The NICU Team
Children's Hospital of Wisconsin is a tertiary care or Level III center, as is Froedtert Hospital. We may be referred to as a subspecialty or regional medical center. Together, these hospitals have the facilities, resources, and specialties to care for the most acutely ill adults, children and babies. The Fetal Concerns Center also is affiliated with the Medical College of Wisconsin. This means most of the attending physicians are professors of medicine who lecture students who are studying to become doctors. They also work with the residents and medical students on the clinical units of the hospital. As part of their instruction, students rotate through various units of the hospital. Rounds are done each day as part of the rotation. During rounds, each patient's case is discussed and his/her plan of care is review by the resident, medical student, fellow and/or attending physician (as well as some of the nursing staff). This allows us to provide the best care available. However, it also can be confusing and overwhelming for patient families who have never been exposed to this kind of medical facility. The descriptions provided below introduce some of the professionals that patients and their families may meet. Patients and their families should feel free to ask questions of anyone on the care team. If someone forgets to introduce himself or herself, please ask for an introduction.
Neonatologist/Attending Physician: A neonatologist is a pediatrician who has special training in the care, diagnosis, and treatment of sick neonates or newborns. He or she is the most experienced and knowledgeable regarding the baby's care and directs the care that is to be provided. There is a neonatologist available either in the Neonatal Intensive Care Unit or on call 24 hours a day, seven days a week.
Neonatal/Surgical Fellow: This is a doctor who has completed medical school and his or her residency (normally three to five years) and is now training to become a specialist. They may be training to become a neonatologist or surgeon. Fellows will often be very involved in the training of residents as well as the plan of care for the babies.
Resident: This is a doctor who has completed medical school and is now in the intensive, hospital based, clinical training. The number of years a doctor spends as a resident depends on the specialty he or she has chosen, however, pediatric residency is usually three years. The residents may be first-, second- or third-year residents. Residents are very involved in the care of neonates, under the supervision of a more experienced resident, fellow and/or attending physician.
Medical student: Medical students are in medical school and usually do not do a lot of "hands on" procedures. Instead, they will do more data collection, such as asking you questions about your medical history. This is a very important part of their learning process.
Specialists: There are many specialists that may be involved in the care of the mother and baby. In pediatrics, there are specialist for each body system. These can include:
Pediatric cardiologist and cardiovascular surgeons for the heart.
Pediatric dermatologist for skin issues.
Pediatric neurologist and neurosurgeons for the nervous system.
Pediatric urologist and nephrologists for the urinary tract.
Pediatric gastroenterologist for the gastrointestinal tract.
Pediatric geneticist for chromosomal issues.
Pediatric hematologist for problems with the blood.
Pediatric orthopedics and orthopedic surgeons for bone issues.
Pediatric surgeons for general surgical issues.
Palliative care specialists for end-of-life issues.
Registered nurse: The primary care nurse is a nurse who is assigned to care for the baby. Many families develop special relationships with several nurses in the NICU. The nurse is the person who spends the most time with the baby and will get to know him or her very well. They are a great source of knowledge. Parents can ask them about all aspects of their baby's care. The nurse will provide parents with the information they need to eventually take the baby home. The RN can help parents learn how to care for and interact with the baby. The NICU nurses go through extensive training to learn the skills necessary to assess and care for the most critically ill infants.
Neonatal nurse practitioner or advanced registered nurse practitioner: These are nurses who have worked in the NICU and then returned to school for a master's or doctorate degree in neonatal nursing. They must pass a standardized test in order to practice as a NNP. These nurses can assess and care for your baby by prescribing medication and performing a variety of invasive procedures. They usually manage their own caseload of patients, under the supervision of the neonatologist.
Clinical nurse specialist: This is a nurse who worked in the NICU and then returned to school for a master's degree. He or she functions as the expert and resource person for the bedside nurse. He or she may also provide educational offerings for staff and/or families. Sometimes these nurses work side by side with the staff either in the orientation process or to assist with the development of a care plan for infants who are not responding well to treatment. This specialized nurse also does a lot of policy and/or program development and may be involved in research and consultation.
