Neonatal Intensive Care Unit (NICU)

Neonatal Intensive Care Unit (NICU)

Neonatology at Johns Hopkins Bayview Medical Center has a rich history, dating back to the former Baltimore City Hospitals when it started one of the first neonatal intensive care units (NICU) in the city. In 1975, Johns Hopkins Bayview became the birthplace of the first Neonatal Transport Team in the state of Maryland.

The Neonatal Intensive Care Unit (NICU) is a 25-bed, Level 3b unit with approximately 400 admissions annually. The unit provides comprehensive care to a full spectrum of newborns, ranging from extremely premature infants, to term or near-term, high-risk and critically ill babies, to babies less critical but still recovering and maturing. State-of-the art medical care is provided and supported by a wide-range of pediatric subspecialty consultants and services.

In March 2007, the Maryland Institute for Emergency Medical Services (MIEMSS) completed its review of the Neonatal Intensive Care Unit (NICU) and Labor & Delivery service at Johns Hopkins Bayview. The NICU Level III+ (3b) status was confirmed and Johns Hopkins Bayview's five-year Perinatal Referral Center re-designation was granted.
  

A Multidisciplinary Approach

The NICU team is made up of board-certified neonatologists, neonatal nurse practitioners (NNP) and a nursing staff experienced in neonatal care. Those in training, including neonatology fellows, and nursing and nurse practitioner students also join the Johns Hopkins Bayview NICU team. Physicians on the team care for infants at both the Johns Hopkins Bayview and Johns Hopkins Hospital NICU.

The team is very cognizant of the need to support the families of infants hospitalized in the NICU. For many families, having a newborn in the NICU is challenging and stressful. Through this difficult time, family support includes:

• Social work consultation for every family of a NICU infant
• Parent sleep room provided for parents traveling from a great distance, and for new mothers to rest while visiting their infants. The sleep room and full bathroom were renovated in May 2004.
• Breast pumping room and breast milk storage for mothers desiring to provide breast milk for their newborns as they recover
• Spanish interpreter services available 24 hours a day. Other Johns Hopkins Bayview employees or The Johns Hopkins University International Office are available as resources for other languages. For the hearing impaired, TDY services are available in house.
• Educational materials, including handouts and books. Videos are available for in-hospital teaching.
• Family conference room for private conversations between families and the NICU medical team regarding an infant's status and ongoing care.
• Infant CPR training
• Newborn hearing screening (OAE and AABR)
• Newborn metabolic screening
    

Patient Population

The NICU's patient population includes:

• Extremely low birth weight, premature infants
• Infants with respiratory distress that may require high-frequency ventilation, including the oscillator and jet ventilators, or nitric oxide therapy
• Infants with congenital problems
• Infants with problems associated with transitioning to extra uterine life
• Infants with Neonatal Abstinence Syndrome (NAS)
   

Nursing Orientation

Nursing orientation to the NICU is highly individualized and based on skill development needs and previous experience. All orientation programs include didactic classes and an individualized unit-based preceptor, with the support of a unit-based educator. The new graduate nurse orientation program is available biannually (February and July) and includes a more-extensive, six-month orientation.

Educational Opportunities:

• Annual critical care skills and competency training
• Hospital-wide and unit-based educational offerings and inservices
• Weekly lectures on a neonatal topic coordinated by the neonatology staff
• Neonatal Resuscitation Program
• Neonatal Certification Review through the Maryland Neonatal Consortium (Johns Hopkins Bayview is an active member)
• Advancement in Clinical Excellence (ACE) Program
   

Scheduling:

• Nightingale/Intragale scheduling on the Web (accessible from any computer)
• Self-scheduling
• Holiday packages
• Weekend alternative
• Limited day/night rotation
• Flexibility with shifts
• Choice of every other or every third weekend
   

Shared Decision-Making Douncil and Frontline Projects:

• Implementation of NPASS pain scale to improve pain management
• Clinical/Ed Council reviewing the literature on the importance of protected sleep for the premature infant
• Replacing unsafe products such as DEHP with input from MD Healthy Environment for Hospitals
• Renovation of new clinical space in the NICU (2 private and 1 semi-private rooms)
• Peripheral IV infiltrates - reducing occurrence, implemented grading scale, analyzing collected data and moving forward with interventions based on best practice
• Implementation of new Protective IV catheter
• Smart Pump technology with standardized concentrations and drug libraries
• Patient Satisfaction survey
• Noise level in the NICU