Babies born premature or with troubling medical conditions are cared for around-the-clock by Saint Peter’s University Hospital’s staff of neonatologists, pediatric specialists, neonatal nurses, neonatal nurse practitioners, neonatal respiratory therapists and pharmacists.
The Neonatal Intensive Care Unit (NICU) at The Children’s Hospital at Saint Peter’s University Hospital is one of the most experienced and one of the largest specialized facilities of its kind on the East Coast, with 54 intensive and special care bassinets.
Preemies require a special brand of care. And the parents of those premature infants are often faced with numerous unknowns.
Selected Podcast
Saint Peter’s University Hospital: The Neonatal Intensive Care Unit
Featured Speaker:
The Children’s Hospital at Saint Peter’s University Hospital.
For more information about Saint Peter’s Healthcare System
Mark Hiatt, MD
Mark Hiatt, M.D. is a Neonatologist and Director of The Neonatal Intensive Care UnitThe Children’s Hospital at Saint Peter’s University Hospital.
For more information about Saint Peter’s Healthcare System
Transcription:
Saint Peter’s University Hospital: The Neonatal Intensive Care Unit
Bill Klaproth (Host): The neonatal intensive care unit or NICU at the Children’s Hospital at Saint Peter’s University Hospital is one of the most experienced and one of the largest specialized facilities of its kind on the East Coast, with 54 intensive and special care bassinets. Preemies require a special brand of care, and the parents of those premature infants are often faced with numerous unknowns. Here to talk more with us is Dr. Mark Hiatt, director of the NICU at the Children’s Hospital at Saint Peter’s University Hospital. Dr. Hiatt has spent more than three decades in the care of these most fragile newborns. Dr. Hiatt, thank you so much for being on with us today. So, tell us, what is a neonatal intensive care unit and what special features does it provide?
Dr. Mark Hiatt (Guest): A neonatal intensive care unit is a facility inside a hospital where there’s specialized equipment and specialized staff who are trained in taking care of newborn infants who have any medical or surgical problem. It’s important to understand that there are different kinds of neonatal intensive care unit, and the American Academy of Pediatrics has established a system whereby you grade these neonatal intensive care units by the depth and breadth of their facilities. The highest level is a level four neonatal intensive care unit that is equipped to take care of any possible problem, and our NICU here in New Brunswick at Saint Peter’s is a level four neonatal intensive care unit.
Bill: Okay. How would somebody know, an average parent or somebody that’s pregnant or somebody that needs to know this, how would they find that information out?
Dr. Hiatt: Probably the easiest way to do it is to discuss it with their obstetrician or the specialist that’s delivering their child. The obstetrician can make an assessment of what that particular family’s needs are. And if something has been discovered during the course of a pregnancy that would require either high-risk maternal care or particularly high-risk newborn care, the obstetrician be well aware of the kinds of facilities that are in their area and where they have delivery privileges, and they direct the patient to the appropriate facility.
Bill: Okay. I got you. So now let’s talk about -- you mentioned high risk in there. Let’s talk about high risk. Is little birth weight the only reason a baby may spend time at the NICU? Or what are the other ones as well?
Dr. Hiatt: As I said, Bill, we really have the capability to take care of any brand new baby who has any kind of medical or surgical problem. Low weight babies only comprise about 40 percent of our admission. The other 60 percent are larger babies, full-term babies whose mothers either have certain medical problems—for instance, diabetes or something like lupus—or the babies have medical problems. By all these attention over the years on taking care of low birth weight infants and extending their survival, the people in my field have learned a lot about newborn medicine and newborn physiology, and we’ve been able to raise the level of care for all infants.
Bill: Okay. So what percentage then of all babies born land in the NICU?
Dr. Hiatt: Overall in the country, about 1 percent of babies are extremely low birth weight—that is, under 1,500 grams. We’re talking about four million births. That’s not an insubstantial number. Overall though, about 8 to 10 percent of babies may be candidates to be admitted to neonatal intensive care units, usually for a shorter time than those smaller and usually more ill infants.
Bill: What are the causes of low birth weight? Getting back to that, is there any prevention through rest, diet, or medication?
Dr. Hiatt: Well, Bill, you have to differentiate between low birth weight due to prematurity and low birth weight due to some impact on the normal growth of the fetus in utero. Most cases of cases of low birth weight—and that we define under 2,500 grams—are due to babies being born earlier. The earlier you’re born, the less you’re going to weigh. But there are a cohort, a group of babies who come to our unit who may not be premature but yet they have low birth weight based on some impairment in their growth, either due to decreased blood flow or maternal high blood pressure or some other complication in the mother. As far as preventing low birth weight, you have to look at preventing, looking in both of these causes of low birth weight. As far as prematurity, there has been some effective intervention in lowering the instance of prematurity, but we don’t understand all the causes. So obviously, we haven’t been unable to eliminate it. There’s a drug that’s being used. Progesterone is being used in the group of women who have short cervix. Those women would usually deliver early, but now, with the use of this drug, that’s been a major change, and we’ve been able to prolong pregnancy. Some early deliveries are due to infection, and effective treatment can prolong the pregnancy. But overall, we just don’t have a magic treatment yet to prevent all premature delivery.
