NICU

Your hospital will probably define a "newborn period" ie. 14 days, and NICU will take anything still falling in the newborn period.

Free standing NICUs yes will take some babies "off the streets" lol. These will include the following: jaundice/exchange transfusion babies who have been home already, babies who have had a seizures at home, query cardiac babies who need to be worked up, late onset sepsis.

Depending on how many isolation beds you have these babies may be prioritised to these rooms but it really depends. Some units might send swabs and then move the kid into general population after they come back.

These Childrens hospital NICUs tend to get lots of surgical babies born nearby because they have the pediatric surgeons. They also end up with a lot of older chronic prems that may have come in with NEC, perf, PDA need ligation or hydrocephalus. They are also where babies from other NICUs will need to go if they need a trach.

Hi,

If you don't mind my asking what state? I have been pondering a move for quite some time now and am just looking for options.

Annie

When I was in nursing school, one of the children's hospitals was attached to an adult hospital (with L&D). The hospital group purchased another hospital a few miles away. They started closing down the redundant units including the L&D dept in the hospital attached to the Children's hospital. That was a very bad mistake. Instead of transporting babies from L&D to the NICU through the tunnel, now they needed to be transported by ambulance the 2 miles to the NICU. Moms that were still in the hospital had to wait until they were discharged to see their baby. Every large Level III/IV NICU that I know are either in a children's hospital attached to an adult hospital or a women's hospital with a L&D.

My previous freestanding pediatric hospital did have a very small low risk L&D, but unless mom was healthy she couldn't labor there. The vast majority of patients came as transfers from other hospitals. If the patient needed admission the NICU would not take any infant at home for more than two days or suspected to have a communicable disease, if they needed critical care they would be admitted to the PICU. There were some babies who would stay in the NICU well into their second year of life and started talking, though in my opinion this was a bit ridiculous.

My current medical center has an adult and pediatric hospital in the same medical center. Our level IV NICU generally takes infants AGA up to 3 months, after that they are admitted or transferred to the PICU for critical care. We do not stop 'dirty' babies from being admitted, we have negative flow rooms for a reason, however most that were discharged home do not necessarily require critical care and may be admitted to the floor. Our ECMO babies are admitted to the PICU regardless of age or gestation due to proximity to the CV OR.

That's not true for the Midwest. I have worked in 3 freestanding Children's hospitals (2 very large and one largish) and none of them were attached to adult hospitals or had L&D. Infants needing intensive level 3 or 4 care were transported by specialized neo/peds transport teams based in the receiving children's Hospital.

I'm curious to know why it was a "very bad mistake"? Neonatal transport has been going strong for decades and found to be very safe.

It's ultimately safest for the baby to be born in a tertiary center rather than be transported, especially micropreemies. I remember transporting a fresh 24 weeker on a small plane once and all I could think about on the ambulance ride to the plane, plane ride, and then ambulance ride to the hospital were all the bumps and pot holes we hit and wondering about this poor baby's head.

You're right that babies probably won't die over a transport (and it was a joke in one of the places where I worked, "no one dies in the ambulance! keep doing CPR until you get to the ED!"-luckily never had that scenario), but outcomes and co-morbidities are likely somewhat different.

I'm curious to know why it was a "very bad mistake"? Neonatal transport has been going strong for decades and found to be very safe.

It has nothing to do with the safety of transport. Do you not see the convenience of transporting the babies via tunnel between the adult hospital and the children's hospital is a lot less complicated and less traumatic than transporting a baby via ambulance? It costs very little money to move the baby via the tunnel instead of ambulance. In addition to time factor. The baby could be moved immediately after delivery via the tunnel. Ambulance could take 30 minutes to several hours depending on the crews demand for the day (they transported neonatal and pediatrics in a 200 mile radius). The mothers are also separated from their baby with little chance of seeing their baby until the mother's discharge. After 3 yrs, the hospital system determined they made a mistake and moved the high risk L&D department to the children's hospital.