The Importance of an On Site NICU

Deborah Howell:: MemorialCare health system. Excellence in health care, presents weekly dose of wellness. Here's your host, Deborah Howell:. Hello and welcome to our show today. You're listening to A Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell:. Today's guest is Doctor Ronald Naglie. Dr. Naglie attended McGill University Medical School and completed his pediatric residency and neonatology fellowship at the University of Michigan. He is board certified in pediatrics and neonatal perinatal medicine. In 1994, Dr. Naglie became the NICU Medical director at Saddleback Memorial. Welcome to you, Dr. Naglie.

Dr. Ronald Naglie: Thank you very much.

Deborah Howell: Today, we're going to be talking about the importance of an on site NICU. First of all, what is an NICU?

Dr. Ronald Naglie: Well, NICU stands for a neonatal intensive care unit. So basically it's a specialized unit, that's, created to address the needs of any newborn, presenting with various medical problems.

Deborah Howell: Okay. And how does a NICU differ from other types of ICUs?

Dr. Ronald Naglie: Well, the interesting thing about that is that if you look at, intensive care units in general, the word “intensive” obviously implies what is going on is that you have a patient that has a significant acute problem. Where it differs in the neonatal intensive care unit is we do obviously admit babies at the outset that present with some kind of an acute, intensive problem. But we keep those babies throughout the rest of their hospitalization. So as opposed to, for example, in a pediatric or an adult ICU where once a patient gets over their acute phase of their illness, they get transferred to some other unit within the institution. In this case, these babies stay with us from the beginning all the way until they are discharged, hopefully to the home environment.

Deborah Howell: That is heartwarming to hear. How much did the smallest and largest babies get in the NICU at SMC weigh?

Dr. Ronald Naglie: Well, I think what it shows you is kind of the vast variety of what we look after in a NICU so it happens that at Saddleback, our smallest baby weighed in at 14, ounces, which is the equivalent of 400g. The largest baby we had here, admitted to be an issue was 14 pounds and two ounces. Your equivalent, if you had an adult, 70 pound adult, you'd be looking after someone from 70 pounds up to 1,120 pounds. So it shows you you have quite a broad spectrum of, patient size and types that you do look after in an NICU.

Deborah Howell: I can't even imagine what the smallest of the babies that you administer beautiful care to, how difficult some of the challenges are.

Dr. Ronald Naglie: It obviously is something that requires a very specialized team, to be able to handle these things and have the appropriate training. it also requires the entire, as you can imagine, hospital to have support services that are, appropriate for that kind of a patient. It's a very different, if you're doing a blood test on, grown adults versus on a 14 ounce baby, and many of the other tests studied. So really requires that you have the entire, multidisciplinary approach to looking after these kind of specialized patient.

Deborah Howell: Let's talk a bit about those specialized teams. What are some of the teams?

Dr. Ronald Naglie: Well, it really I guess it's they often say it takes a village. Well, this is true because obviously we have specialists like myself which are the neonatologist, and we're specialized physicians that have gone through, fellowship training to look after these kinds of patients. But that's just the tip of the iceberg. there's the NICU nursing staff, and again, these are people that they've gone through their nursing and now have specialized very much, attuned to the specific needs of the population that we deal with. We have respiratory therapists that help with various types of, ventilator support and other kinds of, respiratory support that we often have to provide to these patients. The folks that, come up from radiology, from nutrition, all these other aspects of the hospital pharmacy, that have to have familiarity with what are the specific needs when you deal with a patient that the small and often from a gestational age standpoint, very early, very much before term gestation and just the way their system works and the demands are very different than it would be, even for a full term newborn. So those kind of challenges, and that's why it's very important that you have, all of these areas covered and have the appropriate support, personnel as well as equipment to be able to deal with these, demands.

Deborah Howell: Absolutely. And now, at what point, doctor, is the decision made to move a baby into the NICU?

