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NICUs: What is a small baby unit?

Small baby units take the neonatal intensive care unit (NICU) concept to a new level by specializing in the care of the smallest babies – known as micro-preemies – born at fewer than 27 weeks gestation and/or weighing less than 1,000 grams (2.2 pounds).  The design of the units, which are part of a larger NICU, includes providing a dark, quiet environment.  Parents are encouraged to participate in skin-to-skin care (SSC) techniques that fosters bonding, such as Kangaroo Mother Care.  Caregivers are teamed up to deliver two-person care when the micro-preemies need to be touched.  As the babies grow, they may be transitioned out of the small baby unit to the NICU.

Hospitals with Small Baby Units (this is not a comprehensive list)

  • Advocate Lutheran General Hospital (Park Ridge, IL)
  • Children’s Hospital (Orange, CA)
  • Greenville Health System (Greenville, SC)
  • Helen Devos Children’s Hospital (Grand Rapids, MI)
  • Mercyhealth Hospital-Rockton Avenue (Rockford, IL)
  • Nationwide Children’s Hospital (Columbus, OH)

Sources:

Gonya, J., and others. (2017). Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: A retrospective cohort study. BMJ Open, 7.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372108/pdf/bmjopen-2016-012985.pdf

GHS launches NICU small baby unit. (2017, May 12). WSPA-TV. http://wspa.com/2017/05/12/ghs-launches-nicu-small-baby-unit/

Jackson, A. (2015, December 9).  Born at 25 weeks weighing less than 2 pounds, ‘spunky’ girl survives in small baby unit. MLive. http://www.mlive.com/news/grand-rapids/index.ssf/2015/12/small_baby_nicu_at_devos_child.html

Morris, M., Cleary, P., and Soliman, A. (2015, October). Small baby unit improves quality and outcomes in extremely low birth weight infants. Pediatrics, 136(4).  http://pediatrics.aappublications.org/content/pediatrics/136/4/e1007.full.pdf

Watley, K. (2017, February 6). Mercyhealth in Rockford opens region’s first small baby unit to care for micro-preemies. https://mercyhealthsystem.org/mercyhealth-opens-small-baby-unit-rockford/

Woloshyn, E. (2017, April 20). Special unit mimics mother’s womb. Health enews.

http://www.ahchealthenews.com/2017/04/20/special-unit-mimics-mothers-womb/  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

BEST PRACTICES: Implementing a quality improvement bundle for care of high risk infants in the delivery room

This was a case study of 548 high-risk infants born 2010 to 2012 at Palomar Medical Center (Escondido, CA) who were then transferred to the neonatal intensive care unit at Palomar Rady Children’s Hospital (San Diego).  About half of the infants were born before implementation of an quality improvement project intended to standardize delivery room management – a preintervention group.  The merits of each of the changes in practice – such as a significant decrease in intubation – are discussed.  A delivery room checklist is included.

Source: Sauer, C.W., and others. (2016, November 16). Delivery room quality improvement project improved compliance with best practices for a community NICU. Scientific Reports, 6, 37397.  Click here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116615/pdf/srep37397.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BENCHMARKS: Space planning in labor and delivery

This is a rule-of-thumb provided by Hayward & Associates, a health care facility planning firm, that may be used to plan for a labor and delivery area.  In the following ratios, LDR means labor-delivery-recovery.  LDRP means the same except adds a postpartum stay in the same room – this is also known as single-room maternity care.

Space planning based on annual births

  • 100 to 200 births / LDRP room if the LDRP concept is used exclusively
  • 300 to 400 births / LDR or LDRP room if some patients are moved to a separate postpartum room after discharge

Recommended departmental gross square feet (DGSF) and departmental gross square meters (DGSM) are also given in this brief article.

