The NICU at MCV Hospitals soon became one of the largest units on the East Coast after it opened. Now, the program is based at Children's Hospital of Richmond at VCU. (Contributed photo)
By Polly Roberts
The standard of care for treating critically ill or premature babies prior to the 1960s was quite simple. It didn’t exist.
Until the advent of neonatal intensive care units in the ’60s and ’70s, the prevailing wisdom was that these babies wouldn’t survive, or if they did, they wouldn’t thrive.
“At the time, pediatricians were hands-off when it came to premature babies,” said Barry Kirkpatrick, M.D., FAAP. “They didn’t believe in interventional care. They thought these babies had a good chance of dying.”
This mindset dramatically changed with the 1963 death of President John F. Kennedy’s son at 34 weeks gestation. The event spurred the creation of the neonatology field and the push for technologies to treat what was then known as hyaline membrane diseases, a condition that killed about 25,000 children a year.
In 1973, Kirkpatrick established Central Virginia’s first NICU at MCV Hospitals. By 1982, it was treating 900 patients a year and transporting more than 300 patients from outside facilities as the referral unit for 13 regional hospitals. By 1986, it was one of the largest units on the East Coast.
In 2023, the NICU celebrated 50 years of saving the littlest lives on the MCV Campus.
The advent and growth of specialized neonatal care and education
As founding director Kirkpatrick remembers the pace and urgency of those early days when he was the lone neonatologist on the unit.
“I was on call every day and every night for two years straight,” he says. “When that changed to call every other night, I thought I had died and gone to heaven.”
The death of PresidentJohn F. Kennedy’s son at 34 weeks gestation spurred the creation of the neonatology field. (Contributed photo)
He oversaw a series of milestones — including first on the East Coast to use anextra-corporeal membrane oxygenation machine (ECMO) — and developed the staff not only at the medical center but also in the community, traveling with “a cadre of nurses” to teach other hospitals and paramedics how to resuscitate a sick baby.
Their commitment to the emerging specialty paid off. Within three to four years of the NICU’s creation, the pediatric community was on board after seeing high-risk infants including premature babies grow into healthy, thriving toddlers.
The best care for high-risk infants at Children's Hospital of Richmond at VCU
Now, 50 years later, the NICU has evolved beyond what rotating medical students, residents and fellows may remember as cutting edge in the 1970s and 1980s. For example, the large, noisy bays housing dozens of premature or critically ill babies have been replaced with quiet, single rooms that destress infants and discourage maternal separation.
“Operative suites are embedded in the NICU to avoid the movement of children that is known to disadvantage their outcome,” said Karen Hendricks-Muñoz, M.D., M.P.H., professor and the William Tate Graham, M.D., endowed chair of the Division of Neonatal Medicine at Virginia Commonwealth University's School of Medicine and deputy director of the VCU Center on Health Disparities.
She notes that two-thirds of today’s NICU admissions are focused on critically ill term infants with congenital conditions that impact their heart, lung, intestine or brain function. Numerous developed clinical programs are now not only standard of care but areas of excellence, helping contribute to a top 50 neonatology program ranking from U.S. News and World Report in 2023-24.
These include advances in modes of respiratory care such as high frequency ventilation, ECMO and surfactant therapy to dedicated NICU psychologists or the arctic hypothermia cooling programs for the treatment of infants with hypoxic ischemic encephalopathy. Nutrition and neurodevelopmental therapies begin in the NICU and continue in the regional neonatal continuing care outpatient follow-up program that just celebrated its 10th year.
Barry Kirkpatrick, M.D., FAAP, of Children's Hospital of Richmond at VCU is a pioneer inneonatal medicine. (Enterprise Marketing and Communications)
New in recent years is a small baby program to optimize the management of infants born at 22 to 25 weeks gestation.
The question of whether the lives of critically ill or premature babies are worth saving has come a long way in five decades. “It’s really gratifying to see the improvement of care for the majority of premature babies,” said Kirkpatrick, who trained 940 pediatric residents along with fellows and hundreds of medical students. In them he instilled the belief that sick babies were still people to be cared for — a perspective they then carried with them into their careers.
There’s more to be done every day. Hendricks-Muñoz’s vision centers on continuing to contribute to medical care advancements and educating and inspiring the next generation “to continue to push the envelope in our understanding and technologies so that every newborn can have a healthy life to fulfill their optimal potential.”
FAQs
Few parents expect it, but between 10 and 15 percent of all babies born in the United States require special care in the NICU. NICU stands for Neonatal Intensive Care Unit. It is a special unit for preterm babies which are born very early or very ill.
