For most families, the first moments of a baby’s life are filled with joy. But when a baby comes too early or needs urgent medical attention, that joy can quickly turn to fear. While most deliveries go smoothly, roughly 10% of newborns need extra support. In San Diego, that often means a transfer from the delivery hospital to the main neonatal intensive care unit (NICU) at Rady Children’s.
“Rady Children’s NICU is a partner to all birthing centers in San Diego,” says Denise Suttner, MD, clinical director of Rady Children’s NICUs, director of the San Diego Regional ECMO Program and a professor of pediatrics at UC San Diego. “We are committed to delivering the highest level of care that can be provided to babies, and to supporting babies in San Diego County and beyond.”
Though many local hospitals have NICUs, Rady Children’s operates the only Level 4 NICU—the highest level designated by the American Academy of Pediatrics. Rady Children’s 60-bed NICU on its main campus is a major referral center in Southern California, seeing close to 1,000 infants each year.
“When a mom goes into labor at a hospital that doesn’t have the right support to take care of a baby with a complex condition, they oftentimes come to the main Rady Children’s NICU because the condition supersedes what the delivery hospital can offer,” says Jeanne Carroll, MD, medical director of the NICU at Rady Children’s and an associate professor of pediatrics at UC San Diego.
Rady Children’s Health operates Level 2 and Level 3 satellite NICUs inside several hospitals in San Diego and Riverside counties, and a Level 4 NICU at Rady Children’s Hospital in Orange County.
“The NICU at Rady Children’s main campus provides regional care and very specialized critical care. Our satellite locations across Southern California also do an incredible job of caring for babies close to home so that the families can be a part of their daily care, which is so critical,” says Rebecca Schiff, DNP, director of neonatal services at Rady Children’s Health and the Hospital’s NICU CHET.
“We have a specialized delivery team that attends high-risk deliveries,” she continues. “Our hope is that this team gives the baby the best chance at staying close to their families.”
Specialty and Subspecialty Care
The NICU is a specialized department with a highly trained team of doctors, nurses and support staff who work around the clock to provide advanced medical treatment to the most vulnerable patients. Its multidisciplinary team includes board-certified neonatologists, nurse practitioners, advanced practice providers, dietitians, neonatal therapists and other specialists with expertise in caring for critically ill newborns.
“It’s very common for us to have many subspecialists helping to manage the care of a baby at the Rady Children’s main NICU to ensure that the baby is getting the most rapid diagnosis and appropriate treatment in the most expeditious manner,” says Dr. Suttner.
“Nurses help guide the family through what they’re seeing at the bedside—what the alarms mean, what the various tubes are connected to their child,” she says. “We have a dedicated social work team that understands that providing psychological support is really helpful.”
Schiff says that, for her and her fellow nurses, engaging families is an important part of the job. Nurses show parents how to interact with their child in ways that are therapeutic and developmentally appropriate, such as by reading to them. Studies show that reading to babies promotes brain development, reduces stress and helps strengthen the bond between parent and child.
“Part of what we do is to ensure they have the care they need to grow and thrive,” Schiff says.
Along with NICU care, the Hospital’s Division of Neonatology provides a full range of services, including a comprehensive congenital diaphragmatic hernia center and a leading neuro-NICU program. Rady Children’s also has the only pediatric extracorporeal membrane oxygenation (ECMO) program in the county—an advanced life support system for patients with life-threatening heart or lung conditions.
Solving Medical Mysteries
While there are many conditions that require NICU-level care, some babies are admitted with symptoms that are difficult to pinpoint. That’s where genomics comes in. The Rady Children’s Institute for Genomic Medicine aims to find the cause of an infant’s mystery ailments using rapid whole genome sequencing. A diagnosis of a known genetic disease opens up a world of possible interventions.
“Genomic testing has become more common, but it is oftentimes still challenging to get the test turned around quickly. One of the unique things about Rady Children’s is that we can get test results very fast, and we get expert interpretation,” says Dr. Suttner. “It’s one thing to get a genetic test, but having somebody who’s part of our team and is readily available to interpret those results is extremely impactful.”
NICU Care: Then and Now
The expert care vulnerable newborns receive in the NICU is the result of decades of research and innovation.
“The field has evolved tremendously, and continues to do so,” says Dr. Suttner.
There has also been a shift in thinking. The focus is no longer on just ensuring the infant’s survival, but on their long-term development and quality of life.
Looking to the future, Dr. Suttner hopes to see even more research into long-term outcomes because “many of these children still go on to have complex medical needs.” But she’s optimistic.
“It’s my hope that we continue to learn about how to improve the quality of life for NICU babies,” she says. “Many of them go on to be completely fine, but some children need a lot of health care support. It would be tremendous if we could move that trajectory.”