues at the University of Wisconsin. Over the years, these resources for Sick Newborns are ones that I continue to refer to for my NICU articles. The excellent resources are now being hosted by Meriter Health Services.

Sources
Keeling L. Near-term babies at the NICU suffer from deceptive weakness. June 11, 2007. Evansville Courier & Press.
Rubin R. 'Near-term' unease grows. USA Today. October 9, 2005.
Brazy JE. et. al. Sick Newborn Health. Meriter Health Services.

Image:
Matt & Janet Dustin. All her machines at the NICU. Creative Commons License.

7/29 - Encouraging Message - NICU Parents and Families are True Heros

...a hero is an ordinary individual
who finds the strength
to persevere and endure
in spite of overwhelming obstacles.

They are the real heroes,
and so are the families and friends
who have stood by them.

Christopher Reeve
1952 - 2004

NICU Parents are the Real Heroes
I think anyone who has lived through a NICU experience would agree that NICU Parents and their families are the real heroes. These are ordinary people who have been challenged with an extraordinary event (the sudden NICU hospitalization of a newborn) and yet despite this obstacle, somehow find the courage, the strength and the will to persevere despite the challenge.

Christopher Reeve - Superman, Super Human Being
Anyone who was around in 1978 remembers Christopher Reeve as Superman and the Super Hero.

At least for me, the image of Christopher Reeve as Superman is one that has been etched for me...particularly in light of the tragic riding accident in 1995 that left this talented actor and "Man of Steel" a ventilator-dependent quadriplegic for the last decade of his life.

Christopher Reeve's accident has always been a reminder to me that how life can change in just a flash of a moment, a blink of an eye. Everything is normal one moment and very different the next.

The Full Quote
Here is the text of the full quote and how his definition of hero change with time and with circumstances:

When the first Superman movie came out, I gave dozens of interviews to promote it. The most frequent question was: What is a hero? My answer was that a hero is someone who commits a courageous action without considering the consequences.

Now my definition is completely different. I think a hero is an ordinary individual who finds the strength to persevere and endure in spite of overwhelming obstacles. They are the real heroes, and so are the families and friends who have stood by them.

Rising above Tragedy to Focus on Living
I remember being so amazed at how Christopher and Dana Reeve were both able to quickly rise above their family tragedy and focus on the positive. Their grace and great courage in the face of adversity has always been a source of inspiration for me.

The Christopher and Dana Reeve Foundation is an example of one of the many organizations that has formed as a result of a tragic event and gone on to do so much to help so many.

I think another one of his quotes summarizes how he was able to keep on living despite experiencing such a life changing event:

There will be ups and there will be downs,
there will be times when things make sense,
there will be times when they won't,
but you'll always be on an adventure of meaning
if you live for self, family, and others.

These words of wisdom also apply to anyone facing a challenge. I hope that NICU Parents and families will find them to be as inspirational in facing challenging times and I do.

Other Related Blog Posts:
Dyer KA. Comforting Message - Struggling for Your Dreams. July 23, 2007.
Source:
Christopher and Dana Reeve. About Us. Christopher and Dana Reeve Foundation.

Photo Source: Erica Johnson. Superman Pillow. Royalty Free Use.

New Findings on Preterm Labor Meds: Mothers Receiving Magnesium Sulfate More Likely to have NICU Babies

A recent study due to be published in July’s "Green Journal" (Obstetrics & Gynecology Journal) found that newborns whose mothers had received magnesium sulfate were more likely to be admitted to the NICU than those whose mothers had received the alternative treatment (nifedipine). At this point, the researchers cautioned that the data did not offer a clear explanation for this finding and more research needs to be done to rule out other causes.

Deirdre Lyell, MD, a specialist in high-risk obstetrics at the Lucile S. Packard Children’s Hospital at Stanford, CA led the investigations that compared the use of magnesium sulfate with nifedipine for acute tocolysis of preterm labor.

Definitions

• Preterm labor – labor before 37 weeks of gestation (completed weeks of pregnancy).
• Preterm birth – a baby born before 37 gestation (completed weeks of pregnancy). Also called premature birth.
• Acute Tocolysis – the use of medications to delay or inhibit or stop contractions experienced during preterm labor. The medications relax overactive uterine muscles.

Main Study Findings
The researchers found magnesium sulfate was more effective in preventing delivery for 48 hours by quieting uterine contractions. But there were no significant differences in the ability of these treatments to delay delivery, in the gestational age of the newborn or in the birth weight of the infants. What was significant were the side effects experienced by each of the groups.

Two-thirds of the women on magnesium sulfate experienced mild to severe side effects including shortness of breath and fluid build-up in the lungs during the treatment. Other side effects reported with magnesium sulfate include vomiting, lethargy and blurry vision. By comparison, only one-third of the women on nifedipine experienced side effects which included headaches.

