NICU

• Certified neonatologist and neonatal nurse practitioner on site 24/7
• 24-hour neonatal transport team
• Direct admission
• Respiratory therapist on site 24/7
• Highly secured area with state-of-the-art infant security
• CPR training provided to parents and caregivers
• Cuddle program
• Dedicated case manager for the Level III NICU and obstetric areas
• Dedicated support staff in physical therapy
• Donor milk program
• Halo program
• Long-term nutritional support with total parenteral nutrition
• Neonatal speech therapists with specialized training in infant feeding
• Nitric oxide capabilities for persistent pulmonary hypertension
• Parent-baby classes
• Follow-up care
• Bereavement committee with grief counseling

Care is provided for infants of the following ages:

A full-term pregnancy lasts 39 to 42 weeks.  Some infants born during this time need intensive care for problems related to infection, pneumonia, feeding difficulties and/or birth abnormalities. Other full-term infants may need intensive care because of maternal diabetes or problems that may have occurred during labor and/or delivery.

Infants born four to six weeks early typically weigh between four and seven pounds. Many of these infants experience little difficulty after birth, while others may have significant problems maintaining normal blood sugar levels or learning to eat. Some of these infants require oxygen for a few days by oxygen hood or nasal cannula. Others may require a breathing machine. Premature infants often need an incubator to help maintain their body heat to conserve energy.

Infants between 30 and 33 weeks of gestational age are born seven to ten weeks early. Infants born at this time weigh an average of 2.5-4 pounds and need monitoring in an intensive care environment. Often, these infants need some help breathing, which may be in the form of a breathing machine (ventilator), continuous positive airway pressure (CPAP) or oxygen by nasal cannula. Infants born at this time need a tiny feeding tube inserted in their nose or mouth to help them receive nutrition until they are mature enough for breast or bottle feeding.

Infants born at this gestation weigh an average of two to four pounds. Their skin is thin and there is minimal fat. Infants born 10 to 13 weeks early may need ventilator support and may receive artificial surfactant to help their lungs mature more quickly. Intravenous nutrition is important for several weeks as these infants gradually adjust to increasing breast milk or formula volumes through tube feedings. It is often a month or more before these infants are mature enough to try breast or bottle feeding.

Infants born at this gestation weigh an average of 1.5-2 pounds or less and need significant support at the time of delivery because all their organs are very immature. The skin is very thin and can be bruised easily. Lungs are not developed at this age. At birth, the baby may have a weak but audible cry and poor respiratory effort requiring the immediate insertion of a breathing tube and support with a ventilator. These infants benefit greatly from an artificial form of surfactant, a medicine given directly into the lungs through a breathing tube. This helps prevent the fragile air sacs from collapsing.

We encourage you to be with your baby as much as you wish. However, we ask that only four people be at the bedside at one time unless told otherwise. Visitors must be with a parent. Sibling visitation must go through the charge nurse or nurse leader. This enables us to provide a quiet, nurturing environment while maximizing our ability to care for your baby. Additional visitors may wait in the waiting room. Visitors must be over 18 years old unless siblings of the infant.

To ensure privacy during shift change, parents and visitors will be asked to wait in the waiting room during these times (6:30am – 7:30am, 6:30pm – 7:30pm, or until shift change has finished).

Please help protect your baby by telling your family and friends not to visit if they have a cold, cold sores, rashes, chicken pox, intestinal problems or other infectious diseases. Babies are very vulnerable to infections and can easily get sick from visitors. If you are in doubt about whether or not you or a relative should visit, please talk to your baby’s nurse.

To limit your baby’s exposure to illness, we want to let you know sibling visits are approved on a case-by-case basis depending on factors including the health of the sibling (no fever, runny nose, recent illness, for example) and whether there is a high prevalence of viruses such as flu in the community at that time. Prepare children ahead of their visit by describing what they can expect to see, including the special equipment. An adult must supervise children at all times. Since children may have short attention spans, we recommend limiting sibling visits to 20 minutes or less. We try to maintain a quiet environment in the NICU for your baby. We may ask your children to quiet down or leave the area if they become noisy.

With the private rooms in the NICU at Johnston-Willis Hospital, we can re-admit babies who have been discharged directly to the NICU without needing to come through the emergency room.

Re-admission criteria

To be re-admitted to the NICU, the following criteria must be met:

• Less than 30 days old or
• Less than 44 weeks corrected gestational age
• No obvious contagious disease process (RSV, COVID-19 or flu)

Note: If the baby is in the emergency room, we would like respiratory panel and COVID-19 swabs taken, if possible, but we do not need to wait for results for admission to the NICU.
Most common candidates for readmission include by are not limited to:

• Hyperbilirubinemia
• Hypothermia
• Poor feeding (especially in late preterm gestation infants: 34-37 weeks)
• Former NICU baby
• Failure to thrive

If the baby presents at the Johnston-Willis emergency room, consult with the neonatologist for admission to NICU.

If the baby is at Chippenham, consult with Peds/PICU, and they will determine whether the baby should be transferred or admitted to Peds.

We also take babies at high risk for exchange transfusion and babies less than 35 weeks gestation at birth that are still less than 30 days or 44 weeks corrected, who present to the Chippenham emergency department or upon referral from a Peds hospitalist/intensivist. The threshold for bilirubin level is 20. Any baby with a bilirubin level greater than 20 will be referred to the neonatologist.

If a pediatrician wishes to send babies who meet the age criteria to Johnston-Willis Hospital directly to the NICU, they need to reach out to the neonatologist.

We can take and/or transport infants who meet age criteria from other facilities as well. We have a neonatal transport team in-house for all neonatal transports. Additionally, our medical transport helicopter, Air Care Eagle (ACE), is fully equipped to facilitate NICU and newborn transports.

If you have any questions or for direct admit, please reach out to the Johnston-Willis NICU at (804) 483-6350.