Selected Podcast
NICU: Part 1 - What's a NICU?
What's a NICU, why is it important, what is a level III NICU. Tenet Health Central Coast, Sierra Vista is the only NICU level III in the County. What does that mean for the the community?
Featuring:
Steve Van Scoy, MD
Dr. Steven Van Scoy is a Neonatologist and the NICU Medical Director at Tenet Health Central Coast, Sierra Vista Regional Medical Center, the only Level III NICU in San Luis Obispo County. He received his Bachelor of Arts from the University of California, Santa Barbara and his Doctorate of Medicine from the University of Southern California, School of Medicine in Los Angeles. He completed his residency and fellowship at Tripler Army Medical Center in Honolulu, Hi. Dr. Van Scoy has served in various leadership roles at Sierra Vista, including: Chief of Staff, Vice Chief of Staff and as a member of the Governing Board and Medical Executive Committee. He is a Diplomate in Neonatal-Perinatal Medicine and a Diplomate of the American Board of Pediatrics. Dr. Van Scoy is married with two children and enjoys the many outdoor activities that San Luis Obispo County has to offer. Transcription:
Prakash Chandran (Host): When having a baby, parents always hope for everything to go smoothly and their child to be healthy. But in the event that something happens, there's thankfully a resource called the Neonatal Intensive Care Unit or NICU that can quickly assess the situation and provide the care necessary to bring your baby to optimal health. This is part one of a two-part NICU series, and today we'll be talking about NICU General Education. Here with us to discuss is Dr. Steve Van Scoy, the NICU Medical Director and a Neonatologist at Sierra Vista Regional Medical Center. This is Healthy Conversations, the podcast from Tenet Health Central Coast. My name is Prakash Chandran. So, Dr. Van Scoy, it is great to have you here today. Let's just start with the basics. What exactly is a NICU?
Steve Van Scoy, MD (Guest): A NICU is basically a broad term that encompasses an area within a hospital, where infants needing some additional care past delivery, are given the care that they need. This care can last anywhere from minutes to months, depending upon the needs of the baby. And it's in contrast to what is called a Special Care Nursery, which is not a NICU, but basically is an area in the labor and delivery area, that's usually found in smaller hospitals, that's used for very short periods of observation and stabilization of a baby waiting for a transport to a different place.
Host: Understood. And can you elaborate a little bit on some of the real world examples that might send a baby to the NICU?
Dr. Van Scoy: Sure. Probably the most well-known, are babies who are born premature. That's what we generally tend to read about in the media. Particularly those miracle babies that are born three months early and weigh less than a pound. In reality, that's the vast minority of what we actually see. What we mostly see is babies who are born at term or near term who need shorter periods of observation and assistance. They may be born a little bit young and may not know quite how to eat well by mouth, or may have mild issues with breathing. Other babies born at term might have infection issues where we have to treat with antibiotics. There can be babies born with inborn malformations we call them, or birth defects that require special care. And there can be other babies who have had a very stressful delivery that need support until their bodies can heal and go back to mom.
Host: Okay. So, you're kind of mentioning all of these different cases in which a baby might go to the NICU and I've heard that there are different NICU levels. So, can you maybe speak to that a little bit?
Dr. Van Scoy: NICUs are based on levels two through four, and the most common one is a level two and that's generally something which would be found in a town of our size. It is basically an area in which babies born who need mild to moderate assistance, can receive that care. And generally those babies will be over 32 to 34 weeks of gestation. That's in contrast to a term baby who's 40. Those babies usually need a little bit of care and assistance with feeding, may need antibiotics for a week or so. May need a little bit of help with breathing, but certainly nothing serious and long-term with any of those kids. When you step up to a level three, that's actually a big step up because you are now taking care of moderate to severely ill babies, possibly down to 23 weeks gestation, and maybe less than a pound, along with all those other babies that are bigger and less critical. That takes a really big commitment from both the healthcare providers in the hospital, because not only do you have to carve out an area for special care for these kids, but you also have to staff it with specialized professionals, nurses, respiratory therapists, and doctors.
You have to have the infrastructure both in the facility to have beds that have multiple electrical outlets and suction outlets and things and much equipment for those kids. In addition, other departments in the hospital have to be involved such as the pharmacy, radiology. Those need to have special training in order to handle the needs that we put upon them. So, it ends up being a very big commitment both in time, energy and money. And so we're very lucky that in our area, we've had an administration that saw fit to start a program such as ours. And finally there's a level four, which is the ultimate in highly specialized intensive care.