Other support staff
Care partners: These individuals are certified nursing assistants that work in partnership with the nurses to care for the stable infants in the NICU. They also assist with unit operational functions such as reception, answering the phone and greeting visitors and setting up and taking down equipment.
NICU Techs: These individuals are responsible for the maintenance of the NICU equipment and environment. They are supply experts with responsibilities that include setting up and taking down bed spaces, assisting with setup for procedures, stocking the bed spaces and running for almost anything necessary (dropping off blood samples, picking up medicine from the pharmacy, restocking supplies, etc.).
Unit secretary/health unit coordinator: This is the person who sits at the front desk as visitors enter the NICU. He or she is responsible for answering the phone, paging the doctor or nurse as needed, completing medical records paperwork, ordering supplies and general upkeep of many issues within the general NICU, and can be a good source of information.
Social worker: The social worker has earned a master's degree in social work. He or she is available to talk with parents about a variety of issues related to their baby's stay in the NICU and can help you cope with the stress, discuss financial issues and help with discharge planning.
Lactation consultant: These are usually nurses who have had special training related to breastfeeding. The lactation consultant can assist mothers with any breastfeeding issues, especially pumping and storing breast milk and maintaining milk supply until your baby can actually breastfeed. Once the baby is ready to go to breast, the lactation consultant can assist with positioning the baby, getting the baby to latch on and eventually making the transition to full-time breastfeeding.
Respiratory care practitioner: Respiratory care practitioners are specially trained in the care of the respiratory system. If the baby is receiving any type of oxygen therapy, including ventilation, the respiratory care practitioner will be involved in the maintenance and adjustments of the equipment, assisting with procedures like suctioning, intubations and extubations.
Occupational therapist: Occupational therapists are specially trained to provide structured activities aimed at recovery or rehabilitation. In the NICU environment, the initial focus of an occupational therapist may be aimed at feeding issues, specifically related to coordination of the suck, swallow, breathe components. They may also be involved in teaching parents exercises to promote developmental or behavioral issues like holding the head up, reaching, etc.
Physical therapist: Physical therapists are specially trained to provide structured activities aimed at recovery or rehabilitation. These activities may include exercise, massage, and water, light and heat treatments.
Technicians and Procedures
Lab: During a baby's stay in the NICU, frequent blood tests are required to ensure that he or she is doing well. Lab technicians specially trained in drawing blood from a baby will be involved in each baby's care. While a baby has an arterial line, most lab tests can be done on blood drawn from this line. If the baby no longer has an arterial line or is having a test where an arterial line cannot be used, blood will need to be drawn. Blood can be drawn in a variety of ways. Sometimes a needle and syringe will be used to draw blood, and sometimes a "heelstick" will be done to draw smaller amounts of blood. A "heelstick" is a small puncture to the baby's heel. Often, we will warm the foot and then use a small lancet (like that used by diabetics to do a finger stick to check their blood sugar) to puncture the heel to get a steady drip of blood as we gently squeeze the foot. This blood is either collected in a small glass cylinder, or dripped directly onto a test strip.
Ultrasound: Many babies will need a variety of diagnostic tests performed to assess them for various issues. Ultrasound is a noninvasive test, like the one performed on pregnant women. A two-dimensional picture is obtained by using sound waves that bounce off the internal anatomy. A transducer is used in contact with your baby's skin and gel is used to create a closer contact. Ultrasound can be used with Doppler, which gives an ultrasound color picture of blood flow. Ultrasound is a quick bedside procedure, without side effects, so it is used whenever possible to assist with diagnosis. The ultrasound technicians who perform these tests on the baby are specially trained to do ultrasounds on infants and children.
X-ray: Most babies admitted to an NICU will receive some type of X-ray during their stay. This is an important diagnostic test, but it exposes the baby to radiation. The amount of radiation is carefully controlled in relation to each baby's size and weight. Most X-rays can be done at the baby's bedside using portable equipment. The X-ray technicians have been specially trained in X-ray techniques, portable X-ray and performing X-rays on critically ill infants and children.