Source: Hayward, C. (2017, Spring-Summer). Obstetrical services capacity and preliminary space need. SpaceMed Newsletter. Click here: https://www.spacemed.com/newsletter/rule-102-ob.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OBSTETRICS: Reasons OB units close in rural areas

The reasons why rural hospitals closed their labor and delivery services were studied based on a telephone survey of hospitals in nine states.  Of the 263 hospitals that responded, 19 (or 7.2 percent) closed their OB units during the study period of 2011 to 2014.  Here are the reasons that were identified as risk factors for closing:

  • Low birth volume
  • Private (as opposed to public) ownership of the hospital
  • Low number of family physicians practicing in the area
  • Low income surrounding area

Source: Hung, P., and others. (2016, August). Why are obstetrics units in rural hospitals closing their doors? HSR. Health Services Research, 51(4), 1546-1560.  Click here for publisher’s website: http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12441/full  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OBGYN: Providing prenatal care in group visits

The idea of seeing expectant mothers who are at about the same stage of pregnancy together in a group for prenatal care is not new – it was described in the 1990s.  Generally, it is for low-risk patients.  Mazzoni & Carter discuss findings in the literature as to the effectiveness of this approach.  A popular model is called Centering Pregnancy, which is addressed in the other articles cited below.

Selected Sources:

Mazzoni, S.E., and Carter, E.B. (2017, February 9). Group prenatal care. American Journal of Obstetrics and Gynecology.  Click here for the publisher’s website: http://www.ajog.org/article/S0002-9378(17)30185-0/pdf

Crockett, A.H., and others. (2017, January). The South Carolina centering pregnancy expansion project: Improving racial disparities in preterm birth. American Journal of Obstetrics and Gynecology. 216(1 Supplement), S424-S425. Click here for free full text: http://www.ajog.org/article/S0002-9378(16)31441-7/pdf

Carter, E., and others. (2016, January). Group compared to traditional prenatal care for optimizing perinatal outcomes: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 215(1 Supplement), S382.  Click here for free full text: http://www.ajog.org/article/S0002-9378(15)02081-5/pdf

Garretto, D., and Bernstein, P.S. (2014, January). Centering Pregnancy: An innovative approach to prenatal care delivery. American Journal of Obstetrics & Gynecology, 210(1), 14-15.  Click here for free full text: http://www.ajog.org/article/S0002-9378(13)01039-9/pdf

Fausett, M., and others. (2014, January). Centering Pregnancy is associated with fewer early, but not overall, preterm deliveries. American Journal of Obsetrics & Gynecology, 210(1, Supplement), S9.  Click here for free full text: http://www.ajog.org/article/S0002-9378(13)01111-3/pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

BIRTHS: About 10 percent of the 4 million births each year in U.S. are premature

The federal government collects statistics on all births in the United States.  Here are data for 2014 for premature births:

  • 3,988,076 total births in the United States
  • 381,321 (or about 10 percent of all births) were preterm (under 37 weeks gestational age)
  • Of those, 27,320 (or less than 1 percent of all births) were the most preterm (under 28 weeks gestational age)

The data are also presented according to birthweight:

  • 8 percent of all births in the United States in 2014 were LOW birthweight
  • 1.4 percent of all births were VERY LOW birthweight

Also interesting is PLACE OF BIRTH:

  • 3,988,076 total
  • 3,928,272 in the hospital
  •      38,094 at home
  •      18,219 freestanding birthing center

Source: Hamilton, B.E., Martin, J.A., Osterman, M.J.K., and others. (2015, Dec. 23). Births: Final data for 2014. National Vital Statistics Report. 64(12), 50, 53.  http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_12.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BIRTHS: About one-third of all births are C-sections

THE MOST CURRENT STATISTICS (2014)

In the United States, about one-third of all live births today are via cesarean section, according to national data from the U.S. National Center for Health Statistics.  The most current statistic is:  32.2 percent in 2014, compared to what is described as the peak of 32.9 percent in 2009.  When the data are analyzed according to race/ethnicity, the group with the highest percentage of c-sections is non-Hispanic black women (35.6 percent in 2014).

Source: Martin, J.A., Hamilton, B.E., and Oserman, J.K. (2015, Sept.). Births in the United States, 2014. NCHS Data Brief, 216.  http://www.cdc.gov/nchs/data/databriefs/db216.pdf Posted by AHA Resource Center (312) 422-2050, rc@aha.org

TREND OVER PAST 25 YEARS: Going up

A separate report from the National Center for Health Statistics shows that in the ’90s, the c-section rate was much lower – holding at about 20 to 23 percent overall.

Source: Hamilton, B.E., Martin, J.A., Osterman, M.J.K., and others. (2015, Dec. 23). Births: Final data for 2014. National Vital Statistics Report. 64(12). http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_12.pdf   Posted by AHA Resource Center (312) 422-2050, rc@aha.org