Newborn Medicine | Clinical

Neonatal Intensive Care Unit (NICU)

The birth of a child is always an amazing and exciting experience. Expectant parents often dream of the day when their beautiful, perfect baby will be born. Sometimes, complications can occur for mother or baby before, during, or after the delivery, and the baby must receive intensive care. Parents may discover during the pregnancy that their baby is at risk for certain complications (for example, a birth defect like spina bifida is found by ultrasound before delivery, a genetic disease is known to run in the family), complications may arise late in pregnancy (for example, toxemia or preeclampsia) or during delivery.

Whether your child is born prematurely, suffers from a medical condition, or has a birth defect, the experts at St. Louis Children's Hospital's Neonatal Intensive Care Unit (NICU) are ready to provide the very best possible care 24 hours a day, 7 days a week.

The 125 bed NICU provides state of the art treatment and monitoring equipment, including ECMO (a heart/lung machine that can be used temporarily to permit recovery when acute heart and/or lung failure occurs), surfactant therapy (a medicine that helps prematurely born babies to breath more easily), and high frequency oscillatory ventilation (a type of breathing machine that is necessary for some infants to help their lungs develop and heal). The unit is staffed by specially trained physicians, nurse practitioners, staff, and nurses and also includes pediatric residents and neonatal fellows (physicians who are specializing in treating children and sick newborns). In addition, nationally known surgical and medical specialists, including heart specialists, brain specialists, spinal cord specialists, kidney specialists, and many others, are available to consult on any problem that arises for your baby. All of the physicians, nurse practitioners, and nurses take a special interest in ensuring that each infant is receiving the proper medications, including pain relief medicines and sedation. NICU pharmacists are available to ensure proper dosing of medicines and selection of drugs. Portable radiologic and diagnostic equipment is used when clinically feasible to reduce the need to move medically fragile patients for tests.

The NICU nursing staff are registered nurses who have special education and training in the care of critically ill babies. The nurses will assist you in learning to care for your baby, as your involvement and presence are very important. Neonatal Advanced Practice Nurses with specialized training and experience partner with the physicians, nursing staff, and members of the support staff (for example, respiratory therapists, dieticians, pharmacists, and social workers) to provide advanced care for sick babies and their families.

The NICU provides care to high risk (critically ill infants) using Family Centered Care as the guiding principle by which we provide care for the infants. Parents are encouraged to be active members of the team who cares for their baby while in our unit. The goal of Family Centered Care is to partner you with your nurse and the medical team which will help you feel more confident and comfortable caring for your infant.

  • Parents are welcome anytime – night or day.

Brothers and sisters age two years and older are welcome to visit. Anyone who is sick or have symptoms of runny nose, cough or fever should not visit. Parents are asked to provide a list of other relatives or friends who have permission to visit their baby. Because of space limitations, we request that each baby have only two visitors in the NICU at any time.

In the NICU, there are family participation rooms where parents may room in overnight with their child before she or he is discharged to gain confidence in feeding, giving medicines, handling special equipment, and gaining confidence with their baby.

As your new baby grows stronger and healthier, we want your stay to be as comfortable and pleasant as possible. Parents are encouraged to ask questions, attend rounds, make requests, become involved in discharge planning, and learn all they can about the care and treatment of their baby.

A parent support group of veteran parents is available to provide families with advice and support throughout their baby's stay. Full-time social workers are also available to facilitate parental coping.

We want to provide your baby with whatever she or he needs to have the best possible outcome. We want to help you meet all the needs of your special baby.


St. Louis Children's Hospital

The Division of Newborn Medicine faculty provides 24 hours a day, 7 days a week in-house clinical coverage for the 125 bed Neonatal Intensive Care Unit (NICU) at St. Louis Children's Hospital. Additionally, there are two Neonatal-Perinatal Medicine Fellows in-house overnight, advanced practice nurses (APNs), and Pediatric Residents (doctors in training to specialize in Pediatrics) involved in the care of our fragile infants. There are 75 private rooms, and three Family Participation Rooms. The SLCH NICU provides all neonatal services, including evaluation for solid organ transplantation, extracorporeal membrane oxygenation, and a complete spectrum of surgical and medical subspecialty consultants. The SLCH NICU has approximately ~1300 annual admissions and >36,000 patient days per year.
https://www.stlouischildrens.org/conditions-treatments/women-infants-center/newborn-medicine


Women and Infants Center

The Division faculty provide clinical coverage for the high-risk delivery service at our new state-of-the-art Women and Infants Center and the Neonatal Assessment Center (NAC). The obstetrical service delivers approximately 4000 babies per year, many of them high-risk deliveries, and physicians from Newborn Medicine attend approximately 40% of them.


Fetal Care Services

The Division faculty provides outpatient and inpatient antenatal consultation services in collaboration with the Division of Maternal-Fetal Medicine, Genetics, and Ultrasound of the Department of Obstetrics. Patients with high-risk pregnancies are referred by obstetricians for multidisciplinary consultations with Newborn Faculty members as well as faculty from other relevant divisions (e.g., Pediatric Cardiology, Pediatric General Surgery, Pediatric Urology, Pediatric Neurosurgery, etc.). Complex fetal conditions are cared for through the Fetal Care Center that provides multidisciplinary diagnostic and interventional treatments for mother and fetus. Interventions include laser therapy for twin-twin transfusion syndrome, in utero myelomeningocele repair, and EXIT procedures for complex airway anomalies among others (see link below). In addition, families have the opportunity to tour the Neonatal Intensive Care Unit, arrange lodging, and discuss blood transfusions. The Division sees over 500 families as outpatients and approximately 1000 as inpatients annually. Fetal Care Center Link:
https://www.barnesjewish.org/Medical-Services/Women-Infants/High-Risk-Pregnancy/Fetal-Care?videoID=5


Newborn Follow-up Program

The Division faculty provide follow up services for infants discharged from one of these units as well as for infants referred for consultation by pediatricians, family practitioners, or nurse practitioners. A full range of follow up services is available, including developmental testing, ophthalmologic and audiologic testing, and pediatric consultant services. The Follow-up Program sees approximately 1,000 children per year. Although the clinic meets every Thursday, faculty are available on any day to see consultations in coordination with other subspecialty visits.


