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15 questions you should ask about neonatal intensive care units

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Few parents consider the possibility that their baby might be premature or need special medical care after birth. Even fewer think about which neonatal intensive care unit (NICU) might care for their baby.

One out of nine mothers do not carry to full term (37 or more weeks), and roughly 100,000 babies end up in an NICU each year. We hope that your pregnancy and delivery go smoothly, but if the unexpected should occur, here are 15 important questions to ask:

1. How many babies are cared for in the NICU each year?

Research shows that you can expect better results in NICUs that treat larger numbers of babies because they have the experience, equipment, research, and processes to assure the best care possible.

UI Stead Family Children’s Hospital is home to Iowa's largest NICU, with 88 beds. Our NICU team cares for over 930 babies each year.

2. Does the hospital provide you with outcomes and statistics?

Ask your hospital for their NICU outcomes data over the past several years showing survival statistics, including gestational age.

The survival rate among all babies cared for in the UI Stead Family Children’s Hospital NICU is more than 95%, [PDC1] which ranks among the best of any NICU in the country.

Our survival rates for babies born at 22, 23, 24, and 25 weeks are significantly higher than survival rates for extremely premature babies born at other U.S. hospitals (averaged from 2006 through 2020):

  • 22 weeks: 57%
  • 23 weeks: 74%
  • 24 weeks: 86%
  • 25 weeks: 91%
  • 26 weeks: 92%
  • 27 weeks: 96%

3. Are pediatric experts available in the NICU 24 hours a day?

A NICU should have trained pediatric medical and surgical specialists in-house to respond immediately to your baby's needs.

  • The NICU at UI Stead Family Children’s Hospital has 19 board-certified neonatologists with 400 years of combined experience—the largest and most highly trained NICU team in Iowa.
  • Continuous in-house NICU coverage by a team of 32 Neonatal and Pediatric Nurse Practitioners.   
  • UI Stead Family Children’s Hospital is the only hospital in Iowa that is consistently nationally ranked by U.S. News & World Report for pediatric care, and every possible pediatric specialty is available 24/7.
  • Care providers are present in the UI Stead Family Children’s Hospital NICU at all times to address any questions parents may have about their baby’s medical care.

UI Stead Family Children’s Hospital uses an NICU multidisciplinary care team to help achieve the most rapid progress and favorable outcomes for newborn infants.

  • A neonatologist is a pediatrician with additional training in newborn intensive care and is an expert in the care of critically ill infants.  A neonatal nurse practitioner is an advanced practice registered nurse (ARNP) that specialize in the care of newborns ranging from well babies to those that are critically ill. However, babies in the NICU need advanced care provided by a team of pediatric experts. In providing the highest level of neonatal care, the neonatologist are supported by an exceptional team of 32 nurse practitioners, 8 neonatal-perinatal fellows, 2 neonatal hemodynamic fellows, and pediatric residents in providing optimal care.
  • The team members who work closely with our neonatologists have ready information to analyze the full scope of a baby's medical and developmental progress and act on it appropriately. Those team members—all trained in the specific needs of infants—include nurses, respiratory therapists, nutritionists, social workers, pharmacists, lab technicians, and physical therapists.
  • As part of Iowa's only comprehensive children's hospital, our NICU has immediate access to the expertise of every possible pediatric specialist 24/7.

4. Does the hospital have a high-risk OB team?

Our neonatologists work closely with obstetricians by offering prenatal consultation and attending all high-risk deliveries. UI Hospitals & Clinics is home to eight maternal fetal medicine physicians who specialize in the care and management of high-risk pregnancies.

  • Moms who deliver their babies at UI Hospitals & Clinics have peace of mind knowing that NICU care is right there where they need it. No matter what, families stay together and never need to be transferred to another hospital for more advanced care.
  • 65% of babies cared for in our NICU were delivered at UI Hospitals & Clinics, while 35% are transferred from other hospitals in Iowa and nearby states.

5. Do all NICUs have the same capabilities?

All NICUs care for babies who need special help, but different NICUs offer different levels of care. The first hour of life for a very low birth weight baby is often called "the golden hour" because it's so important to a premature baby's future. The level of care that a baby receives in the first hour of life will determine how that baby does for the rest of its life. There are many studies that show that babies born at the highest-level center have much better outcomes. If you're having a premature baby, you want to have that baby at the highest-level center available. UI Stead Family Children’s Hospital is home to a Level IV NICU–the highest designation possible, according to standards specified by the American Academy of Pediatrics. In addition, the NICU at UI Stead Family Children’s Hospital has an established specialty program in neonatal hemodynamics (care of the newborn heart), lung rehabilitation (care of the newborn lung and breathing), and neonatal neurocritical care (care of the newborn brain), which includes neonatologists who have complete additional formal training in these areas. This ensures we have the highest level of expertise at all times for the most common and challenging newborn illnesses and conditions.

