A Day in the Life of a NICU Doctor

A doctor cares for a baby in the NICU.
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Having a baby is a life-changing event, and for most new parents, it's a happy event. However, for some families, this moment is life changing because of unforeseen complications during labor and delivery, from preterm birth to congenital malformations. Families may suddenly find themselves working with a team of neonatal specialists caring for their newborn in a neonatal intensive care unit, or NICU. NICU teams work with infants born anywhere from 23 week's gestation (micro-preemies who are born more than 4 months ahead of schedule) to full-term babies born with complications that need immediate, short or long-term attention.

We spoke with Edmund La Gamma, MD, a practicing neonatologist who is chief of the Division of Newborn Medicine in the Department of Pediatrics, professor of Pediatrics, Biochemistry & Molecular Biology at the New York Medical College and the director of the Regional Neonatal Center of the Maria Fareri Children's Hospital at Westchester Medical Center, to find out more about the NICU and just what it takes to work in one. First, Dr. La Gamma gives us an overview of how the NICU is set up.



An Overview of the NICU

Dr. La Gamma works within a network of neonatal intensive care programs at 11 hospitals across the Lower Hudson Valley Region of New York State.

"To give you an idea of how the division I work within is organized, there are four levels of neonatal services for pregnant women and newborns, depending on the level of care that's needed.


Level I is for pregnant women and newborns who are at low risk. Level II is for pregnant women and newborns with moderate risk for complications, such as a mother with gestational diabetes. These services are what you'd find at your community hospital. Level III is high risk, and Level IV is the highest risk. Levels III and IV provide care and services for babies who are preemies or who need special treatment in neonatal intensive care units (the NICU).

For example, babies who are below 2.2 pounds -- micro preemies -- make up only .5 percent of all births, about 110 per year in the NICU. The highest risk for delays and complications -- a whole slew of things -- these are those babies. Babies who are born with acute illness, respiratory problems, babies with total lung or total heart failure who need ECMO (Extra Corporeal Membrane Oxygenation), cardiac surgery cases, abdominal surgery cases, neurosurgery, orthopedic surgery -- these are other examples of the types of complications we face.

Ninety-five percent of the time labor and delivery goes well but there is always potential for something to go wrong. The rare and unusual becomes common for us."


Concentrated Excitement

"The thing that is most dramatic about the NICU is the majority of couples who find they need us are really totally unprepared. The reasons why? Often, they are young -- they haven't thought about the difficulties of life. Having a baby is a happy, great moment in any couple's life. When that is shattered with a problem with their baby, there is shock of dealing with bad news, overwhelming emotions, new medical terminology, who will help. The thing that strikes me about families in this environment is the shock.

If you have a habit in life like smoking and you get cancer, that's a consequence you should be prepared for. We know smoking causes cancer. But when you have a normal pregnancy and you're a healthy woman, you don't expect there to be complications with your infant.


[There are] two scenarios: finding out about a potential problem during pregnancy and complications in the delivery room. If the couple is able to prepare weeks ahead instead of waiting for delivery, there is a process of awareness and meeting the team that allows the family to prepare psychologically and emotionally about what happens next. We also put families in touch with other couples who have gone through it. The shock is what is most dramatic.

Ultimately, no one really knows until that moment of birth what is going to happen. In the hospital setting, there is an expectation of treating and correcting everything. There are times where you go into a situation and you have no idea what happened. There are hundreds of reasons why complications happen. Decreased fetal movement is common. There's a vision from everyone in the room that this is the rest of someone else's life.

In the delivery room, it's a combination of all the wonderful things about having a child, a family is growing, and there's a lot of blood and people crying in pain and it's totally unpredictable until it's done. It's concentrated excitement. The decisions we make -- what needs to happen now, in the next five hours, in the next five weeks -- all need to happen quickly and be communicated to the family. If they understand how and why you're doing things, they're better involved and less panicked."