There are several of them in California, generally associated with an academic medical center. So, a learning center. They're in big cities and they take care of very rare and special diseases and very invasive and intensive care. In general, community level three NICUs like ours can take care of about 95 to 98% of what is placed in them. But rarely, we do need to send to something of that size.
Host: Understood. So, it really does sound like the majority of cases are either that level two or level three and level three, as you're mentioning really requires a multi-disciplinary collaborative team in order to service every case that comes into it. Isn't that correct?
Dr. Van Scoy: It does. And when you think about what we require in our little hospital here. At the bedside, we have critically trained nurses, respiratory therapists, the doctors are specialized pediatricians who take an extra three years to become a neonatologist. And this is all we do is take care of sick and young babies. We have nursing support from the administrative side. We have people who are regularly in the NICU, such as physical therapists, dietician, social workers, lactation consultants, and a case manager. And in our case, we have cuddlers to help the babies stay comfortable when their parents are not there.
And then all the other departments throughout the hospital receive specialty training and in addition, we actually consider an extended part of our family, the community services that we actually send our babies to, after they are discharged, if they need it. Those are both the state programs and private programs such as Martha's Place.
Host: Wow, that sounds incredible. I just can't believe that you have so many different people that are a part of servicing this NICU, including cuddlers. I've really never heard of that before.
Dr. Van Scoy: It's really a big team. And it's, it's a big family and the beauty of it is that being a parent who has a baby in the NICU, you really don't know that all that is behind your baby. In fact, when we have babies being visited by their parents, they're there behind curtains in a private little area, not knowing all this is going on behind the scenes. And that's how we want it.
Host: Yeah. Yeah, absolutely. That actually leads me to my next question. I heard that there's this concept of an open NICU. You were kind of talking about how the parents are sometimes separated. Maybe talk about what the open NICU concept means.
Dr. Van Scoy: This is sort of the classic concept of an NICU. And it's, it basically means an open floor plan where all babies, or at least a certain number of them, are in a common room. And really the advantages of that are that it tends to be a little bit more social for the parents. Although we do have ways to give parents pretty good privacy within those rooms. A lot of parents like to be able to look around the room, talk with other parents, talk with nurses who are there and the physicians when they come through. There's more free nursing to parent interaction because they can have conversations because they're not locked in their own little room as what you would consider a closed NICU.
It's easier to monitor those patients from the nurse's standpoint and it's easier to communicate between nurses. So, pretty much if you're in one of those rooms as a healthcare provider, you know, what's going on with everybody, which is a great advantage. The disadvantages to an open NICU versus one that has private rooms are that it tends to be noisier at every bedside because you've got a common area and there's a little bit less privacy, but we really take pains to minimize that.
Host: I'm reminded that when my friend went to the NICU, earlier this year for his son, he was talking about the other parents that were there and the type of relationship that he formed with them, you know, and just having someone that you can rely on that is going through the same thing. It must be a very bonding experience, isn't it?
Dr. Van Scoy: Oh, absolutely. I think that more often than not, parents whose babies are there for more than say several days, begin to form relationships with other parents, as well as the nurses, who take care of their babies so closely and many stay in touch. They're mutually supportive and we have a yearly NICU reunion that parents get to see each other and see each other's kids as they, as they grow. So, it ends up being a real positive, I think.
Host: It's probably safe to say that no parent wants or hopes to need the NICU. Like for example, my wife and I, we're giving birth to our second in August. And obviously it's not something that's even on my mind. But what might be something that you would share with parents or expectant parents like myself, about their concerns about giving birth or the potential need for a NICU?
Dr. Van Scoy: I fully agree. Nobody wants to ever be in a NICU or meet any of us who work there. And we understand that and that's one of those things that we have a certain proportion of our parents who know they're going to be in there. Certainly the ones who say, come in when they're have pre premature labor, know they're going to be delivering a preterm baby. We make sure that we get the neonatologist, the NICU doctor down to talk to them before delivery, if we can, to prepare them for what they're going to go through. But for the majority of patients and parents, they have no idea that they're going to end up with a baby in the NICU. First of all, I let them know that we've done this before, their baby is in good hands. And we understand that they are somewhat shell shocked, stressed obviously, usually tired. And usually don't have a whole lot of coping mechanisms at that point. So, we gently indoctrinate them into here's what we're doing.
Here is why we're doing it, about how long we're going to have to be doing it for and how long your baby is going to have to stay with us. And then we inform them along the way, we empower them to ask questions. We invite them to stay as much as they can by the bedside, because we know that those babies are their babies. We're the people who are taking care of that baby for the time being. But they have to go home with that baby after our care. And we always keep an eye on that. But one of the nice things about having a NICU in the facility where you deliver is that there is a great amount of support for you and your baby before birth, during birth and after birth.