Dr. Ronald Naglie: There's a lot of different ways that a baby would end up being admitted to the NICU. many of the things actually can, be determined even before, birth. Nowadays, with the advancements in, various types of testing, ultrasounds, etc., that a mom may go through during her pregnancy, we can often identify, something going on with that fetus that would require that that at the time of birth, that that baby does get admitted to the NICU to address those issues. The some of the decision is actually made even before, birth. Many of the instances then occur, at the time of birth, and it relates to one of the priorities relates to just how old gestational age that baby is. And as I mentioned earlier, a full term baby would be, 38 to 40 weeks gestation. Babies that are born, basically 34 weeks or less. Those baby babies automatically do have to get admitted to the NICU after they're born because of some of the problems that they may have, basically adapting to, being born. Once you get beyond 34 weeks gestation, it depends again on the individual baby, whether they need intensive care or not. So gestational age does come into play as sometimes an automatic admission. Other things that occur, may relate to the baby at the time of birth, presenting with breathing problems, or other signs or symptoms that the baby needs additional support for the baby may need at that time of delivery. Then, the other group that we, will get admitted to the NICU is a baby whose has done fine. Born. There aren't any, complications to note at birth. That baby, in parents room, basically post delivery and everything's going fine. And at some point during the, family's hospital stay, the babies start present with any kinds of signs of symptoms that there is a problem going on. And that could be things like infection. It could be babies who are having problems maintaining their blood sugars. So there are things that evolve after the baby's birth, that were unanticipated, that prior to present themselves and then warrant that that baby has to be moved into the neonatal intensive care.

Deborah Howell: Understood. Maybe you can take us inside the NICU or the NICU at Saddleback Memorial. I know there are three levels. Maybe you can, itemize those for us.

Dr. Ronald Naglie: Yeah. What happens is, the designations for, NICUs, and actually, they've expanded that in the not too distant past to actually four, and what it starts out with is what would be referred to as a level one would be a basic, normal nursery, meaning there aren't really advanced, care available for a baby, as I said, other than a healthy newborn. And pretty much any baby that would present with any thing above that would require going into a next level. Level two generally refers to and then ICU that would look after certain kinds of patients, down to certain gestational ages, but maybe not some of your very, very, early gestational ages, and go down to certain size of babies. And as I mentioned before, we had a baby at that back that was 14oz. and a level two wouldn't get down to babies that are that tiny because they have specific needs. When you get to a level three such as Saddleback, and we're referred to as a community level three, we would look after any pre-term baby down to the earliest the pre terms, which viability, probably for babies, goes down to as low as 23 weeks gestation as at least possible viability. And right through the gambit. So we don't we're not restricted by size or gestational age in term, that wasn't the thing. and can care for most of the babies we, look after, certain kinds of heart diseases. But we wouldn't do the more complex, cardiac surgery that would require going to a higher level. And then we also, now undertake various kinds of pediatric or neonatal surgeries that may be required, that we could look after. so it kind of relates to the levels tend to relate to the spectrum or to what level you can, give care when you get to what I refer to as a level four, that becomes more of a specialized referral center. So we pretty much can handle up to most of things that would be required for, for pretty much the vast majority of newborn, and only would require a, a smaller percentage that, would not be able to be cared for

Deborah Howell: Okay. Understood. I have one final question for you. What is the importance of having an NICU on site?

Dr. Ronald Naglie: I think it's kind of most of us may not like to buy insurance, but we generally do buy insurance and find that when you need it, you really want to have it. And that's how I guess I look at a NICU. That the good news is the vast majority of pregnancies result in healthy, happy babies, and that's obviously what we all hope for. On the other hand, there definitely is a percentage of instances where that isn't the case. And to be able to at an instant moment, be able to provide the support. Keep that baby, on the premises, the same site as the mom would be in her recovery. So you're not having to separate families, is obviously of great importance. And I think the other thing that it not only is bringing the actual physical facility where the baby could go to, but it brings a level of expertise into the hospital that's here, 24/7. So in many instances in a situation, if you don't have that presence, perhaps something would get unnoticed or be allowed to go for a longer period of time before some expertise was brought into the situation.

Deborah Howell: Thank you. I'm sorry I have to stop you there, Dr. Naglie, because we are out of time. Thank you so much to Dr. Naglie. I am Deborah Howard. Please join us again next time for weekly dose of Wellness. Have a great day.