How much do babies grow in NICU? ›
Otherwise healthy preterm infants first catch up in head circumference, then weight and length. Weight gain of 20-30 g/day is desirable in preterm infants (>2 kg). Increases by approximately 1.1 cm/wk until term. From term-3 months, 0.75 cm/wk.
What are two reasons a baby may be admitted to the neonatal intensive care unit? ›
Reasons Why Your Baby Might Be Sent to the NICU
- Prematurity. Babies born early (less than 37 completed weeks) is the most common reason for a NICU admission. ...
- Respiratory Distress Syndrome (RDS). ...
- Sepsis or infection. ...
- Hypoglycemia. ...
- Perinatal depression. ...
- Maternal chorioamnionitis.
The NICU is a nursery in a hospital that provides around-the-clock care to sick or preterm babies. It has health care providers who have special training and equipment to give your baby the best possible care. Learn about the levels of medical care that NICUs provide and what level your baby needs.
What are the odds of a baby surviving in the NICU? ›
A reasonably easy to remember guide is that the survival rate is about 40% for all babies born at 24 weeks' gestation, 50% for those born at 25 weeks, 60% for those born at 26 weeks, 70% for those born at 27 weeks, and 80% for those born at 28 weeks.
Can you refuse NICU care? ›
Can you discharge your child from the NICU? You have the legal right to sign your child out of the hospital and refuse further treatment. But this is considered discharge against medical advice. If doctors believe it is in your baby's best interest to stay, they may get Child Protection Services involved.
How much does it cost a day for a baby to be in the NICU? ›
A NICU stay in the U.S. can range from $3,000 to $20,000 per day. In severe cases where infants require prolonged stays or multiple surgeries, the total cost can soar into the hundreds of thousands or even cross a million dollars.
Where do babies go after NICU? ›
Some babies go home directly from the NICU, but most NICU babies are eventually transferred to a step-down unit for less intensive care before discharge. The step-down unit may be within the NICU itself or very nearby.
Do NICU babies develop slower? ›
Reaching developmental milestones may take a little longer for premature babies by comparison with babies born at full term. This is because they are younger. Your baby will be assessed according to their 'corrected age'. This is your baby's age from your due date, rather than the day they were born.
Can I leave my baby at the hospital if I don't want it? ›
In every state, women who decide to surrender their babies are protected by Safe Haven laws. To answer the question, "Is it legal to leave a baby in the hospital," the answer is yes.
If you choose to leave without your baby after delivery, the hospital will contact the appropriate authorities (usually the police and the local foster care department) to come and assume temporary custody of the baby until a foster family or permanent adoptive parents are found. The hospital does not keep the baby.
What is considered a neonatal death? ›
Neonatal death is defined as the death of a baby in the first 28 days of life. It happens in about 3.58 in every 1,000 births (less than 1 percent) each year in the United States. Your baby's health care provider can help you learn as much as possible about why this happened. What are common causes of neonatal death?
What are the most common reasons babies go to the NICU? ›
Most babies admitted to the NICU are preterm (born before 37 weeks of pregnancy), have low birth weight (less than 5.5 pounds), or have a health condition that needs special care. In the U.S., nearly half a million babies are born preterm. Many of these babies also have low birth weights.
Is NICU considered critical care? ›
A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants.
What does Wimpy White Boy syndrome mean? ›
“Wimpy White Boy Syndrome” (WWBS) is a social phenomenon and belief that. exists in the neonatal intensive care unit (NICU), where white boys fare the worst and. Black girls fare the best. However, this belief is based on little to no empirical evidence.
At what point do babies not need NICU? ›
Any preemie that's born earlier than 34 weeks gestation should spend several weeks in the NICU. On average, doctors recommend preemies stay in the NICU until three to four weeks before what their regular due date would have been.
What is the ratio for NICU patients? ›
a nurse-to-infant ratio of one to one (15,16) (one nurse for one infant) for infants requiring intensive care, of one to two (15,16) (one nurse for two infants) for infants needing intermediate care, and a ratio of at least one to four for all infants requiring special care (15)
What is the NICU admit rate in the US? ›
Results: Between 2016 and 2021, US births decreased by 7% (3,945,875 to 3,664,292/year). NICU admissions increased from 344,454 to 351,775 (+2%) and admit rate from 8.7% to 9.6%.
Which babies need NICU? ›
What Is the NICU? When babies are born early, have health problems, or a difficult birth they go to the hospital's NICU. NICU stands for "neonatal intensive care unit." There, babies get around-the-clock care from a team of experts. Most of these babies go to the NICU (NIK-yoo) within 24 hours of birth.
The NICU at MCV Hospitals soon became one of the largest units on the East Coast after it opened. Now, the program is based at Children's Hospital of Richmond at VCU. (Contributed photo) 