Certainly we can be available for a birth as a NICU team within about 30 seconds to a minute of being called. We can have a nurse and a respiratory therapist in the room to make sure that small problems don't become big problems. And there are numerous cases every year where our NICU team was able to go into a delivery room, take care of a problem that was temporary and leave the baby with the parents in the room.
And baby never has to come into the NICU. They just are a well infant after that. Other times we've had babies in the mother-baby couplet area after delivery where the NICU nurse or respiratory therapist goes down to basically check a baby when one of the nurses there has concerns and has been able to again, keep that little problem from becoming a big problem, but it's a big team that is invisible unless you need us.
And that's what we want to be. We don't want people to know we're there. We don't want people to be delivering in the hospital that has a NICU only for that reason. They want him to come in because we have safe care. We have water labor. We have a doula. We have midwifery, we have in-house obstetricians, all those things that make it a safe and caring place to deliver. We're just the safety net in case they need us.
Host: Well, I can tell you that is very reassuring. So, thank you for sharing all of that. You know, just the final question that I had was when a baby goes to the NICU, you can't help as a parent but wonder, is there something that I could have done differently? So, is there anything that you can share with expectant parents around either taking care of themselves or doing things to avoid potentially going to the NICU?
Dr. Van Scoy: I think that's a really good question because over the years I've done this, it is really evident to me that even though the words aren't said, moms feel very guilty that a baby is in the NICU. And almost universally, it's nothing they could've done differently. Nature is not black and white. There's a lot of things that happen and giving birth is a very complex and at times difficult process. It's not as easy as it looks like on TV. So honestly, I think that starting with taking care of yourself when you were pregnant, both the mom and the dad , mutually supporting each other during that time, listening to each other and forming a plan of what's going to happen around delivery time, as far as being able to get to the delivery hospital in time, and then if, if something does go wrong and we're here and ended up with a baby in the NICU , one of the first things I make sure I do is to find out how the parents are feeling, what their understanding is about what's going on and to allay their fears number one. To let them know that we are experienced with this because there's rarely anything we haven't seen before. And the other part is to let mom know that rarely, is there anything she could have done differently. But this is mostly a happenstance and that she should take care of herself so that she can be there for her baby. And her most important other task is to make breast milk for her baby. And so as much as she can do that, that's great for us.
Host: All right, Dr. Van Scoy, I really appreciate your time today. This has been hugely informative and I definitely feel way more informed going into the birth of my child in August. That's Dr. Steve Van Scoy, the NICU Medical Director and a Neonatologist at Sierra Vista Regional Medical Center. Don't forget to tune in to part two of our NICU series where we'll cover local specific NICU information as it relates to you.
For more information on this topic and more general topics, please visit our This email address is being protected from spambots. You need JavaScript enabled to view it.. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy Conversations, the podcast from Tenet Health Central Coast. Thank you so much. And we'll talk next time.
Prakash Chandran (Host): When having a baby, parents always hope for everything to go smoothly and their child to be healthy. But in the event that something happens, there's thankfully a resource called the Neonatal Intensive Care Unit or NICU that can quickly assess the situation and provide the care necessary to bring your baby to optimal health. This is part one of a two-part NICU series, and today we'll be talking about NICU General Education. Here with us to discuss is Dr. Steve Van Scoy, the NICU Medical Director and a Neonatologist at Sierra Vista Regional Medical Center. This is Healthy Conversations, the podcast from Tenet Health Central Coast. My name is Prakash Chandran. So, Dr. Van Scoy, it is great to have you here today. Let's just start with the basics. What exactly is a NICU?
Steve Van Scoy, MD (Guest): A NICU is basically a broad term that encompasses an area within a hospital, where infants needing some additional care past delivery, are given the care that they need. This care can last anywhere from minutes to months, depending upon the needs of the baby. And it's in contrast to what is called a Special Care Nursery, which is not a NICU, but basically is an area in the labor and delivery area, that's usually found in smaller hospitals, that's used for very short periods of observation and stabilization of a baby waiting for a transport to a different place.
Host: Understood. And can you elaborate a little bit on some of the real world examples that might send a baby to the NICU?
Dr. Van Scoy: Sure. Probably the most well-known, are babies who are born premature. That's what we generally tend to read about in the media. Particularly those miracle babies that are born three months early and weigh less than a pound. In reality, that's the vast minority of what we actually see. What we mostly see is babies who are born at term or near term who need shorter periods of observation and assistance. They may be born a little bit young and may not know quite how to eat well by mouth, or may have mild issues with breathing. Other babies born at term might have infection issues where we have to treat with antibiotics. There can be babies born with inborn malformations we call them, or birth defects that require special care. And there can be other babies who have had a very stressful delivery that need support until their bodies can heal and go back to mom.
