Neonatology

Patient Care
- Clinical Services by Specialty

Clinical Services

University of Washington Medical Center Neonatal Intensive Care Unit:
Dennis E. Mayock, MD, NICU Medical Director
Thomas P. Strandjord, MD, Associate Medical Director
In 1980, the 6-North wing at UWMC was remodeled to increase the capacity to 32 neonatal intensive care beds. Prior to this time the NICU consisted of a 16-bed unit located adjacent to the delivery room, the site now occupied by obstetric labor rooms. The most recent labor and delivery renovation was completed in 2002. Four new bed spaces were developed from current office and lounge space and became available in October 2009 making our current capacity 36 neonatal intensive care beds. A new 50 bed NICU in a new hospital tower is currently being planned, with planned opening in 2012.

Seattle Children's Hospital Neonatal Intensive Care Unit:
J. Craig Jackson, MD, MHA, NICU Medical Director
The Neonatal Intensive Care Unit at Seattle Children's Hospital shares a 45-bed ICU with the Pediatric ICU and Cardiac ICU. The average census of NICU patients (including surgical neonates and pre-operative CICU neonates) is 16 with peak census up to 21. The NICU medical team includes a faculty neonatology attending, a neonatal fellow, and 3 second- or third-year pediatric residents. They round daily with the NICU nurses, respiratory therapists, nutritionist, pharmacist, social worker, and patients' families. The NICU team accepts admissions for all neonates up to 44 weeks' corrected gestational age from a 4-state area and from other NICUs for unusual or challenging problems.

Overlake Hospital Medical Center (2003 – Present):
Shilpi Chabra, MD, SCN Medical Director
Thomas P. Strandjord, MD, Associate Medical Director
In May 2003, Overlake Hospital Medical Center obtained a Certification of Need (CON) for opening a Level III NICU with a total capacity of 14 beds. Prior to this time the Special Care Nursery transferred ventilated neonates to units with a higher level of care. Currently OHMC delivers between 3,500 – 4,150 babies per year resulting in 300 – 425 admissions to the NICU. The care model at OHMC is 24/7 in-house NNPs under the direction of attending neonatologists.

Providence Regional Medical Center Everett (2000 – Present):
Michael D. Neufeld, MD, MPH, NICU Medical Director
The 29-bed capacity Providence Regional Medical Center Everett (PRMCE) NICU opened on Mother’s Day, 2002. The unit was developed through the efforts of an alliance between PRMCE and Seattle Children's Hospital. Individual rooms provide privacy for patients and their families. The multidisciplinary team meets daily with parents and concentrates on family centered care, teaching parents how to take care of their infants, especially those with special needs. In preparation for discharge, parents are provided in-depth instruction on how to manage situations that may arise in the home and review cardiopulmonary resuscitation skills. The care model at PRMCE includes 24/7 in-house NNPs under the direction of attending neonatologists.

Regional Perinatal Care and Outreach Programs:

Thomas P. Strandjord, MD, Contractor, Washington State Department of Health

Northwest Perinatal Regional Network (NWPRN):
Our program faculty are involved in a state funded regional perinatal/neonatal quality improvement program which facilitates quality improvement activities in all 26 hospitals providing obstetric care in northwest Washington State. The NWPRN is currently developing perinatal quality indicators that can be used to reliably provide benchmarking. It is also organizing a network of Washington State neonatal intensive care units to facilitate statewide efforts to improve care of critically ill neonates.

NRP and Resuscitation Skills Labs:
Our faculty, fellows, neonatal nurse practitioners, and transport team members are involved in several aspects of NRP training. They conduct skills labs with resuscitation training sessions/reviews, which include airway skills, as well as x-ray and case reviews for Seattle Children's Hospital and Airlift Northwest flight nurses and respiratory therapists.

WWAMI (Washington, Wyoming, Alaska, Montana, Idaho):
In the sphere of outreach education, the faculty are also involved in the 5-state WWAMI program for medical student and resident education. Two or three times per year, faculty members visit selected programs for outreach education.

Infant Ground Transport Program:

Linda Wallen, MD, Medical Director
The Division of Neonatology directs the Infant Ground Transport Team service and the newborn component of Airlift Northwest transport services. Most of the infants are brought to Seattle Children's Hospital but we also transport newborns and infants to the University of Washington and Providence Regional Medical Center Everett, in addition to serving other area hospitals. The Ground Transport Team is composed of specially trained transport nurses and respiratory therapists, and can provide full ventilator support including oscillation, nitric oxide administration, and cardiopulmonary monitoring including blood gas analysis. ALNW transport is staffed by specially trained pediatric and adult critical care nurses and can provide full ventilatory support and monitoring. The Division of Neonatology is dedicated to training and supervision of team members of both transport systems, including case review, resuscitation skills, endotracheal intubations, insertion of umbilical catheters, x-ray interpretation, and treatment of pneumothorax.

Medical Consultation Program/Children's Communication Center:

The division provides 24 /7 medical consultation services and medical control for neonatal ground and air transport for the 5 state WWAMI region for about 600 patients per year – most involving multiple calls.

High Risk Infant Follow-Up Clinic:

Director: F. Curt Bennett, MD
The University of Washington High Risk Infant Follow-up Clinic began in 1975, linked to the UWMC NICU for outcomes research purposes. Since then, it has expanded and taken on additional clinical service and interdisciplinary training functions. Its present staff includes health care professionals from developmental pediatrics, neonatology, psychology, audiology, nutrition, physical and occupational therapy, and social work.

The majority of infants seen were either born prematurely or experienced prenatal drug exposure. Very low birth weight infants weighing less than 1500 grams at birth are prioritized for follow-up. Other infants with specific neonatal concerns, e.g., chronic lung disease, intracranial hemorrhage, infection, are also followed. Scheduled evaluation times include 4, 12, 24, 36, and 54 months and 6 and 8 years corrected age. Approximately 600 high-risk infants and children are seen annually in the clinic. About 40 percent of these visits are infants in the first year of life.

Neonatal-Perinatal Database:

Database Coordinator: Michael D. Neufeld, MD, MPH
The University of Washington Medical Center Neonatal Intensive Care Unit has a QA , QI , and research NICU database that includes all infants admitted to the NICU, as well as all infants delivered at UWMC over 22 weeks gestation. The database has been developed by the Division of Neonatology and is maintained by division staff and faculty. In addition, since 2000, the University of Washington NICU has participated in the Vermont-Oxford (VO) database for 401-1500 gram infants. Data is selected for inclusion in the NICU database by consensus of the neonatology faculty and fellows. The NICU database contains a superset of the data required by the VO database and as such includes extensive admission, diagnostic, outcome and local QA/QI data. The outcome (morbidity and mortality) data is generated annually and reviewed with the faculty and fellows. In addition, ad hoc queries are performed at the request of fellows and faculty and reviewed as a group as well.