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Extra Help When Your Baby Needs It All babies need care, but there are times when some may need a little more than others. For those newborns, Plantation General Hospital offers an NICU that is not only committed to providing the best care possible for babies but also to making a trying time a little easier for parents. Delivering more than 4,000 babies each year, Plantation General Hospital houses one of the busiest NICUs in the country. The 31-bed NICU offers a Level III unit for newborns who need critical care and a Level II progressive care unit for babies who are more stable. In the Level II unit, parents receive help with discharge planning, as well as education designed to help them care for their newborn. For Perri and Neil Trenk whose daughter Alexa received care in the NICU, Plantation General's up-to-date technology and capable staff were invaluable. "Alexa was born when I was only 23 weeks pregnant, and she was given a 20 percent chance to make it," says Trenk. "Today, she is in kindergarten, and the quality of her life is as normal as it could be. I'm so thankful she was born at Plantation General--they did a wonderful job." The Best Care for Baby Newborns are in good hands at Plantation General's NICU. Five board-certified and attending-level neonatologists are on staff full time. As an added bonus, a neonatologist is on-site 24 hours a day, so parents have the assurance a specialist is always available to provide extra care for their newborn. In addition to the expertise of the neonatologists, the NICU at Plantation General employs a top-notch nursing staff. All the nurses in the NICU have been trained in neonatal intensive care, and they keep up-to-date on the latest advances by attending seminars throughout the year. In addition to being knowledgeable, the nursing staff is also experienced. "One of the strengths of our NICU is its stability," says Barry Chandler, M.D., neonatologist and medical director of the NICU at Plantation General. "We've had the same nursing staff for many years. Because of this stability, we've built an excellent relationship with one another and function as a truly integrated team. Parents see this, and they know we are providing their babies with unified care. In a stressful environment, this has a calming effect on parents." This integrated care can be seen every Monday in the NICU during group rounds. "During these rounds, an interdisciplinary team consisting of a case manager, nurse practitioner, neonatologist, respiratory therapist, nurse and lactation consultant visits each and every newborn's bedside to discuss the baby's care," explains Donna Nicorgski, director of Plantation General Hospital's NICU. "All the disciplines are involved and offer their input. This type of communication has improved the quality of care for our infants."

Family-Centered Care When a newborn needs extra care, the staff at Plantation General's NICU knows that it's not only the baby who is affected. While providing the highest quality care for the newborn, the NICU staff also seeks to meet the needs of the family in a variety of ways. Lean on Us The days, weeks, or months a newborn spends in NICU can be a trying time for parents. To help ease parents' concerns, the NICU offers a monthly Parent Support Group. "Parents who had premature babies are invited to come back and talk with parents of babies who are currently in the NICU," explains Nicgorski. "This gives parents firsthand experience with people who understand what they are going through." This level of communication goes a long way to ease parents' concerns, and it isn't just confined to support group meetings. Families speak with a nurse practitioner every day, and a doctor is always available when the family has questions or concerns. The nursing staff at Plantation General works to assure families they aren't isolated from their newborn just because the baby is in NICU. "Because parents want to be in the NICU when it's convenient for them, we offer open visitation. Parents can visit any time, night or day," says Nicorgski. "The only time the NICU is not open is during a shift change or in an emergency." Open visitation gives parents the opportunity to interact with their newborn and learn how to care for their baby. When babies are more stable, this interaction may take the form of Kangaroo Care. "Studies have shown that skin-to-skin contact helps babies grow, stabilizes their temperatures, and provides important bonding time with parents," explains Nicorgski. Aptly named after the kangaroo's practice of carrying its newborn close to its body in a pouch, Kangaroo Care at Plantation General offers parents the opportunity to sit in a private area and hold their newborn next to their bare skin. Breastfeeding Options A baby in the NICU may not be able to breastfeed immediately. To assure that babies start with mothers' milk, women who plan to breastfeed can store their pumped breast milk and colostrum in an on-site freezer until it's needed. Plantation General also has a lactation center. To assure that moms who haven't been able to breastfeed immediately are successful, lactation consultants are available to work with new moms one-on-one. Lactation consultants offer "Breastfeeding Your Baby" classes before delivery, and upon request, they meet with new moms after delivery.

