What is a Neonatal Intensive Care Unit?  A Neonatal Intensive Care Unit (NICU) is a special care nursery with highly specialized staff and equipment to care for premature or seriously ill newborns.  The newborns are cared for by neonatologists and staff with neonatal critical care training.

Baystate Children’s Hospital (BCH) Neonatal Intensive Care Unit (NICU) is the regional tertiary care facility for newborn infants delivered in Western Massachusetts who require highly specialized care.  From October 2002 through September 2009, over 5,300 babies were cared for in the BCH NICU.  In 1997, as part of ongoing efforts to monitor and improve quality, the Division of Newborn Medicine began participating in the Vermont Oxford Network.  Currently, there are 800 neonatal intensive care units throughout the world, with 850 in the United States, (including 9 sites in Massachusetts), Canada and other countries, participating in the Network and sharing information related to the care and outcome of very low birth weight infants.

Premature infants are at high risk for complications, including respiratory distress syndrome (RDS), retinopathy of prematurity (ROP), intracranial bleeding, infections, and mortality.

Highlights

• Respiratory distress syndrome (RDS) is often the most acute problem among preterm infants and accounts for a significant proportion of neonatal deaths.  When preterm delivery is imminent, early intervention with antenatal steroids is necessary to enhance fetal lung maturity.  
• In 2010, the BCH rate of antenatal steroid usage was 79.5%, comparable to the Network average* of 80.3%. 
• After birth, early identification and treatment of retinopathy of prematurity (ROP) by a pediatric ophthalmologist are imperative to prevent progression to more severe ophthalmologic complications.
  • The 2010 rates of ROP and severe ROP remain impressively low at 15.4% and 1.5%, respectively, compared with the Network values* of 33.5% and 6.8%.

• The rates of cranial ultrasound to rule out bleeding and malformation have been high (BCH is 96.7%, Network is 90.7%) for the last eleven years.
• The BCH rate of coagulase-negative staphylococcus infections (any infection) for 2010 is 0%, and the rate of nosocomial infections is 1.1%, both below the Network rates of 8.81% and 15.4%, respectively.
• The BCH risk-adjusted mortality value for 2010 is 6.9%, well below the Vermont Oxford Network value of 9.8% (3-year average), and our BCH risk-adjusted mortality 3-year average (2008-2010) of 5.5% places us in the top 25th percentile of hospitals (1st Quartile is 6.5%)

Benchmarked rates of mortality and complications demonstrate the excellent care provided by the physicians, nurses, and staff of the NICU at BCH.  Multidepartmental efforts, such as campaigns emphasizing the importance of hand hygiene, VAP and bloodstream infection prevention, increased steroid use for selected patients with preterm labor, rapid transport system, adoption of new technologies, appropriate triage/level of care criteria, screening programs, and processes to improve quality of care and efficiency are in place and reflect the commitment of Baystate Children’s Hospital to continuous improvement.

*Network rate is a 3-year average (2008-2010).

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