When your Baby Needs NICU Care

This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. You are listening to Weekly Dose of Wellness, brought to you by MemorialCare Health System. I am Deborah Howell. Today, our guest is Dr. Penny Jacinto, Medical Director of the NICU and Chief of Pediatrics at Orange Coast Memorial Medical Center. She's with us today to discuss the reasons why your baby may need NICU care and what to know and expect if they do. Welcome, Dr. Jacinto.

Penny Jacinto, MD: Good morning, Deborah.

Deborah Howell (Host): What is a NICU, please?

Penny Jacinto, MD: The NICU is short for Neonatal Intensive Care Unit, so all the four letters are there. It's a hospital department specializing in the care of ill newborns or premature infants. In the NICU, it's a combination of advanced technology. You have well-trained healthcare personnel to provide care for the tiniest and the sickest babies.

Deborah Howell (Host): Okay, so that kind of answers a question I had in the back of my mind. What are some of the reasons a baby would need specific NICU care?

Penny Jacinto, MD: Most of the infants admitted to the NICU are born prematurely. Here at Orange Coast, if they're less than 2,000 grams or they're less than 35 weeks they automatically get admitted to the NICU. So twins, triplets, and other multiples are admitted to the NICU as they tend to be smaller and they are born earlier than the single infants. Almost like half a million babies are born prematurely and many of them have low birth weight. So just to make it clear, not all NICU babies are preterm. Some are full-term babies, but they may have like a medical condition that requires special care. Those who are born with congenital heart problems, birth anomalies, or babies that have to be treated for infections can also be admitted to the NICU.

Deborah Howell (Host): So, Doctor, what are some of the risk factors that can contribute to a premature birth?

Penny Jacinto, MD: Once you have a premature delivery, you're for certain that there's a higher chance of having another baby. And multiples, like twins, triplets, they tend to deliver earlier because, like, the placenta is made only for a room for one. So a room for two, you need to push one baby out sooner. Like pregnancies that occur with an interval of, like, less than six months in between pregnancy. Mother's problems like if they're atomical problems with the uterus, her cervix, or her placenta. And maternal problems like poor maternal nutrition, if she does illicit drugs or if she smokes cigarettes. Or chronic conditions like if the mother's obese or has high blood pressure or is diabetic. Those are the ones that are prone to deliver earlier.

Deborah Howell (Host): I see.

Penny Jacinto, MD: And it’s been shown, also Debroah, I think that if mother is less than 16 years old or above 35, there would be a higher risk for preterm delivery.

Deborah Howell (Host): Wow above 35. It seems like that age gets lower and lower. What are the survival rates of babies who are born preterm, and how does having immediate NICU care for preterm babies really help with their survival rate?

Penny Jacinto, MD: The infants born with the lowest gestational age, meaning like if you're 25 weeks or less, and their birth weights and low birth weights have the largest impact on infant mortality. Let's say they're less than 1,000 grams or less than 2 pounds. They account for only less than 1% of the births in the United States, but they comprise like 50% of the death rate in the United States.

Deborah Howell (Host): I see.

Penny Jacinto, MD: The survival rates of the preterm vary depending on both their gestational age and their birth weight. So let's say you're born greater than 32 weeks, your survival rate is higher. It's like 98% versus if you're born less than 25 weeks, your survival rate is down to 50 to 80%. So having an immediate NICU care allows for like life-saving and critical service made readily available for the infants who are born ahead of time.

Deborah Howell (Host): So if you're pregnant, know where your NICU units are nearby.

Penny Jacinto, MD: Right. It has to be a joint decision between the parents and the obstetrician because they know what's best for their baby.

Deborah Howell (Host): Okay. Maybe you can explain the different levels of NICU care and why it's so important for you to know the level of NICU care the hospital you will give birth at actually has.

Penny Jacinto, MD: Okay. There are actually four levels of neonatal care, of NICU care. And in 2012, I think that's when the American Academy of Pediatrics Committee on the Fittest and Newborn reviewed the data supporting the evidence of the tiered provision of neonatal care. Like, let's say, Level 1 is a hospital nursery. They're able to perform neonatal resuscitation, postnatal care of the healthy newborns. They can provide care for babies who are born at 35 to 37 weeks who are physiologically stable. They're also able to take care of babies born less than 35 weeks in transition to another facility which would be able to take care of these babies. And then you have a Level 2, which is a hospital special care nursery. They're able to take care of babies greater than 32 weeks or greater than 1,500 grams or more than three pounds. They can have problems like apnea of prematurity. There could be problems like inability to maintain their temperature or not able to feed by nippling. And they're able to also provide mechanical ventilation babies on the respiratory there and continuous air pressure for a brief period of time. And then those are the first two levels. And Level 3 units have personnel and equipment to provide continuous life support for the extremely high-risk newborn infants. They have pediatric surgical specialists. They have medical subspecialists and advanced imaging with interpretation. In the last level, the highest level is Level 4, which has a level 3 capability, but they are able to perform on-site surgical repair of serious congenital or acquired malformations. and they're also able to transport babies, facilitate transport, and provide education for the community hospitals around them. So it's important for a parent to know what level of NICU the hospital she will deliver has for ones who are diagnosed with congenital heart defects or abdominal defects, then it's best that she deliver in a hospital with a level 4 NICU.

Deborah Howell (Host): For sure, and it's also important for her to know that not every hospital has a NICU on site, right?

Penny Jacinto, MD: Right. And then what we have, Deborah, we have maternity tours every month. So the parents are aware of what's available for them, the resources and how the NICUs are run, how the newborn nursery and postpartum services are run as well.

Deborah Howell (Host): Oh, that's awesome. I hope people take advantage of that.

Penny Jacinto, MD: Okay. And then usually we encourage the neonatologist to be there. So if they have any questions, not to scare them that the babies would be admitted to the NICU, but at least they know if something's wrong with a term delivery, we're always there to help though.

Deborah Howell (Host): Right, right. That's just, I can imagine the degree of security that gives a mother who's about to have, say, her first child or children, you know, just to know you're there and that that's exactly what you do on many, many levels.

Penny Jacinto, MD: Mm-hmm.

Deborah Howell (Host): What's the most important thing for expectant mothers to know about NICU care?

Penny Jacinto, MD: Well, what I'd like to tell them is like having a baby, a normal baby is stressful, but very stressful if the baby ends up being in the natal intensive care unit in the NICU. But what I was assuring to them should be that the healthcare personnel treat their patients as though they were their own babies. So they're assured of the highest quality of care for their infants. And the healthcare personnel, they're composed of neonatologists who are trained doctors, experienced nurses, therapists, and social workers who work hand-in-hand in the planning for the most optimal outcome for their babies. And it's an ICU patient-friendly, so it has allowed maximum involvement of parents taking care of their babies. There's like an Orange Coast, there's a family-centered care system, and it's designed to ensure the privacy, the safety, and the protection of both parents and their infants.

Deborah Howell (Host): Dr. Jacinto, thank you so, so much for your time today. It's been very enlightening and very comforting to know that you're there, and on many, many levels, we really got their back, and you're there for the entire family, not just their baby.

Penny Jacinto, MD: Oh, thank you very much, Deborah. You have a good morning.

Deborah Howell (Host): You too, and we'd love to have you back. And please, I know you've had a very long night. I hope you get some rest over the weekend.

Penny Jacinto, MD: I know. Thank you very much, Deborah. I hope to talk to you again.

Deborah Howell (Host): To listen and find out more about these wonderful services available to you at NICU, by all means, please visit memorialcare.org. That's memorialcare.org. And join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. I'm Deborah Howell. Have yourself a terrific day.