The side effects of magnesium sulfate are long remembered by the women who are on the medications. According to Dr. Lyell, "Women who have had magnesium sulfate remember it; they don't like it. Those who receive nifedipine don't feel as bad."

Take Home Message from Study
According to Dr. Lyell, there were no significant differences in relevant outcomes between the two groups studied.

What was significant, this study found, was the difference in the side effects experienced by the women, some of these were very serious.

You can read about a first hand account from Dr. Kristie McNealy on being in preterm labor and treated with both magnesium and nifedipine at the NICU 101 Blog.

First Hand Account:
McNealy K. June 29, 2007. More Side Effects with Magnesium Sulfate. NICU 101 Blog.

More Info on Preterm Labor and Preterm Birth:
March of Dimes. February 2006. Preterm Labor. Common Complications of Pregnancy. http://www.marchofdimes.com/pnhec/188_1080.asp
March of Dimes. February 2007. Preterm Birth. Quick Reference and Fact Sheet. http://www.marchofdimes.com/professionals/14332_1157.asp
Weissmiller DG. Preterm Labor. American Family Physician. 1999;59(3).
http://www.aafp.org/afp/990201ap/593.html

Sources:
Lyell DJ, Pullen K, Campbell L, Ching S, et. al. Magnesium Sulfate Compared With Nifedipine for Acute Tocolysis of Preterm Labor. Obstetrics & Gynecology. 2007;110:61-67. Abstract online at: http://www.greenjournal.org/cgi/content/abstract/110/1/61
Lucile Packard Children's Hospital. June 28, 2007. Press Release. Common Preterm Labor Drug Has More Side Effects than Alternative, Finds Study from Packard Children's Hospital and Stanford.
http://www.lpch.org/newsEvents/NewsReleases/2007/pretermLaborDrugs.html

Photo Credit: Adam Ciesielski. IV Drip - Intravenous Drug. Royalty Free Use.

What are the NICU Levels of Care?

It is likely if my youngest daughter had been born even 10 years earlier than she was, or born in a more rural setting that she would not be with us here today because she may not have gotten the treatment that she needed to support her heart and lungs (cardio-respiratory system) during the first few critical hours of life.

In our case, she was born at a hospital with a Level 3 standing for their Neonatal Intensive Care unit. In order to get from basic newborn care (Level 1) to the more highly skilled care unit they moved her from one room in the hospital to another.

Ultimately she ended up needing even more specialized care and was transferred to the regional Level 4 NICU that had the potential to deliver the highest level of sick newborn care.

Levels of Neonatal Care Units
The levels of care are used as a method of designating the care provided by hospitals for newborn infants. It is based according to the complexity of care provided, ranging from basic care or level one to the most complex care

• Level I - Basic Neonatal Care The minimum required for any facility that provides inpatient maternity care. The hospital must have the necessary personnel and equipment to

• Perform neonatal resuscitation
• Evaluate healthy newborn infants
• Provide postnatal care
• Stabilize ill newborn infants until transfer to a facility that provides intensive care.

• Level II - Specialty Care Nurseries In addition to providing all of the basic care listed above, Special Care Nurseries can

• Provide care to infants who are moderately ill with problems that are expected to resolve rapidly
• Provide care to infants who are recovering from serious illness treated in a level III (subspecialty) NICU.

• Level III - Subspecialty NICU's Care for newborn infants with extreme prematurity or who are critically ill or require surgical intervention.

• Level IV - Regional Subspecialty NICU's (Level IV is a designation about the Level II, only found in a limited number of the states).The Level IV NICU's are often found in regional academic medical centers and can provide the most complex level of neonatal care including
  
• Advance diagnoses
• Treatment of fetuses, preemies and newborns with complicated conditions.
  

Source:
Committee on Fetus and Newborn. Levels of Neonatal Care. Pediatrics. 2004. 114;5:1341-1347. Available online at: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;114/5/1341

What's in a Name? NICU, NNICU, ICN, SNCN, SBCU, SCN, PICU

NICU, NNICU, ICN, SNCN, SBCU, SCN, PICU - What term do I use?

There are a variety of different terms used to describe the hospital care for newborns, sick newborns and premature infants (preemies).

Which term is used often depends on the age of the newborn or child, country of origin and the level of care provided being.

The following list is a list of the various different abbreviations I was able to find.

• ICN - Intensive Care Nursery, (neonatal) Intermediate Care Nursery
  

• NICU - Neonatal Intensive Care Unit
  


• NNICU - Neonatal Intensive Care Unit (UK)
  

• NNU - Neonatal Unit (UK)
  

• PICU - Pediatric Intensive Care Unit
  

• SBCU - Special Care Baby Unit (UK)
  

• SCN - Special Care Nursery (Canada)
  

• SNCN - Sick Newborn Care Unit (India)
  

If you know of others, let us know.




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