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Neonatal Intensive Care Unit

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.

 

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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.  Since October 2002, more than 6,000 babies have been 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 more than 900 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 death.

 

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 2011, the BCH rate of antenatal steroid usage was 89.8%, much better than the Network average* of 81.9%. 
  • 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 2011 rates of ROP and severe ROP remain impressively low at 14.9% and 4.6%, respectively, compared with the Network values* of 31.3% and 6.0%.
  • The 2011 rates of cranial ultrasound to rule out bleeding and malformation have been high (BCH is 96.3%, Network is 90.7%) for the last twelve years, and the rate of severe intraventricular hemorrhage (IVH) is 5.7%, below the Network rate of 8.1%.
  • The BCH rate of coagulase-negative staphylococcus infections (any infection) for 2011 is 0%, and the rate of nosocomial infections is 4.8%, both below the Network rates of 6.9% and 13.3%, respectively.
  • The BCH risk-adjusted mortality excluding early deaths value for 2011 is 6.5%, well below the Vermont Oxford Network value of 10.0% (3-year average).

 

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 (2009-2011).

 

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