Neonatal Intensive Care Unit (NICU) Q & A with Dr. Gary Dreyer

As reported in St. Louis Woman magazine, "Ask the Doctor"
April 2008

Q: When is a baby considered premature?

A: A baby born at less than 37 weeks’ gestation is considered premature (that is, born before complete maturity). The National Center for Health Statistics reports that the rate of premature births continues to rise, with more than 525,000 babies, or 12.7 percent, born prematurely. The large numbers of multiple births in recent years has contributed to this increase. Twins and other multiples are about six times more likely to be premature than single-birth babies. The rate of premature single births is slightly increasing each year.

Q: How are premature babies treated?

A: Premature babies usually need care in a neonatal intensive care unit (NICU), a special area that provides care for sick and premature newborns. Some hospitals do not have an NICU or neonatology specialists on staff, and these babies must be transferred to another hospital.

The NICU team is typically led by neonatologists (pediatric physicians with additional training in the care of sick and premature babies) and may include neonatal nurse practitioners, respiratory therapists, and registered nurses, all of whom specialize in the care of premature or special care babies . St. John’s Mercy Medical Center has eight full-time neonatologists and one who works part-time. We provide 24-hour coverage for about 70 babies each day in the St. John’s Mercy NICU. Each year we care for approximately 150 to 200 babies who weigh less than three pounds.

Care of premature infants is based on individual needs, but common treatments include: temperature-controlled beds; monitoring of temperature, blood pressure, heart and breathing rates, and oxygen levels; giving extra oxygen by mask or with a mechanical ventilator (breathing machine); intravenous (IV) fluids when feedings cannot be given, or for medications; placement of a catheter (small tube) into the umbilical cord to give fluids and medications and to draw blood; special feedings of breast milk or formula, sometimes with a tube into the stomach if a baby cannot suck; medications and other treatments for complications, such as antibiotics; kangaroo care – a method of caring for premature babies using skin-to-skin contact with the parent.

Q: What additional support is provided to families with babies in the NICU?

A: At St. John’s Mercy, families with a baby in the NICU receive support and information from our specially trained staff and through additional support programs. BabyICU.com is our secure internet web site that provides information, education and support to NICU families. In addition, we offer a parent support group called NICUPs (Neonatal Intensive Care Unit Parents). The NICUPs work closely with NICU staff to help make the NICU an environment where families can come together and focus on their child's recovery. For more information, visit www.stjohnsmercychildrenshospital.com.

Q: When can a premature baby go home from the hospital?

A: Premature babies often need time to “catch up” in both development and growth. In the hospital, this catch-up time may involve learning to eat and sleep, as well as steadily gaining weight. Consult your baby’s physician for information about the specific criteria for discharge of premature babies at your hospital. General goals for discharge may include the following: serious illnesses are resolved; stable temperature – able to stay warm in an open crib; taking all feedings by breast or bottle; no recent apnea or low heart rate; parents are able to provide care, including medications and feedings.

Even though they are otherwise ready for discharge, some babies continue to have special needs such as extra oxygen or tube feedings. With instruction and the right equipment, these babies are often able to be cared for at home by parents. A hospital social worker can often help coordinate discharge plans when special care is needed.

Q: What can be done to help prevent premature birth?

A: Prenatal care is a key factor in preventing preterm births and low birthweight babies. At prenatal visits, the health of both mother and baby can be monitored. Because maternal nutrition and weight gain are linked with fetal weight gain and birthweight, eating a healthy diet and gaining weight in pregnancy are essential. Prenatal care is also important in identifying problems and lifestyles that can increase the risks for preterm labor and birth. Some ways to help prevent prematurity and to provide the best care for premature babies may include the following: identifying mothers at risk for preterm labor; prenatal education on the symptoms of preterm labor; avoiding heavy or repetitive work or standing for long periods of time, which can increase the risk of preterm labor; early identification and treatment of preterm labor.

St. John’s Mercy Medical Center operates the only Level III (highest level) neonatal intensive care unit (NICU) in St. Louis County and the busiest NICU in the region.

© 2008 St. John's Mercy Health Care
615 S. New Ballas Rd., St. Louis, Missouri, 63141