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The Importance of an On Site NICU

While Saddleback Memorial plans for perfect deliveries and healthy babies, it has an on-site level III Neonatal Intensive Care Unit (NICU) and an expert team dedicated to caring for medically fragile infants who require special attention.

This special unit provides piece of mind knowing that should the need arise, Saddleback Memorial can provide immediate, advanced care for your newborn.

Dr. Ronald Naglie, M.D. come on the show to discuss how a NICU differs from other types of "ICU's" and to describe the importance of the multidisciplinary approach to pregnancy, delivery and baby's post-delivery care.

 The Importance of an On Site NICU
Featured Speaker:
Dr. Ron Naglie, MD
Dr. Naglie attended McGill University medical school. He completed his Pediatric residency and Neonatology Fellowship at 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.

Organization: Saddleback Memorial - Laguna Hills

Deborah Howell (Host): Hello and welcome to our show today. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell. Today's guest is Dr. 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 (Guest): Thank you very much.

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

Dr. 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: Okay. How does a NICU differ from other types of ICUs?

Dr. Naglie: Well, the interesting thing about that is 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, 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.

Deborah: Right.

Dr. Naglie: In this case, these babies stay with us from the beginning all the way until they are discharged, hopefully, to the home environment.

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

Dr. Naglie: I think what it shows you is the vast variety of what we look after in the NICU. So it happens that at Saddleback, our smallest baby weighed in at 14 ounces, which is equivalent to 400 grams.

Deborah: Wow.

Dr. Naglie: The largest baby we had here admitted in the NICU was 14 pounds and 2 ounces. Equivalent if you had a 70-pound adult, you'd be looking after someone from 70 pounds up to 1,120 pounds. So it shows you that you have quite a broad spectrum of patient size and types that you do look after in an NICU.

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

Dr. 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 could imagine, hospital to have support services that are appropriate for that kind of patient. It's very different if you're doing a blood test on a grown adult versus on a 14-ounce baby and many of the other tests and studies. So really, it requires that you have the entire multidisciplinary approach to looking after these kinds of specialized patients.

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

Dr. Naglie: I guess they often say it takes a village. Well, this is true because obviously, we have specialists like myself, which are the neonatologists, 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 have gone through their nursing and now have sub-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 the patient this small and, often, from a gestational age standpoint, very early, very much before term gestation. Just the way their system works and the demands are very different than it would be even for a full term newborn.

Deborah: Yes.

Dr. Naglie: So it poses those kinds of challenges, and that's why it's very important that you have all of these areas covered and have the appropriate support, both personnel as well as equipment, to be able to deal with these demands.

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

Dr. 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, et cetera—that a mom may go through during her pregnancy, we can often identify something going on with that fetus that would require at the time of birth of that baby does get admitted to the NICU to address those issues. So, some of the decision is actually made even before birth. Many of the instances then occur at the time of birth, and one of the priorities relates to just how old, gestational age, that baby is. And as I mentioned earlier, full term baby would be 38 to 40 weeks gestation. Babies that are born basically 34 weeks or less, those 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.

Deborah: Sure.

Dr. Naglie: 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. It's 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 this baby needs additional support. It may be me made right at that time of the delivery. Then, the other group that will get admitted to the NICU is the baby who has done fine, born, there aren't any complications to note at birth, that baby is in parent's room basically post-delivery and everything's going fine, and at some point during the family's hospital stay, the baby starts to presents with any kinds of signs or symptoms that there is a problem going on. 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 but start to present themselves and then warrant that baby has to be moved into the neonatal intensive care unit.

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

Dr. Naglie: Yes. What happens is the designations for NICU. And actually, they've expanded that in the not too distant past to, actually, four. What it starts out with is what would be referred to as the 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. Pretty much any baby that would present with anything above that would require going into a next level. Level two generally refers to an NICU 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. As I've mentioned before, we had a baby at Saddleback who was 14 ounces, 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 preterm baby down to the earliest of pre-terms, which [viability] probably for babies to go down to as low as 23 weeks gestation as at least possible viability. And it runs through the [gambit]. So, we're not restricted by size or gestational age in terms of those kinds of things 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 surgeries; that would require going to a higher level. We also now undertake various kinds of pediatric or neonatal surgeries that may be required that we could look after. So, the levels tend to relate to the spectrum or to what level you can give care. When you get to what I referred to as a level four, that becomes more of a specialized referral center. So we pretty much can handle up to most of the things that would be required for pretty much the vast majority of newborns and only would require a smaller percentage that would not be able to be cared for.

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

Dr. Naglie: Most of us may not like to buy insurance, but we generally give by insurance and find that when you need it, you really want to have it. That's how I guess I look at an NICU. 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, provide the support to keep that baby on the premise, at the same site as the mom would be in her recovery, not having to separate families is obviously of great importance.

Deborah: Yes.

Dr. Naglie: And I think the other thing that it's not only 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 present, perhaps something would get unnoticed or be allowed to go for a longer period of time before some expertise was brought into the situation. Unfortunately that could result...

Deborah: Well, 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 Howell. Please join us again next time for Weekly Dose of Wellness. Have a great day.