A Newborn ICU

• The
Department of
Neonatology /
Newborn
Services
specializes in
taking care of
infants for the
first 28 days of
life.
Neonatal Intensive Care Units

◆ Understand how an NICU works

◆ What is the patient population in the NICU

?
◆ Who are the clinical care givers ?

◆ Who are the key decision makers ?

◆ What are some key questions to ask ?

Neonatal Intensive Care Unit

◆NICU - Patient Population

– premature babies (25 to 35 weeks)
– critically ill infants (Full Term)
– babies that are 28 days or less of life
– beds vary from 10 to 40 bed ICU’s
Types of Neonatal Intensive
Care Unit’s
◆ Nursery’s are defined by the level of care
that they provide and licensed
◆ NICU’s are defined by:

– Level II - Short Term Ventilation

◆can vary with region
– Level III - Long Term Ventilation
 Newborn Intensive Care Units
Where Babies Are Ventilated
◆ Level II nursery - less sophisticated
– oxygen administration
– short term ventilation (24-48 hours)
– nasal CPAP treatment
– babies not as sick
◆ Level III nursery - experts in neonatal
ventilation
– short and long-term ventilation
– high frequency ventilation
– inhaled nitric oxide
– Provide or transport to ECMO facility
– surgery
*
Equipment in the NICU
• A neonatal intensive care unit (NICU)
can be a confusing place with lots of
complicated-looking
• electronics,
• wires,
• tubes,
• strange noises,
• beeps, alarms, buzzers,
• flashing lights,
• pressure hoses,
that are confusing to visitors and
parents.
NICU - Bedside

Typically Close Quartered

Neonatologist Completing
Patient Rounds

High Caregiver / Patient Ratios

High Acuity (critical) Patient
• Here is a sampler of the equipment that
is commonly seen in an NICU.
Radiant warmers
• Radiant warmers are used
when a baby is very
unstable or extremely
premature.
• Small babies have a large
surface area compared to
their volume, and little body
fat, and cannot maintain
their own temperature.
• The overhead arm contains
electric heating elements
that are directed down
toward the infant.
Incubator
• When a baby is
relatively stable but
still premature or
requiring intravenous
fluids or other special
attention, he or she
is cared for in an
"incubator."
• The incubator keeps
the baby warm with
moistened air in a
clean environment,
and helps to protect
the baby from noise,
drafts, infection, and
excess handling.
scale • The scale is one of the most
important pieces of equipment in
the NICU. Every feeding, IV
solution, and medication is
calculated and based on the
baby's weight, and it's critically
important that the weight be
accurate. It's part of the morning
ritual in every NICU to weigh
each baby at the same time and
in the same way each day, and
then chart the weight on the
baby's flow sheet.
 • A physiologic monitor,
Monitor sometimes called a
cardiorespiratory monitor, is
attached to sensors on the baby
and provides a constant read-
out of the baby's heart rate and
rhythm, breathing rate, arterial
or central venous pressure, and
other useful information. Alarms
can be configured to provide an
alert when any of the vital signs
being monitored goes above or
below a certain limit.
Pulse Oximeter
• The pulse oximeter,
monitors the oxygen
saturation of the baby's
blood. It does this by
shining light through the
baby's skin and
measuring the color of
the light that is
transmitted.
Mechanical Ventilation
Infant Ventilators
• There are many
different types and
brands of
ventilators in use in
NICUs; the one
shown here, the
Sechrist 100B, was
popular in the
1980's and is still in
common use today.
• Recent models of
infant ventilators are
heavily computerized
and support diverse
modes of operation,
including "assist
control."
• Some models can
provide real-time data
on the baby's
pulmonary function.
 • An "oscillator," or "high
High frequency
frequency
oscillatory ventilator
oscillatory
(HFOV)
ventilator" (HFOV), is a new
type of ventilator that came
into use in the 1990's. The
equipment shown here is the
Sensor-Medics 1000A, a
popular brand. Unlike
traditional ventilators, which
essentially inflate and deflate
the baby's lungs like a set of
billows, the oscillator keeps
the lungs open with a
constant positive end-
expiratory pressure ("PEEP")
and vibrates the air at a very
high rate (up to 600 times per
• The vibration helps gases to quickly
diffuse in and out of the baby's airways
without the need for the "bellows"
action which may damage delicate lung
structures.
• Although oscillators are not
appropriate for every disorder and
situation, there is no doubt that
because of their incredible power,
oscillators have made it easier to care
for the very sickest babies with certain
types of lung problems.
 Neonatal ECMO
Started In The Late 70’s
◆ Extracorporeal
membrane oxygenation
– can be $ 5,000.00 per
day to run
◆ Form of
cardiopulmonary bypass
support
◆ Patients with reversible
respiratory and/or
cardiac failure
◆ Patients that demonstrate
at least an 80% percent
predicted mortality
*
 Inhaled Nitric Oxide
◆ Cost of drug
– $3,000 per day

◆ Easy to use and

administer
◆ INO Vent - Doses
and monitors NO
◆ Works with most
ventilators

*
IV Pumps, or Infusion Pumps
• IV pumps, or infusion pumps,
are a crucial item of equipment
in an NICU. Most sick babies
have one or more intravenous
(IV) or arterial lines, and the fluid
that is delivered through those
lines must be very carefully
regulated, all the way down to
the amount of 0.1 cc per hour.
There are many brands, sizes,
and shapes of IV pumps; the
pump shown here is called an
IVAC.
Blood gas • A blood gas machine
analyzer analyzes a sample of the
baby's blood, usually
obtained from an arterial
catheter or from a
"heelstick," and reports the
pH and the level of oxygen
and carbon dioxide. It also
calculates values for the
bicarbonate level, oxygen
saturation, base deficit,
and so on."
• These values are then used by the
neonatologist, nurse practitioner, or
respiratory therapist to adjust the
setting of the ventilator and the oxygen
blender.
• It was not practical to do blood gas
tests on babies until the 1970's, when
simple techniques for umbilical arterial
catheterization were developed and
blood gas machines appeared that
could perform tests on "micro-samples
VIEWER
Chest X-Ray
• X-rays are RDS / Infiltrates
clipped onto the
front of the light
box and can then
be viewed and
interpreted by
transmitted light.
• A transport incubator is
used when a sick or
premature baby is moved
from one hospital to another
• In fact, a transport incubator
is like a little self-contained
intensive care unit on
wheels.
• It usually has a
 Miniature ventilator
 Cardio-respiratory monitor
 IV pump,
 pulse oximeter, and
oxygen supply built right into
its frame.
• A defibrillator is used to
"shock" the heart from an
abnormal rhythm pattern back
into a normal rhythm.
• Every neonatal ICU has one
of these devices, but they are
rarely used there.
• Abnormal heart rhythms are
quite unusual in babies, even
those babies with several
cardiac abnormalities .
• Arrhythmias are more typical
of aged patients with damaged
heart muscle or conduction
pathways.