Host: Okay. So, you're kind of mentioning all of these different cases in which a baby might go to the NICU and I've heard that there are different NICU levels. So, can you maybe speak to that a little bit?
Dr. Van Scoy: NICUs are based on levels two through four, and the most common one is a level two and that's generally something which would be found in a town of our size. It is basically an area in which babies born who need mild to moderate assistance, can receive that care. And generally those babies will be over 32 to 34 weeks of gestation. That's in contrast to a term baby who's 40. Those babies usually need a little bit of care and assistance with feeding, may need antibiotics for a week or so. May need a little bit of help with breathing, but certainly nothing serious and long-term with any of those kids. When you step up to a level three, that's actually a big step up because you are now taking care of moderate to severely ill babies, possibly down to 23 weeks gestation, and maybe less than a pound, along with all those other babies that are bigger and less critical. That takes a really big commitment from both the healthcare providers in the hospital, because not only do you have to carve out an area for special care for these kids, but you also have to staff it with specialized professionals, nurses, respiratory therapists, and doctors.
You have to have the infrastructure both in the facility to have beds that have multiple electrical outlets and suction outlets and things and much equipment for those kids. In addition, other departments in the hospital have to be involved such as the pharmacy, radiology. Those need to have special training in order to handle the needs that we put upon them. So, it ends up being a very big commitment both in time, energy and money. And so we're very lucky that in our area, we've had an administration that saw fit to start a program such as ours. And finally there's a level four, which is the ultimate in highly specialized intensive care.
There are several of them in California, generally associated with an academic medical center. So, a learning center. They're in big cities and they take care of very rare and special diseases and very invasive and intensive care. In general, community level three NICUs like ours can take care of about 95 to 98% of what is placed in them. But rarely, we do need to send to something of that size.
Host: Understood. So, it really does sound like the majority of cases are either that level two or level three and level three, as you're mentioning really requires a multi-disciplinary collaborative team in order to service every case that comes into it. Isn't that correct?
Dr. Van Scoy: It does. And when you think about what we require in our little hospital here. At the bedside, we have critically trained nurses, respiratory therapists, the doctors are specialized pediatricians who take an extra three years to become a neonatologist. And this is all we do is take care of sick and young babies. We have nursing support from the administrative side. We have people who are regularly in the NICU, such as physical therapists, dietician, social workers, lactation consultants, and a case manager. And in our case, we have cuddlers to help the babies stay comfortable when their parents are not there.
And then all the other departments throughout the hospital receive specialty training and in addition, we actually consider an extended part of our family, the community services that we actually send our babies to, after they are discharged, if they need it. Those are both the state programs and private programs such as Martha's Place.
Host: Wow, that sounds incredible. I just can't believe that you have so many different people that are a part of servicing this NICU, including cuddlers. I've really never heard of that before.
Dr. Van Scoy: It's really a big team. And it's, it's a big family and the beauty of it is that being a parent who has a baby in the NICU, you really don't know that all that is behind your baby. In fact, when we have babies being visited by their parents, they're there behind curtains in a private little area, not knowing all this is going on behind the scenes. And that's how we want it.
Host: Yeah. Yeah, absolutely. That actually leads me to my next question. I heard that there's this concept of an open NICU. You were kind of talking about how the parents are sometimes separated. Maybe talk about what the open NICU concept means.
Dr. Van Scoy: This is sort of the classic concept of an NICU. And it's, it basically means an open floor plan where all babies, or at least a certain number of them, are in a common room. And really the advantages of that are that it tends to be a little bit more social for the parents. Although we do have ways to give parents pretty good privacy within those rooms. A lot of parents like to be able to look around the room, talk with other parents, talk with nurses who are there and the physicians when they come through. There's more free nursing to parent interaction because they can have conversations because they're not locked in their own little room as what you would consider a closed NICU.
It's easier to monitor those patients from the nurse's standpoint and it's easier to communicate between nurses. So, pretty much if you're in one of those rooms as a healthcare provider, you know, what's going on with everybody, which is a great advantage. The disadvantages to an open NICU versus one that has private rooms are that it tends to be noisier at every bedside because you've got a common area and there's a little bit less privacy, but we really take pains to minimize that.
Host: I'm reminded that when my friend went to the NICU, earlier this year for his son, he was talking about the other parents that were there and the type of relationship that he formed with them, you know, and just having someone that you can rely on that is going through the same thing. It must be a very bonding experience, isn't it?
