Neonatal Services: Conditions & Treatments

Conditions of Premature Birth

Nearly 13% of U.S. babies are born prematurely. Premature babies have an increased risk of infections, heart conditions, lung problems and lasting disabilities, including cerebral palsy. UCI Medical Center has one of Orange County’s highest-level Neonatal Intensive Care Units (NICUs) to care for the smallest and sickest infants.

Our neonatologists have cared for babies as young as 23 weeks old and weighing less than one pound. Our state-of-the-art NICU is equipped to treat the most complex cases, including babies born with brain injury from asphyxia and respiratory failure.

In addition to prematurity, babies can be admitted into the NICU because they are underweight, have a congenital birth defect, a condition that needs surgery or a medical condition that requires special attention.

• Apnea of prematurity — Because their brains and lungs are not fully developed, periods where breathing stops called apnea occurs in 85% of babies born before 34 weeks. Apnea may come with periods of bradycardia (or "bradys"), where the heart slows down. Stimulation usually helps the baby start breathing again. Monitors also make sure that episodes are caught right away. Medication and respiratory support may also help.

• Jaundice — Jaundice is yellowed skin caused by bilirubin, a product of red blood cells. It affects about half of term babies and up to 80 percent of preemies. It is treated with special lights. Premature infants are at risk for a rapid rise in bilirubin, and are treated more often than term babies to prevent kernicterus, a complication in which high levels of bilirubin damage the brain.

• Respiratory distress syndrome — Respiratory distress affects as many as 43% of premature babies born between 30 and 32 weeks, and almost all babies born before that time. Full-term babies make surfactant, a chemical that helps keep the lungs inflated. Without enough surfactant, premature babies’ lungs don’t inflate well. Preemies may need artificial surfactant, or may need help breathing while their lungs mature.

• Gastroesophageal reflux disease (GERD) — GERD affects up to 5-% of premature babies. In gastroesophageal reflux, stomach contents come back up the esophagus, causing the baby to spit up. Infants with GERD may vomit, lose weight or have respiratory problems like cough or pneumonia. Medication may be given to treat the condition, which preemies outgrow with time.

• Intraventricular hemorrhage (IVH) — Premature babies, especially those born before 30 weeks, have fragile blood vessels in their brains. If those vessels break, an intraventricular hemorrhage (IVH) may occur. This bleeding into the brain, which occurs in up to 14% of infants born between 30 and 32 weeks and 36% of infants born before 26 weeks, may be mild or severe. Severe bleeds can have serious consequences, such as developmental delays. Mild bleeds usually have no long-term effects.

• Retinopathy of prematurity (ROP) — Preemies are born with immature eyes. In retinopathy of prematurity (ROP), blood vessels in the eye grow abnormally. This can result in retinal detachment and blindness. The disease affects almost 50% of infants born before 26 weeks, but only 1% of preemies born after 30 weeks. An eye exam at 1 to 2 months of age screens for ROP, which is usually treated with laser surgery or cryosurgery.

• Patent ductus arteriosus (PDA) — Before birth, babies depend on the placenta for oxygen and have a different circulatory system from that after birth. One difference is the ductus arteriosus, an opening between the major vessels. The ductus usually closes at birth so that blood can flow normally. In preemies, it may remain open, causing PDA. This condition, which occurs in 8% of infants born between 30 and 32 weeks and more often in younger preemies, causes abnormal circulation. Medication or surgery may be needed to close the ductus.

• Bronchopulmonary dysplasia (BPD) — BPD is a chronic lung condition caused by airway inflammation. It affects infants who were on a ventilator for long periods of time, and can cause difficulty breathing and low blood oxygen levels. BPD affects as many as 62% of babies born before 26 weeks, but only 3% of those born between 30 and 32 weeks. Infants with BPD may need extra oxygen until the condition subsides.

• Necrotizing enterocolitis (NEC) — NEC affects the intestines of as many as 13% of babies born before 26 weeks, but only 3% of babies born between 30 and 32 weeks. With this condition, the lining of the intestines becomes infected and dies. Symptoms include a distended belly, lethargy and feeding intolerance. When it’s caught early, NEC is treated with antibiotics. Feedings are stopped and infants receive nutrition through an IV. Serious cases may require surgery. 

• Sepsis — Caused by bacteria in the blood, sepsis is a serious problem in preemies. Sepsis may occur early from exposure to bacteria in the womb or birth canal, or later from contaminated equipment or IV lines. Symptoms include breathing problems, lethargy and a swollen belly. Antibiotics are used to treat sepsis, which is most easily treated when caught early.

Family-centered care

UCI Health Neonatalology Services has a philosophy of care that embraces partnership between families and healthcare providers. The NICU is designed with this in mind.

The current structure of the unit allows parents to bond and spend unrestricted time with their newborns. We encourage parental involvement in infant caregiving and keeping an open line of communication with parents. Because of these continual interactions with the parents, physicians and nurses are able to support a family-centered environment during a very stressful time. 

Some of the things that we do in the NICU include:

• Use of banked breast milk — The best alternative food for any baby whose own mother's milk is not available is the breast milk of another healthy mother. Our NICU obtains banked breast milk from a source that has screened its donors and takes other precautions to help ensure the safety of the milk.

• Whole body cooling — Decreased oxygen and/or blood flow to the brain is a significant cause of brain injury in newborns. To help minimize the severity of oxygen or blood deprivation, we administer a treatment called therapeutic hypothermia, or whole body cooling. This procedure is done both in the neonatal intensive care unit (NICU) and in our specially equipped neonatal transport vehicles under the supervision of a team of neonatal intensive care specialists.

• Kangaroo care — This is a technique that allows newborn, usually preterm, infants to be held skin-to-skin with an adult. This may be restricted to a few hours per day, but if they are medically stable, that time may be extended.

• Maternal Fetal Transport Services — The UCI Health Maternal-Fetal Transport Service is staffed by a multidisciplinary team of medical specialists who transfer critically ill infants and high-risk expectant mothers to UCI Medical Center. This service is available around the clock, seven days a week.

• Neonatal Transport Services — The service provides a team of physicians, neonatal nurses (for neonatal transport) and respiratory therapists. The ambulance is equipped with specialized isolettes and life support for infants and enhanced hydraulics for a smoother ride.

• Nutrition services — UCI Medical Center is staffed by registered dietitians who monitor the weight gain and nutritional health of infants in our NICU. They work in conjunction with other members of the medical team to ensure that each infant receives optimal nutrition.

• Lactation services — Breastfeeding or giving breast milk to a premature infant can be a challenge. Our NICU lactation consultants meet with mothers after their infant’s arrival to show them how to use electric breast pumps, how to store and transport breast milk, maintain breast health and a good milk supply.

• Cuddler volunteer program — The birth of a baby who needs intensive medical care is often unexpected. Many families cannot visit the hospital every day to spend time with their new baby. Cuddler volunteers can provide support to babies and their families, giving personal attention and developmentally appropriate stimulation. Cuddler volunteers read books, talk, sing and console babies in gentle, soothing tones. Volunteers are screened, guided and directed by the NICU medical staff. Babies eligible for the program are determined by the NICU staff. Note: This program has been suspended due to COVID-19.

• Child Life Services — The child life services department focuses on the emotional well-being of the family and children in the healthcare setting. Child life specialists work with families, particularly the siblings of NICU patients, to help them cope with the fear, anxiety and stress of the hospital intensive care setting. They provide a service called "supervised-sibling at play" on specific hours during family visits in the NICU.