CPR Classes The staff at Plantation General's NICU wants parents to feel confident caring for their baby at home. To increase parent's confidence, Plantation General holds infant CPR classes once a week for families with babies in the NICU. "A large number of the babies in our unit were born premature," says Nicorgski. "These classes, led by nurses certified in teaching CPR, help parents feel more comfortable when they take their baby home." More Than A Day's Work "Working in the NICU has been very rewarding," says Dr. Chandler. "In 1986, for example, we cared for the smallest, surviving premature baby --she was only 21 weeks gestation. Now she's 14 years old." Nicorgski agrees that the rewards of the job are many. "All the nurses in the unit love their work, and it shows in how they care for the babies," she says. "It's extremely satisfying to work with these babies so they can go home with their parents. It's especially rewarding when parents come back with their children to visit us." Neonatal Intensive Care Unit (NICU) The birth of a baby is a wonderful yet very complex process. Many physical and emotional changes occur for mother and baby. A baby must make many physical adjustments to life outside the mother's body. Leaving the uterus means that a baby can no longer depend on the mother's circulation and placenta for important physiologic functions. Before birth, breathing, eating, elimination of waste, and immunologic protection all came from the mother. When a baby enters the world, many body systems change dramatically from the way they functioned during fetal life: * The lungs must breathe air. * The cardiac and pulmonary circulation changes. * The digestive system must begin to process food and excrete waste. * The kidneys must begin working to balance fluids and chemicals in the body and excrete waste. * The liver and immunologic systems must begin functioning independently. Image Your baby's body systems must work together in a new way. Sometimes, a baby has difficulty making the transition to the world. Being born prematurely, having a difficult delivery, or birth defects can make these changes more challenging. Fortunately for these babies, special newborn care is available. What is the neonatal intensive care unit? Image Newborn babies who need intensive medical attention are often admitted into a special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced technology and trained healthcare professionals to provide specialized care for the tiniest patients. NICUs may also have intermediate or continuing care areas for babies who are not as sick but do need specialized nursing care. Some hospitals do not have the personnel or a NICU

and babies must be transferred to another hospital. Although about 9 percent of all newborn babies require care in a NICU, giving birth to a sick or premature baby can be quite unexpected for any parent. Unfamiliar sights, sounds, and equipment in the NICU can be overwhelming. This information is provided to help you understand some of the problems of sick and premature babies. You will also find out about some of the procedures that may be needed for the care of your baby. Which babies need special care? Most babies admitted to the NICU are premature (born before 37 weeks of pregnancy), have low birthweight (less than 5.5 pounds), or have a medical condition that requires special care. In the US, nearly 12 percent of babies are born preterm, and many of these babies also have low birthweights. Twins, triplets, and other multiples often are admitted to the NICU, as they tend to be born earlier and smaller than single birth babies. Babies with medical conditions such as heart problems, infections, or birth defects are also cared for in the NICU. The following are some factors that can place a baby at high risk and increase the chances of being admitted to the NICU. However, each baby must be evaluated individually to determine the need for admission. High-risk factors include the following: * maternal factors: o age younger than 16 or older than 40 years o drug or alcohol exposure o diabetes o hypertension (high blood pressure) o bleeding o sexually transmitted diseases o multiple pregnancy (twins, triplets, or more) o too little or too much amniotic fluid o premature rupture of membranes (also called the amniotic sac or bag of waters) * delivery factors: o fetal distress/birth asphyxia (changes in organ systems due to lack of oxygen) o breech delivery presentation (buttocks delivered first) or other abnormal presentation o meconium (the baby's first stool passed during pregnancy into the amniotic fluid) o nuchal cord (cord around the baby's neck) o forceps or cesarean delivery * baby factors: o birth at gestational age less than 37 weeks or more than 42 weeks o birthweight less than 2500 grams (5 pounds, 8 ounces) or over 4,000 grams (8 pounds, 13 ounces) o small for gestational age o medication or resuscitation in the delivery room o birth defects o respiratory distress including rapid breathing, grunting, or apnea (stopping breathing) o infection such as herpes, group B streptococcus, chlamydia o seizures * hypoglycemia (low blood sugar) * need for extra oxygen or monitoring, intravenous (IV) therapy, or medications o need for special treatment or procedures such as a blood transfusion Who will care for your baby in the NICU? The following are some of the specially trained healthcare professionals who will be involved in the care of your baby: * neonatologist - a pediatrician with additional training in the care of sick and premature babies. The neonatologist supervises pediatric fellows and residents, nurse practitioners, and nurses who care for babies in the NICU. * respiratory therapists

* occupational therapists * dietitians * lactation consultants * pharmacists * social workers * hospital chaplains The members of the NICU team work together with parents to develop a plan of care for high-risk newborns. Ask about the NICUs parent support groups and other programs designed to encourage parental involvement.