6. How are the nutritional needs of babies in the NICU met?

Make sure that pediatric nutritionists are part of the NICU care team and that their practice reflects the latest understanding of infant nutrition.

  • The NICU care team at UI Stead Family Children’s Hospital includes nutritionists who specialize in the nutritional needs of infants. They advocate for the best nutritional resources for your infant, which includes breast milk. Our doctors have been leaders in the field of infant nutrition for over 75 years.
  • Breast milk is by far the best nutrition for premature babies. Because of that, we have a milk bank at the University of Iowa—the only milk bank in Iowa—and provide milk to some of the other NICUs in the state. Breast milk has been shown to increase the IQ of babies as well as their ultimate neurologic outcome. It's been shown to decrease the risk of a very serious bowel infection.
  • Doctors who specialize in the pediatric digestive system are available to be sure that nutrition is optimized for an infant's specific condition.

7. How are breathing (respiratory) problems managed?

Asking the right questions is critical: Are all the latest respiratory therapies available? Are infants in the care of respiratory therapists who specialize in the treatment of infants? Are there specialized teams to take care of infants with more severe lung disease?

  • The UI Stead Family Children’s Hospital NICU is equipped with high-frequency ventilation, nitric oxide, and extracorporeal membrane oxygenation (ECMO). These therapies aren't available in every NICU, and the time it takes to transfer the baby to a center that provides these therapies may delay treatment. Research has shown that high-frequency ventilation and nitric oxide, used in combination, can reduce the likelihood that more dangerous and expensive treatments will be needed for critically ill, full-term babies. In addition, high-frequency ventilation reduces the risks of ventilator-induced lung injury in small premature babies, leading to better survival and outcomes in our youngest and smallest infants.
  • Neonatologists and specially trained respiratory therapists at UI Stead Family Children’s Hospital are at the forefront of these leading breathing therapies. They are actively engaged in teaching other doctors and therapists around the world in perfecting these techniques.
  • At the UI Stead Family Children’s Hospital, our NICU has a specialized multiprofessional chronic lung rehabilitation team that follows infants with more severe lung disease. This team provides continuity of care for the patient and their family as well as specialized expertise on lung rehabilitation, leading to improved management and outcomes of this complex patient population. 

8. How are heart and blood (cardiovascular) circulation problems managed?

Babies cannot communicate illness like an older child or adult. Early signs of sickness may be difficult to identify. It is very important to be able to identify illness and provide treatment as soon as possible to have the best chance at keeping babies well and making them better.

  • UI Stead Family Children’s Hospital is the only NICU in the Midwest, and one of the only NICUs in the country, with a special team of doctors who have both advanced training in heart ultrasound and advanced training in neonatal intensive care. This team is actively involved in helping a baby’s primary doctor choose customized treatments for each baby and each situation throughout the baby’s development.
  • The NICU at UI Stead Family Children’s Hospital practices pre-emptive medicine to make sure babies at risk of problems with the cardiovascular system have screening heart ultrasounds regularly throughout their hospitalization. This way, possible problems can be recognized early and treated before becoming more serious.

9. How are neurological (brain) problems managed?

Babies in the NICU are in a critical time of brain maturation and development. The NICU care team prioritizes brain-focused care by providing timely neurologic assessments, neuromonitoring, neuroprotective interventions, and supporting optimal brain development.

  • Our NICU is equipped with the latest brain monitoring devices such as amplitude-integrated EEG and conventional video EEG to provide brain surveillance 24/7 for infants with high risk of seizures or brain injury.
  • To protect our patients from brain injury, we have dedicated guidelines for delivery room management and specialized medical care for extremely preterm or critically ill neonates.
  • For our full-term infants who experience brain injury around delivery—sometimes called hypoxic ischemic encephalopathy, or HIE—we provide therapeutic hypothermia (cooling) to minimize brain injury
  • The NICU care team will assess your baby’s neurologic status and pain level. Pain has been shown to impact brain development, so our team will use pain prevention or treatment strategies.
  • Our full team will support you and your baby to optimize brain growth through great nutrition, bonding experiences such as skin-to-skin (kangaroo) care, and age-appropriate sensory experiences such as lighting, positioning, reading, music, and interactive play.

