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re related changes upload file permanent link page information cite this page get shortened url switch to legacy parser print export download as pdf printable version in other projects wikimedia commons wikidata item appearance move to sidebar hide from wikipedia the free encyclopedia intensive care for newborn infants nicu redirects here for other uses see nicu disambiguation not to be confused with neurological intensive care unit medical intervention neonatal intensive care unit a premature infant in an incubator 1978 us specialty neonatology a neonatal intensive care unit nicu a k a an intensive care nursery icn is an intensive care unit icu specializing in the care of ill or premature newborn infants the nicu is divided into several areas including a critical care area for babies who require close monitoring and intervention an intermediate care area for infants who are stable but still require specialized care and a step down unit where babies who are ready to leave the hospital can receive additional care before being discharged 1 neonatal refers to the first 28 days of life neonatal care including specialized nurseries or intensive care has been around since the 1960s 2 the first american newborn intensive care unit designed by louis gluck was opened in october 1960 at yale new haven hospital 3 an nicu is typically directed by one or more neonatologists and staffed by resident physicians nurses 4 nurse practitioners pharmacists physician assistants respiratory therapists and dietitians many other ancillary disciplines and specialists are available at larger units the term neonatal comes from neo new and natal pertaining to birth or origin 5 roles and tasks edit a neonatal nurse practitioner is a registered nurse who has been specially trained to help with the care of a newborn a dietitian helps ensure the baby gets enough nutrients for healthy growth a respiratory therapist helps with managing oxygen and ventilators breathing machines a physical or occupational therapist watches the baby s development 6 nursing and neonatal populations edit a pediatric nurse checking recently born triplets in an incubator at ecwa evangel hospital jos nigeria healthcare institutions have varying entry level requirements for neonatal nurses neonatal nurses are registered nurses rns and therefore must have an associate of science in nursing asn or bachelor of science in nursing bsn degree some countries or institutions may also require a midwifery qualification 7 some institutions may accept newly graduated rns having passed the nclex exam others may require additional experience working in adult health or medical surgical nursing 8 some countries offer postgraduate degrees in neonatal nursing such as the master of science in nursing msn and various doctorates a nurse practitioner may be required to hold a postgraduate degree 7 the national association of neonatal nurses recommends two years experience working in a nicu before taking graduate classes 8 as with any registered nurse local licensing or certifying bodies as well as employers may set requirements for continuing education 8 there are no mandated requirements to becoming an rn in an nicu although neonatal nurses must have certification as a neonatal resuscitation provider some units prefer new graduates who do not have experience in other units so they may be trained in the specialty exclusively while others prefer nurses with more experience intensive care nurses undergo intensive didactic and clinical orientation in addition to their general nursing knowledge in order to provide highly specialized care for critical patients their competencies include the administration of high risk medications management of high acuity patients requiring ventilator support surgical care resuscitation advanced interventions such as extracorporeal membrane oxygenation or hypothermia therapy for neonatal encephalopathy procedures as well as chronic care management or lower acuity cares associated with premature infants such as feeding intolerance phototherapy or administering antibiotics nicu rns undergo annual skills tests and are subject to additional training to maintain contemporary practice citation needed history edit the problem of premature and congenitally ill infants is not a new one as early as the 17th and 18th centuries there were scholarly papers published that attempted to share knowledge of interventions 9 10 11 it was not until 1922 however that hospitals started grouping the newborn infants into one area now called the neonatal intensive care unit nicu 12 stéphane tarnier before the industrial revolution premature and ill infants were born and cared for at home and either lived or died without medical intervention 13 in the mid nineteenth century the infant incubator was first developed based on the incubators used for chicken eggs 14 stephane tarnier is generally considered to be the father of the incubator or isolette as it is now known having developed it in 1880 to attempt to keep premature infants in a paris maternity ward warm 13 other methods had been used before but this was the first closed model in addition he helped convince other physicians that the treatment helped premature infants france became a forerunner in assisting premature infants in part due to its concerns about a falling birth rate 13 after tarnier retired pierre budin followed in his footsteps noting the limitations of infants in incubators and the importance of breastmilk and the mother s attachment to the child 15 budin is known as the father of modern perinatology and his seminal work the nursling le nourisson in french became the first major publication to deal with the care of the neonate 16 the incubator was improved in 1890 in marseilles by alexandre lion who founded in 1891 the œuvre maternelle des couveuses d enfants in nice and in january 1896 in paris 17 18 19 another factor that contributed to the development of modern neonatology was martin couney and his permanent installment of premature babies in incubators at coney island a more controversial figure he studied under budin and brought attention to premature babies and their plight through his display of infants as sideshow attractions at coney island and the world s fair in new york and chicago in 1933 and 1939 respectively 14 infants had also previously been displayed in incubators at the 1897 1898 1901 and 1904 world fairs 20 early years edit children s hospital at the oskar ziethen hospital berlin in 1989 doctors took an increasing role in childbirth from the eighteenth century onward however the care of newborn babies sick or well remained largely in the hands of mothers and midwives some baby incubators similar to those used for hatching chicks were devised in the late nineteenth century in the united states these were shown at commercial exhibitions complete with babies inside until 1931 robert bauer at henry ford hospital in detroit michigan successfully combined oxygen heat humidity ease of accessibility and ease of nursing care in 1931 21 it was not until after the second world war that special care baby units scbus pronounced scaboos were established in many hospitals in britain early scbus opened in birmingham and bristol the latter set up with only 100 in 1946 pediatrician beryl corner established a special care baby unit at