Bill: I was just going to say, so in either case, no matter what the cause of a low birth weight baby, is there an effect on development later on in a child’s life, or is that random? Is there any way to know that?
Dr. Hiatt: There are many ways to know it. I think that the takeaway message is that the vast majority of our children who come through neonatal intensive care unit, even the ones who are born very early, go on to lead productive lives and, for the most part, fulfill their biologic potential. We usually can get some indication while they’re in the hospital of what their prognosis is. We’re not yet at the point where 100 percent of our graduates go on without any complications, but I can -- I’m proud to tell you and I’m very gratified that every year, that’s getting to be a smaller percentage of those children who go on to have problems later on in life and those problems sometimes can affect the way children move. There’s something called cerebral palsy. The way that their minds work, there can be cognitive impairments. But fortunately, those are less common than they were, and they’re getting to be almost rare.
Bill: That’s very good news. Let’s talk about the parents for a little bit. It’s got to be very difficult for a parent whose child may be in the NICU for a long time. How do you help the parents deal with that, who may have to spend weeks or even months at the hospital?
Dr. Hiatt: Well, this is one of our major challenges. It is extraordinarily disruptive, both physically and mentally and emotionally, financially, on parents who normally would expect to take their brand new baby home after two to three days. Now we have an artificial situation where they’re separated from their child for weeks, sometimes months. They may have other children they have to take care of. The mothers themselves may not feel well. We have a lot of work to do to try to help them. We have a specialist on staff, social workers, psychologists, nurses. All of us are focused to try to ease this transition and make this situation a little bit more tolerable for the parents. One of the things that Saint Peter’s has done in the last six months is develop a system or purchase a system called the NicView System. This is a terrific addition to our equipment. This is a camera that, in real time, allows the parents to look at their infants in the NICU on any one of their devices, whether it’s their smartphone, their iPad, their computer. They have 24-hour access to their infant. And if they go home, they can just pull up their child’s picture on the screen, see what’s going on, call the nurse if they have any questions. We’re one of the only few hospitals that has this, and we really are fortunate because we’ve got a lovely grant from the Provident Bank Foundation to purchase this system, and I think it’s been a game changer for us.
Bill: Well, we are very fortunate to have level four NICU units like you have there at Saint Peter’s there to take care of our most vulnerable young children, and we thank you for that. Dr. Hiatt, thank you so much for your time today. We really appreciate it. For more information on the NICU at Saint Peter’s, please visit saintpetershcs.com. This is Saint Peter’s Better Health Update. I’m Bill Klaproth. Thanks for listening.
Saint Peter’s University Hospital: The Neonatal Intensive Care Unit
Bill Klaproth (Host): The neonatal intensive care unit or NICU at the Children’s Hospital at Saint Peter’s University Hospital is one of the most experienced and one of the largest specialized facilities of its kind on the East Coast, with 54 intensive and special care bassinets. Preemies require a special brand of care, and the parents of those premature infants are often faced with numerous unknowns. Here to talk more with us is Dr. Mark Hiatt, director of the NICU at the Children’s Hospital at Saint Peter’s University Hospital. Dr. Hiatt has spent more than three decades in the care of these most fragile newborns. Dr. Hiatt, thank you so much for being on with us today. So, tell us, what is a neonatal intensive care unit and what special features does it provide?
Dr. Mark Hiatt (Guest): A neonatal intensive care unit is a facility inside a hospital where there’s specialized equipment and specialized staff who are trained in taking care of newborn infants who have any medical or surgical problem. It’s important to understand that there are different kinds of neonatal intensive care unit, and the American Academy of Pediatrics has established a system whereby you grade these neonatal intensive care units by the depth and breadth of their facilities. The highest level is a level four neonatal intensive care unit that is equipped to take care of any possible problem, and our NICU here in New Brunswick at Saint Peter’s is a level four neonatal intensive care unit.
Bill: Okay. How would somebody know, an average parent or somebody that’s pregnant or somebody that needs to know this, how would they find that information out?
Dr. Hiatt: Probably the easiest way to do it is to discuss it with their obstetrician or the specialist that’s delivering their child. The obstetrician can make an assessment of what that particular family’s needs are. And if something has been discovered during the course of a pregnancy that would require either high-risk maternal care or particularly high-risk newborn care, the obstetrician be well aware of the kinds of facilities that are in their area and where they have delivery privileges, and they direct the patient to the appropriate facility.