The Neonatal Neurocritical Care Program at UI Stead Family Children’s Hospital consists of an interprofessional team of neonatologists with neurological expertise, neonatal neurologists, neurophysiologists, pediatric neurosurgeons, pediatric neuroradiologists, developmental and behavior pediatricians, pain and palliative care pediatricians, physical medicine and rehabilitation pediatric specialists, critical care nurses and nurse practitioners, pharmacists, dieticians, social workers, care coordinators, and specialized therapists (physical therapy, occupational therapy, speech therapy, music therapy, and child life services). We collaborate to help our infants minimize brain injury, optimize brain development, and thrive in their life after being in our NICU.

10. How do our doctors and care teams maintain their competence with life-saving procedures?

Many babies require life support (resuscitation) and life-saving procedures at birth. Neonatal simulation refers to the use of high- or low-fidelity mannequins to help individual learners and teams practice resuscitation and procedural skills.

  • All NICU team members (nurses, nurse practitioners, staff physicians, resident physicians, fellow physicians, and respiratory therapists) have the opportunity to train using NICU-specific simulation. In addition to procedural competence, this training focuses on optimizing neonatal resuscitation skills, teamwork, leadership, communication, and patient safety.

11. Are resources available to support parents?

A long-term NICU stay can be difficult for parents and families. Counseling and other social support services should be readily available.

  • At UI Stead Family Children’s Hospital, we care for families as well as babies. Our services for parents and siblings include counseling, peer support groups, a resource library, and online information tailored to a family's needs.
  • We promote family-centered care, inviting parents to participate in the care of their baby and allowing family visitation, including siblings, around the clock.

12. What is the environment in the NICU like, and are overnight stays for parents welcome and convenient?

Research shows that the critically ill patients do better when noise is minimized and direct light is reduced. Every NICU patient at UI Stead Family Children’s Hospital is cared for in a private room, which allows for complete control of lighting and noise exposure. Twins or triplets may share a room.

The presence of families is extremely important. Babies know their parents. It's important that moms and dads can touch, talk to, and read to their baby.

  • Patient rooms in the NICU on Level 6 of UI Stead Family Children's Hospital include a sleeping area for two adults.
  • Also, within walking distance of the hospital, families can use the comfortable, inexpensive accommodations provided by the Iowa City Ronald McDonald House.
  • UI Stead Family Children’s Hospital offers parents the opportunity to stay in a patient guest house near the hospital that is close, quiet, and comfortable.

13. Is the NICU actively involved in research and education?

Advances in medical care can happen rapidly, and involvement in research is a good indicator of whether your NICU is a leader in developing new and improved treatments.

  • The UI Stead Family Children’s Hospital NICU is a leader in research to improve the care of premature and sick infants.
  • The most advanced care is available in hospitals that are affiliated with medical schools (also known as academic medical centers). UI Stead Family Children’s Hospital is part of University of Iowa Health Care, which includes the UI Carver College of Medicine. Our doctors are involved in the research that leads to improved methods of care, so the newest cutting-edge treatments are available first in university NICUs.
  • Our neonatologists have been invited to speak at hundreds of international conferences and prestigious institutions worldwide over the past three years. In addition, our neonatologists write textbooks and provide both the initial training and continuing education to other neonatologists.
  • Doctors and health care providers complete official and extended site visits as teams to learn about the care we provide to extremely preterm babies and how our hemodynamics team functions, which highlights our global reputation.

14. How do families prepare to go home?

A NICU should involve your local pediatrician or family physician in planning for your baby's discharge. Parents should also receive thorough training and an explanation of what to expect at home.

  • The UI Stead Family Children’s Hospital team works closely with the family's local doctor to see that any remaining medical concerns are addressed.
  • UI Stead Family Children’s Hospital specialty-trained nurses, called discharge planners, provide education to the parents of all NICU infants. We know that training makes a big difference in a family's ability to meet the needs of a fragile infant. After discharge, we call every family to ensure the transition from hospital to home has gone smoothly.

15. Is there a plan in place for regular follow-up care?

Members of the NICU team should be involved in the developmental follow-up of NICU babies well beyond the first months at home.

  • UI Stead Family Children’s Hospital NICU graduates are enrolled in the Iowa High-Risk Infant Follow-Up Program, a series of periodic examinations during the first several years of life to monitor the child's growth and development.
  • Our most fragile infants are followed in our clinic by a neonatologist of the family's choice and a nurse practitioner.
  • We also have a continuity-of-care team that works to coordinate medical care after discharge, if necessary.
  • In addition, UI Stead Family Children’s Hospital team members work closely with the child's local doctor to see that any remaining medical concerns are addressed.