southmead hospital in bristol which became a model for other units in the united kingdom 22 incubators were expensive so the whole room was often kept warm instead cross infection between babies was greatly feared strict nursing routines involved staff wearing gowns and masks constant hand washing and minimal handling of babies parents were sometimes allowed to watch through the windows of the unit much was learned about feeding frequent tiny feeds seemed best and breathing by the mid 1950 s high concentrations of supplemental oxygen had been identified as a cause of retinopathy of prematurity then known as retrolental fibroplasia which could result in blindness 23 the 1960s were a time of rapid medical advances particularly in respiratory support that were at last making the survival of premature newborn babies a reality very few babies born before thirty two weeks survived and those who did often had neurological impairments herbert barrie in london pioneered advances in resuscitation of the newborn barrie published his seminal paper on the subject in the lancet in 1963 24 one of the concerns at this time was the worry that using high pressures of oxygen could be damaging to newborn lungs barrie developed an underwater safety valve in the oxygen circuit the tubes were originally made of rubber but these had the potential to irritate sensitive newborn tracheas barrie switched to plastic this new endotracheal tube based on barrie s design was known as the st thomas s tube 25 in 1964 pediatric radiologist william northway while conversing with neonatologist philip sunshine at noted a consistent pattern of cystic changes in the lungs on the radiographs of premature babies northway found that all of the babies had received high concentrations of oxygen and mechanical ventilation causing damage his 1967 paper in which the term bronchopulmonary dysplasia was coined described the disease and comorbidities this led to worldwide reductions in supplemental oxygen levels and ventilation pressure improving the health outcomes of premature infants the paper has been called one of the most important most cited and influential articles in the history of neonatology 26 27 in 1980 fujiwara and colleagues reported the first successful use of surfactant replacement therapy to treat neonatal respiratory distress syndrome 28 increasing technology edit neonatal intensive care unit from 1980 by the 1970s nicus were an established part of hospitals in the developed world in britain some early units ran community programs sending experienced nurses to help care for premature babies at home but increasingly technological monitoring and therapy meant special care for babies became hospital based by the 1980s over 90 of births took place in hospitals the emergency dash from home to the nicu with the baby in a transport incubator had become a thing of the past though transport incubators were still needed specialist equipment and expertise were not available at every hospital and strong arguments were made for large centralized nicus on the downside was the long traveling time for frail babies and parents a 1979 study showed that 20 of babies in nicus for up to a week were never visited by either parent centralized or not by the 1980s few questioned the role of nicus in saving babies around 80 of babies born weighing less than 1 5 kg now survived compared to around 40 in the 1960s from 1982 pediatricians in britain could train and qualify in the sub specialty of neonatal medicine 29 neonatal intensive care unit in 2009 not only careful nursing but also new techniques and instruments now played a major role as in adult intensive care units the use of monitoring and life support systems became routine these needed special modification for small babies whose bodies were tiny and often immature adult ventilators for example could damage babies lungs and gentler techniques with smaller pressure changes were devised the many tubes and sensors used for monitoring the baby s condition blood sampling and artificial feeding made some babies scarcely visible beneath the technology furthermore by 1975 over 18 of newborn babies in britain were being admitted to nicus some hospitals admitted all babies delivered by caesarian section or under 2500 g in weight the fact that these babies missed early close contact with their mothers was a growing concern the 1980s saw questions being raised about the human and economic costs of too much technology and admission policies gradually became more conservative changing priorities edit a new mother holds her premature baby at kapiolani medical center nicu in honolulu hawaii nicus now concentrate on treating very small premature or congenitally ill babies some of these babies are from higher order multiple births but most are still single babies born too early premature labour and how to prevent it remains a perplexing problem for doctors even though medical advancements allow doctors to save low birth weight babies it is almost invariably better to delay such births a premature infant weighing 990 grams 35 ounces intubated and requiring mechanical ventilation in the neonatal intensive care unit over the last 10 years or so as of scbus have become much more parent friendly encouraging maximum involvement with the babies routine gowns and masks are gone and parents are encouraged to help with care as much as possible cuddling and skin to skin contact also known as kangaroo care are seen as beneficial for all but the frailest very tiny babies are exhausted by the stimulus of being handled or larger critically ill infants less stressful ways of delivering high technology medicine to tiny patients have been devised sensors to measure blood oxygen levels through the skin for example and ways of reducing the amount of blood taken for tests some major problems of the nicu have almost disappeared exchange transfusions in which all the blood is removed and replaced are rare now rhesus incompatibility a difference in blood groups between mother and baby is largely preventable and was the most common cause for exchange transfusion in the past however breathing difficulties intraventricular hemorrhage necrotizing enterocolitis and infections still claim many infant lives and are the focus of many new and current research projects the long term outlook for premature babies saved by nicus has always been a concern from the early years it was reported that a higher proportion than normal grew up with disabilities including cerebral palsy and learning difficulties now that treatments are available for many of the problems faced by tiny or immature babies in the first weeks of life long term follow up and minimising long term disability are major research areas besides prematurity and extremely low birth weight common diseases cared for in a nicu include perinatal asphyxia major birth defects sepsis neonatal jaundice and infant respiratory distress syndrome due to immaturity of the lungs in general the leading cause of death in nicus is necrotizing enterocolitis complications of extreme prematurity may include intracranial hemorrhage chronic bronchopulmonary dysplasia and 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 premature infant in the nicu at mcmaster children s hospital 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 1 400 grams 3 1 pounds usually about 30 weeks gestation rarel...