Neonatal intensive care units (NICU) care for the tiniest patient population – newborn babies who are born prematurely or with other serious medical complications.
“Some of the most difficult decisions regarding life and death are made in the NICU,” says Craig Anderson, D.O., a neonatologist with Ascension St. John Medical Center in Tulsa.
Anderson explains that while there are heroic celebrations for families and staff when a once medically critical newborn is able to go home, there are also times of overwhelming emotion with a dying child and grieving family.
“Some newborns are delivered at the threshold of viability and in spite of all the technology and interventions, some cannot be saved,” he says. “There is also a population of newborns born with unsurvivable anomalies, lethal genetic disorders, and morbidities due to maternal complications that also cannot survive. We have a palliative care team to address these situations and assist the parents in the grieving process.”
To manage the healthcare of such small patients who are unable to communicate verbally, Anderson says they “rely on invasive and non-invasive monitoring as well as laboratory results and physical assessments to determine and treat the clinical diagnosis.”
He also shares that the NICU staff are always ready for an emergent case with a team of neonatologists, neonatal nurse practitioners, registered nurses and registered respiratory therapists on standby to attend high risk deliveries.
“These complex and critical deliveries are not always planned nor anticipated, so highly skilled caregivers are ready to intervene at any time 24 hours a day,” he says. “Many of these complicated deliveries lead to critical newborns requiring continuous care and monitoring in the NICU. Procedures performed on these tiny and often critical newborns require intense precision and accuracy.”
According to Anderson, more than 75% of all admissions to the NICU are for newborns with respiratory distress, and while there’s many health issues newborns can face, he says some of the most common conditions are as follows.
“Transient tachypnea of the newborn (TTN) is more common in near term babies born to mothers who were not in natural labor but rather induced or delivered for another serious medical condition,” he says. “The fetal lungs are naturally full of fluid and the clearance of this fluid after birth is compromised leading to respiratory distress. This naturally resolves in two to five days. Respiratory distress syndrome (RDS), also known as hyaline membrane disease (HMD), is commonly seen in babies born premature – less than 37 weeks – due to the deficiency of a natural substance produced in the human lung called surfactant. Fortunately, there are prenatal and postnatal interventions that can successfully prevent and treat this common disorder.”
In addition, he says there are a group of congenital anomalies that compromise a newborn’s breathing.
“Cysts, solid masses, displaced intestinal contents, cardiac and abnormal airway disorders make up a long list of possible abnormalities that may occur,” says Anderson. “Fortunately, prenatal ultrasounds can diagnose the majority of these abnormalities and provide the neonatal team with information necessary to provide the proper intervention after birth for the best possible outcome. Pediatric surgery is often required for many of these airway and lung abnormalities and therefore we have a surgical team on call 24 hours a day to assist in the care.”
He also notes that while having a wealth of medical information readily available online can be beneficial for family members, it can also cause difficulties if the information is incomplete or misunderstood. It’s important to know that neonatologists and neonatal nurse practitioners obtain years of medical training to be experts within their field and all team members are working together to provide each patient with excellent care.