Bill: Okay. I got you. So now let’s talk about -- you mentioned high risk in there. Let’s talk about high risk. Is little birth weight the only reason a baby may spend time at the NICU? Or what are the other ones as well?
Dr. Hiatt: As I said, Bill, we really have the capability to take care of any brand new baby who has any kind of medical or surgical problem. Low weight babies only comprise about 40 percent of our admission. The other 60 percent are larger babies, full-term babies whose mothers either have certain medical problems—for instance, diabetes or something like lupus—or the babies have medical problems. By all these attention over the years on taking care of low birth weight infants and extending their survival, the people in my field have learned a lot about newborn medicine and newborn physiology, and we’ve been able to raise the level of care for all infants.
Bill: Okay. So what percentage then of all babies born land in the NICU?
Dr. Hiatt: Overall in the country, about 1 percent of babies are extremely low birth weight—that is, under 1,500 grams. We’re talking about four million births. That’s not an insubstantial number. Overall though, about 8 to 10 percent of babies may be candidates to be admitted to neonatal intensive care units, usually for a shorter time than those smaller and usually more ill infants.
Bill: What are the causes of low birth weight? Getting back to that, is there any prevention through rest, diet, or medication?
Dr. Hiatt: Well, Bill, you have to differentiate between low birth weight due to prematurity and low birth weight due to some impact on the normal growth of the fetus in utero. Most cases of cases of low birth weight—and that we define under 2,500 grams—are due to babies being born earlier. The earlier you’re born, the less you’re going to weigh. But there are a cohort, a group of babies who come to our unit who may not be premature but yet they have low birth weight based on some impairment in their growth, either due to decreased blood flow or maternal high blood pressure or some other complication in the mother. As far as preventing low birth weight, you have to look at preventing, looking in both of these causes of low birth weight. As far as prematurity, there has been some effective intervention in lowering the instance of prematurity, but we don’t understand all the causes. So obviously, we haven’t been unable to eliminate it. There’s a drug that’s being used. Progesterone is being used in the group of women who have short cervix. Those women would usually deliver early, but now, with the use of this drug, that’s been a major change, and we’ve been able to prolong pregnancy. Some early deliveries are due to infection, and effective treatment can prolong the pregnancy. But overall, we just don’t have a magic treatment yet to prevent all premature delivery.
Bill: I was just going to say, so in either case, no matter what the cause of a low birth weight baby, is there an effect on development later on in a child’s life, or is that random? Is there any way to know that?
Dr. Hiatt: There are many ways to know it. I think that the takeaway message is that the vast majority of our children who come through neonatal intensive care unit, even the ones who are born very early, go on to lead productive lives and, for the most part, fulfill their biologic potential. We usually can get some indication while they’re in the hospital of what their prognosis is. We’re not yet at the point where 100 percent of our graduates go on without any complications, but I can -- I’m proud to tell you and I’m very gratified that every year, that’s getting to be a smaller percentage of those children who go on to have problems later on in life and those problems sometimes can affect the way children move. There’s something called cerebral palsy. The way that their minds work, there can be cognitive impairments. But fortunately, those are less common than they were, and they’re getting to be almost rare.
Bill: That’s very good news. Let’s talk about the parents for a little bit. It’s got to be very difficult for a parent whose child may be in the NICU for a long time. How do you help the parents deal with that, who may have to spend weeks or even months at the hospital?
Dr. Hiatt: Well, this is one of our major challenges. It is extraordinarily disruptive, both physically and mentally and emotionally, financially, on parents who normally would expect to take their brand new baby home after two to three days. Now we have an artificial situation where they’re separated from their child for weeks, sometimes months. They may have other children they have to take care of. The mothers themselves may not feel well. We have a lot of work to do to try to help them. We have a specialist on staff, social workers, psychologists, nurses. All of us are focused to try to ease this transition and make this situation a little bit more tolerable for the parents. One of the things that Saint Peter’s has done in the last six months is develop a system or purchase a system called the NicView System. This is a terrific addition to our equipment. This is a camera that, in real time, allows the parents to look at their infants in the NICU on any one of their devices, whether it’s their smartphone, their iPad, their computer. They have 24-hour access to their infant. And if they go home, they can just pull up their child’s picture on the screen, see what’s going on, call the nurse if they have any questions. We’re one of the only few hospitals that has this, and we really are fortunate because we’ve got a lovely grant from the Provident Bank Foundation to purchase this system, and I think it’s been a game changer for us.
Bill: Well, we are very fortunate to have level four NICU units like you have there at Saint Peter’s there to take care of our most vulnerable young children, and we thank you for that. Dr. Hiatt, thank you so much for your time today. We really appreciate it. For more information on the NICU at Saint Peter’s, please visit saintpetershcs.com. This is Saint Peter’s Better Health Update. I’m Bill Klaproth. Thanks for listening.