Dr. Van Scoy: Oh, absolutely. I think that more often than not, parents whose babies are there for more than say several days, begin to form relationships with other parents, as well as the nurses, who take care of their babies so closely and many stay in touch. They're mutually supportive and we have a yearly NICU reunion that parents get to see each other and see each other's kids as they, as they grow. So, it ends up being a real positive, I think.
Host: It's probably safe to say that no parent wants or hopes to need the NICU. Like for example, my wife and I, we're giving birth to our second in August. And obviously it's not something that's even on my mind. But what might be something that you would share with parents or expectant parents like myself, about their concerns about giving birth or the potential need for a NICU?
Dr. Van Scoy: I fully agree. Nobody wants to ever be in a NICU or meet any of us who work there. And we understand that and that's one of those things that we have a certain proportion of our parents who know they're going to be in there. Certainly the ones who say, come in when they're have pre premature labor, know they're going to be delivering a preterm baby. We make sure that we get the neonatologist, the NICU doctor down to talk to them before delivery, if we can, to prepare them for what they're going to go through. But for the majority of patients and parents, they have no idea that they're going to end up with a baby in the NICU. First of all, I let them know that we've done this before, their baby is in good hands. And we understand that they are somewhat shell shocked, stressed obviously, usually tired. And usually don't have a whole lot of coping mechanisms at that point. So, we gently indoctrinate them into here's what we're doing.
Here is why we're doing it, about how long we're going to have to be doing it for and how long your baby is going to have to stay with us. And then we inform them along the way, we empower them to ask questions. We invite them to stay as much as they can by the bedside, because we know that those babies are their babies. We're the people who are taking care of that baby for the time being. But they have to go home with that baby after our care. And we always keep an eye on that. But one of the nice things about having a NICU in the facility where you deliver is that there is a great amount of support for you and your baby before birth, during birth and after birth.
Certainly we can be available for a birth as a NICU team within about 30 seconds to a minute of being called. We can have a nurse and a respiratory therapist in the room to make sure that small problems don't become big problems. And there are numerous cases every year where our NICU team was able to go into a delivery room, take care of a problem that was temporary and leave the baby with the parents in the room.
And baby never has to come into the NICU. They just are a well infant after that. Other times we've had babies in the mother-baby couplet area after delivery where the NICU nurse or respiratory therapist goes down to basically check a baby when one of the nurses there has concerns and has been able to again, keep that little problem from becoming a big problem, but it's a big team that is invisible unless you need us.
And that's what we want to be. We don't want people to know we're there. We don't want people to be delivering in the hospital that has a NICU only for that reason. They want him to come in because we have safe care. We have water labor. We have a doula. We have midwifery, we have in-house obstetricians, all those things that make it a safe and caring place to deliver. We're just the safety net in case they need us.
Host: Well, I can tell you that is very reassuring. So, thank you for sharing all of that. You know, just the final question that I had was when a baby goes to the NICU, you can't help as a parent but wonder, is there something that I could have done differently? So, is there anything that you can share with expectant parents around either taking care of themselves or doing things to avoid potentially going to the NICU?
Dr. Van Scoy: I think that's a really good question because over the years I've done this, it is really evident to me that even though the words aren't said, moms feel very guilty that a baby is in the NICU. And almost universally, it's nothing they could've done differently. Nature is not black and white. There's a lot of things that happen and giving birth is a very complex and at times difficult process. It's not as easy as it looks like on TV. So honestly, I think that starting with taking care of yourself when you were pregnant, both the mom and the dad , mutually supporting each other during that time, listening to each other and forming a plan of what's going to happen around delivery time, as far as being able to get to the delivery hospital in time, and then if, if something does go wrong and we're here and ended up with a baby in the NICU , one of the first things I make sure I do is to find out how the parents are feeling, what their understanding is about what's going on and to allay their fears number one. To let them know that we are experienced with this because there's rarely anything we haven't seen before. And the other part is to let mom know that rarely, is there anything she could have done differently. But this is mostly a happenstance and that she should take care of herself so that she can be there for her baby. And her most important other task is to make breast milk for her baby. And so as much as she can do that, that's great for us.
Host: All right, Dr. Van Scoy, I really appreciate your time today. This has been hugely informative and I definitely feel way more informed going into the birth of my child in August. That's Dr. Steve Van Scoy, the NICU Medical Director and a Neonatologist at Sierra Vista Regional Medical Center. Don't forget to tune in to part two of our NICU series where we'll cover local specific NICU information as it relates to you.
For more information on this topic and more general topics, please visit our This email address is being protected from spambots. You need JavaScript enabled to view it.. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy Conversations, the podcast from Tenet Health Central Coast. Thank you so much. And we'll talk next time.