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. The first official ICU for neonates was established in 1961 at Vanderbilt University by ProfessorMildred Stahlman, officially termed a NICU when Stahlman was the first to use a ventilator off-label to assist a baby with breathing difficulties.
A NICU is typically directed by one or more neonatologists and staffed by nurses, nurse practitioners, pharmacists, physician assistants,resident physicians, and respiratory therapists. Many other ancillary disciplines and specialists are available at larger units. The termneonatal comes from neo, “new”, and natal,
“pertaining to birth or origin”.
By the 1970s, 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. By the 1980s, over 90% of births took place in hospital. 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.
A 1979 study showed that 20% of babies in NICUs for up to a week were never visited by either parent. Centralised or not, by the 1980s few questioned the role of NICUs in saving babies. Around 80% of babies born weighing less than 1.5 kg now survived, compared to around 40% in the 1960s. From 1982, pediatricians in Britain could train and qualify in the sub-specialty of neonatal medicine.
. Not only careful nursing but also new techniques and instruments now played a major role. As in adult intensive-care units, the use of monitoring and life-support systems became routine. These needed special modification for small babies, whose bodies were tiny and often immature. Adult ventilators, for example, could damage babies’ lungs and gentler techniques with smaller pressure changes were devised. The many tubes and sensors used for monitoring the baby’s condition, blood sampling and artificial feeding made some babies scarcely visible beneath the technology.
Furthermore, by 1975, over 18% of newborn babies in Britain were being admitted to NICUs. Some hospitals admitted all babies delivered by Caesarian section, or under 2500 g in weight. The fact that these babies missed early close contact with their mothers was a growing concern. The 1980s saw questions being raised about the human, and the economic costs of too much technology. Admission policies gradually changed. In addition, treating low-birth-weight infants is expensive, especially when there are much cheaper ways of ensuring healthy babies. The key is prevention. Money can be spent on programs educating mothers on staying healthy during their pregnancy.
One program (one that encourages women to stop smoking) is one-third the price of neonatal intensive care and has been proven to work. During this program, a significant number of women often quit.