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Like many moms-to-be, actress Danielle Fishel, who played Topanga on the ‘90s sitcom “Boy Meets World,” had a birth plan. But, as so often happens, life threw her a curve.
When she was 35 weeks pregnant, Fishel’s water broke and she was hospitalized. An ultrasound revealed fluid in her baby’s lungs, and her baby was delivered four weeks early. Adler Lawrence Karp was born on June 24 at 4:52 a.m.
It was joyful and terrifying all at once. Fishel, 38, wrote on Instagram that she and her husband felt helpless and powerless.
“We wanted so badly to follow our birth plan, unsurprisingly none of which involved leaving our beautiful baby boy at the hospital for the first weeks of his life,” she wrote.
Still, Fishel said she “can’t wait to sing the praises of his NICU care team,” including her “thoughtful and outlandishly skilled nurses.”
A neonatal intensive care unit, or NICU, is the kind of place most people know intimately well or not at all. Knowing what to expect can make a challenging experience a little more predictable.
To explain what a NICU is and the work its people do, we went to our senior executive officer at AdventHealth for Children and AdventHealth for Women, Rajan Wadhawan, MD, who formerly served as the Medical Director of neonatology.
How the First NICUs Started
“In 1922, hospitals began creating spaces specifically for newborns and the first NICUs were born,” said Dr. Wadhawan. However, it wasn't until the 1970's that they were an established part of every hospital in the developed world.
In 2004, the American Academy of Pediatrics introduced what we now know as the levels of NICU. In 2012, the academy laid out four NICU levels to set forth expectations and regulations to be certified in each level.
Understanding how these levels work is a big part of getting to know a NICU.
Most Babies Go to Level I
Level I NICUs are where most babies go after birth. Full-term, healthy babies with a low risk of complications go to this nursery after they're born. It isn't really a NICU in the way that most people think, since there's no need for the intensive care aspect.
Babies who were born after 35 weeks go to Level I. This NICU also stabilizes newborn infants who are ill and those who were born at less than 35 weeks gestation until they can be sent to a higher-level NICU.
A Level I NICU must be staffed by pediatricians, family physicians, nurse practitioners and other advanced practice registered nurses.
Level II NICUs Offer Specialized Care
“Level II NICUs have to be able to do everything that a Level I can do and are often called special care nurseries,” says Dr. Wadhawan. They’re for babies who are born prematurely at 32 weeks or later and weigh at least 1,500 grams (3.3 pounds).
In addition to the requirements at a Level I, a Level II NICU must have immunologists, nutritionists and specialized nurses.
This level of NICU is able to:
- Provide care for babies who are moderately ill with problems that are expected to get better quickly and aren't anticipated to need special care urgently
- Provide care for babies feeding and growing stronger or getting better after intensive care
- Provide mechanical ventilation for a brief duration for at least 24 hours or can maintain continuous positive airway pressure
- Stabilize and transfer babies that need to be moved to a Level III NICU
- Required to have neonatologists, immunologists, pediatric hospitalists and neonatal nurse practitioners in addition to the Level I health care providers
Level III NICUs Offer Highest Level of Care in Florida
Level III NICUs are for all degrees of prematurity. Until 2012, they were the highest level of NICU.
“Babies with congenital malformations (birth defects) are sent to Level III,” explained Dr. Wadhawan.
Level III units are required to have pediatric surgeons in addition to the care providers required for Level II and Level I. They are also required to have pediatric medical subspecialists, pediatric anesthesiologists and pediatric ophthalmologists (eye doctors) on site or nearby.
These NICUs can:
- Provide sustained life support
- Provide comprehensive care for babies born before 32 weeks who weigh less than 1,500 grams (3.3 pounds)
- Provide comprehensive care for babies born at any number of weeks and birth weight that have a serious illness
- Provide a full range of respiratory support
- Provide advanced imaging and interpretation
- Provide access to a full range of pediatric surgical specialists, pediatric medical subspecialists, pediatric ophthalmologists and pediatric anesthesiologists
Level IV: Not Yet in Florida
“Currently, in the state of Florida there is no official Level IV designation, but here at AdventHealth we've taken the initiative and made all of our Level III NICUs meet or exceed the requirements for Level IV while we continue to lobby the state legislature to change the law,” said Dr. Wadhawan.
The additional requirements for Level IV are like the previous levels in that they must be capable of doing what the lower levels do but with the following differences:
- Must have the capability to provide surgical repair of complex congenital or acquired conditions
- Maintain a full range of pediatric medical subspecialists, pediatric surgical subspecialists and pediatric anesthesiologists at the site
- Provide transportation and outreach education
We don’t know what level of NICU Fishel’s baby needs. She hasn’t said how much her baby weighs and has asked for privacy. As of Monday, little Adler remained in the NICU. It can be hard to predict how long a newborn will need the services of a NICU.
Where to Find Florida’s Best NICUs
In the latest ranking of children’s hospitals around the country by U.S. News & World Report, AdventHealth for Children has again made the top 50 in neonatology care. It’s one of the top programs in the country and the best in Florida.
Few moms plan for their baby to need a NICU. But it can be comforting to know that one is close by. If you're pregnant and looking for the highest level of care for you and your baby, please click here or call Call 407-303-4HER to schedule an appointment with one of our specialists.