Missouri Baptist Medical Center

The Faculty members in the Division of Newborn Medicine provide clinical coverage at a level 3 NICU and delivery services at Missouri Baptist Medical Center (MBMC) in a suburban community hospital setting. The Division works closely with the Division of Pediatric Hospitalists from Washington University School of Medicine as well as private and academic pediatricians/obstetricians/maternal-fetal medicine providers. The obstetric service delivers appropriately 4000 infants each year. The NICU at MBMC has 25 licensed beds (average daily census of 10-18) and has >300 admissions per year and 4600 patient days. The MBMC NICU cares for many types of infants, including preterm infants with birth weights of >1 kg. Therapeutic interventions and capabilities include conventional mechanical ventilation, non-invasive ventilatory support, central line placement, echocardiograms, and diagnostic radiology such as x-rays, ultrasounds, and upper GI studies. On-site Pediatric subspecialists are available including cardiology and ophthalmology, while additional subspecialty consults from St. Louis Children's Hospital are also available by phone. Ancillary services include occupational therapy, physical therapy, lactation consultants, respiratory therapy, 24-hour pharmacy support, social services, and dietitians.


Progress West Hospital

The Division faculty provides clinical coverage for the Newborn Intensive Care Unit, Well Baby Nursery, and delivery services at Progress West Hospital. In addition, the Division collaborates closely with Obstetrics faculty members to provide antenatal consultation at this site and with the Department’s Pediatric Hospitalists who cover the Newborn services after hours. The obstetrical service delivers approximately 800 babies per year. The Newborn Intensive Care Unit (level II) opened in July 2017 and admits babies born as young as 32 weeks gestation.


Memorial Hospital Belleville & Memorial Hospital East

Washington University Physicians in Illinois, Inc. (WUPI)* provides clinical coverage at the level 2 intermediate care nursery (Belleville), level 2e special care nursery (SCN, East), Well Baby Nurseries, and delivery services at the Memorial Network hospitals in Belleville, IL. WUPI Neonatologists work closely with the WUPI Pediatric Hospitalists to provide newborn coverage 24/7 as well as with private pediatricians, obstetricians, and maternal-fetal medicine providers. The obstetric service delivers appropriately 2000 infants each year. The level 2e SCN opened in the spring of 2018 and admits babies born as young as 30 weeks gestation and birth weights >1250g. Therapeutic interventions and capabilities at the level 2e SCN include conventional mechanical ventilation, non-invasive ventilatory support, central line placement, echocardiograms, and diagnostic radiology such as x-rays, ultrasounds, and upper GI studies. Pediatric subspecialist consultation is available from St. Louis Children's Hospital by phone. Ancillary services include occupational therapy, physical therapy, speech therapy, lactation consultants, respiratory therapy, 24-hour pharmacy support, social services, and dietitians.

*Washington University Physicians in Illinois, Inc. (WUPI) is the corporate entity that governs Washington University School of Medicine’s clinical practice in Illinois.


Specialized Clinical Services

The Division currently has the largest experience in the world with infants with inherited causes of neonatal respiratory failure, including surfactant protein-B deficiency and ABCA3 deficiency, as well as the genomics of birth defects (Jennifer Wambach, MD, MS and F. Sessions Cole, MD). In addition, we have several experts in the enteric microbiome (Barbara Warner, MD, MS, necrotizing enterocolitis Misty Good, MD, MS, and neonatal neurology Amit Mathur, MD, Zachary Vesoulis, MD, and Cynthia Ortinau, MD.

The neonatal intensive care unit at St. Louis Children's Hospital is also experienced in the evaluation of infants for solid organ transplantation, including heart, lung, and liver transplantation. The Division also offers long-term follow up for patients with a congenital diaphragmatic hernia (CDH) once a month on Thursdays. This multidisciplinary cooperative effort includes pediatric surgery and newborn medicine faculty (Dr. Tasnim Najaf) who provide long-term follow up for these infants.

The Division maintains an active neonatal database and is a member of the Vermont-Oxford Network (VON) and the emerging Children’s Hospitals Neonatal Consortium (CHNC) collaborative. The Division provides other educational opportunities through webcasts of Divisional meetings, regional conferences, informal presentations, and practitioner participation in clinical services. These opportunities can be developed and arranged through SLCH Physician Services.

The Division has experience in international clinical and research collaborations, including the U.K., Netherlands, Italy, Australia, and New Zealand. In addition, Dr. Joan Downey and other Washington University / SLCH sub-specialists visit Juticalpa, Honduras annually to provide multidisciplinary evaluations and care for infants and children, some who come to St. Louis Children’s Hospital for treatment. This is a Washington University School of Medicine Pediatrics Away Rotation and a wonderful global health opportunity for our Pediatric Residents and Neonatal-Perinatal Medicine Fellows.


Newborn Medicine Practice Opportunity

St. Louis Children’s Hospital is consistently ranked as a top 10 Children’s Hospital in the country and is affiliated with the Washington University School of Medicine, the most selective medical school in the US, and offers unique opportunities for patient care, research, and education. For more information, click here.

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