A neonatal intensive care unit NICU , also known as an intensive care nursery ICN , is an intensive care unit specializing in the care of ill or premature newborn infants.
Neonatal refers to the first 28 days of life. Neonatal care, as known as specialized nurseries or intensive care, has been around since the s. NICU is typically directed by one or more neonatologists and staffed by nurses ,  nurse practitioners , pharmacists , physician assistants , resident physicians, 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". Neonatal nurse practitioners are advanced practice nurses that care for premature babies and sick newborns in intensive care units , emergency rooms , delivery rooms , and special clinics. Prematurity is a risk factor that follows early labour, a planned caesarean section, or pre-eclampsia.
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Healthcare institutions have varying entry-level requirements for neonatal nurses. Some countries or institutions may also require a midwifery qualification. 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. As with any registered nurse, local licensing or certifying bodies as well as employers may set requirements for continuing education. There are no mandated requirements to becoming an RN in an NICU, although neonatal nurses must have certification as a neonatal resuscitation provider.
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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 already under their belt. 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. 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. Before the industrial revolution , premature and ill infants were born and cared for at home and either lived or died without medical intervention.
Stephane Tarnier is generally considered to be the father of the incubator or isolette as it is now known , having developed it to attempt to keep premature infants in a Paris maternity ward warm. France became a forerunner in assisting premature infants, in part due to its concerns about a falling birth rate. After Tarnier retired, Dr.
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. Another factor that contributed to the development of modern neonatology was thanks to Dr. Martin Couney and his permanent installment of premature babies in incubators at Coney Island. A more controversial figure, he studied under Dr. 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 and , respectively.
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 At Southmead Hospital, Bristol, initial opposition from obstetricians lessened after quadruplets born there in were successfully cared for in the new unit.
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.
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Much was learned about feeding—frequent, tiny feeds seemed best—and breathing. Oxygen was given freely until the end of the s, when it was shown that the high concentrations reached inside incubators caused some babies to go blind. Monitoring conditions in the incubator, and the baby itself, was to become a major area of research. The s 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 suffered neurological impairment. Herbert Barrie in London pioneered advances in resuscitation of the newborn. Barrie published his seminal paper on the subject in The Lancet in Barrie developed an underwater safety valve in the oxygen circuit.
The tubes were originally made of rubber, but these had the potential to cause irritation to sensitive newborn tracheas: Barrie switched to plastic. Most early units had little equipment, providing only oxygen and warmth, and relied on careful nursing and observation. In later years, further research allowed technology to play a larger role in the decline of infant mortality.
The development of pulmonary surfactant , which facilitates the oxygenation and ventilation of underdeveloped lungs, has been the most important development in neonatology to date. By the s, NICUs were an established part of hospitals in the developed world.
In Britain, some early units ran community programmes, 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. The emergency dash from home to the NICU with 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, centralised NICUs. On the downside was the long travelling time for frail babies and for parents. Centralised or not, by the s few questioned the role of NICUs in saving babies.
From , pediatricians in Britain could train and qualify in the sub-specialty of neonatal medicine. The study aims were to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia. Over a 2 week period, all children from birth to 15 years undergoing elective or urgent anaesthesia for diagnostic or surgical procedures at OLCHC were invited to participate.
The results of the study highlighted a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. All Physician's Name. We Treat Emergency procedures Surgical procedures Children being treated with chemotherapy Children undergoing gastrointestinal procedures Children requiring radiographic processes Children with Down Syndrome Children with Sickle Cell Anemia Children with other complex diseases.
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