What makes a NICU a NICU? In the very simplest terms, its ability to meet the complex care needs of extremely pre-mature, extremely low birth weight, or extremely ill newborns.
NICU stands for Neonatal Intensive Care Unit. These units provide the highest level of care available for severely ill or premature newborns, as designated by the Washington State Department of Health.
In neonatal care, the levels of care are rated I – III, with level III being the highest. While all level III units are referred to as NICUs, in our state, the Department of Health currently designates two subcategories within this level, level IIIA and level IIIB. These subcategories distinguish the degrees of medical complexity and risk a unit has the ability to treat in the newborns it cares for.
Generally speaking, newborn infants who weigh at least 1,000 grams (about 2 pounds) at birth and have a gestational age (number of weeks in the mother’s womb) of at least 28 weeks — but are otherwise mostly healthy — can be cared for in level IIIA NICUs. These facilities have the capability to perform minor surgeries and can provide conventional mechanical ventilation for as long as needed.
Newborns who are extremely premature, (28 weeks' gestation or less), have an extremely low birth weight (1,000 grams or less), or who have severe and/or complex illnesses at birth, however, have specialized needs that can only be addressed in a level IIIB NICU. A level IIIB NICU offers 24/7 access to a broad range of pediatric medical subspecialists and pediatric surgical specialists, highly skilled nursing and respiratory care staff, advanced respiratory support and monitoring equipment, laboratory and imaging facilities, nutrition and pharmacy support with pediatric expertise, social services, and other support services for these fragile babies and their families.
The only level IIIB NICU in the South Sound region — and only one of a small handful in the state — is the Neonatal Intensive Care Unit at MultiCare Tacoma General Hospital. That means it has the following capabilities:
- A dedicated, specially trained NICU team led by board-certified neonatologists (doctors who specialize in caring for premature or ill newborns) who remain in the hospital around the clock to provide state-of-the-art medical care and can respond immediately to these babies’ often rapidly changes conditions.
- An on-call team of pediatric surgical specialists that can address the most complex surgical needs of these newborns, including intestinal, urologic, cardiac, orthopedic and neurosurgical problems.
- Onsite access to advanced equipment and treatments, such as Extracorporeal Membrane Oxygenation (ECMO), an advanced technology that functions as a replacement for a critically ill infant’s heart and lungs.
- A specialized NICU transport team available 24/7 to provide support newborns that need to be transferred from other hospitals in the surrounding area that do not offer the necessary level of care.
Of course, with the exception of women who are experiencing high-risk pregnancies, few mothers-to-be know in advance if their baby is going to need NICU-level care after birth. However, it can be reassuring to families to know that this level of care is in close proximity to the location of birth, if the unexpected were to happen.
Ray Sato, MD, is a board-certified neonatologist with Peditrix Medical Group of Washington, and is part of the dedicated team of neonatologists that staff Tacoma General’s NICU 24 hours a day, seven days a week, 365 days a year.
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