Neonatal Intensive Care Unit (NICU)

with John Wolf, M.D., Neonatologist, Columbia St. Mary’s

Posted: Jan. 1, 2004

Dr. John Wolf is not the kind of doctor you want to see, but you’re sure glad he’s there when you need him. He’s a neonatologist, a pediatrician who specializes in the care of sick term and/or premature newborns.

He’s also the director of the Neonatal Intensive Care Unit (NICU) at Columbia St. Mary’s Hospital, which provides care to up to 21 infants at any given time.

John Wolf, M.D., Neonatologist, Columbia St. Mary's "We used to look at the parents as visitors when actually we're the visitors in the lives of these babies."

Family-centered care
In the 17 years since Dr. Wolf began practicing in Milwaukee, he’s seen – and taken part in – a transformation on the part of medical staff who care for the smallest and most vulnerable newborns. The movement toward family-centered care has permeated nearly every branch of medicine, but the changes that have resulted for NICU patients and their parents have been particularly striking.

“In the 1970s and 1980s, babies would be admitted into the NICU and often mothers wouldn’t see their babies for days and they wouldn’t hold them for weeks or months,” Dr. Wolf said. “All the care would be in the nurses’ hands and parents wouldn’t be encouraged to get involved.”

Today visiting hours are 24/7 and parents are encouraged to participate in the planning and provision of care. Dr. Wolf and his staff also have done everything possible to make the environment inviting and supportive.

Maintaining a welcoming environment is important, Dr. Wolf said, particularly because the parents of NICU patients are often in crisis.

“Often they’re not expecting their term or near-term baby to have a problem, or they think premature babies are tiny healthy babies who will grow and be fine, and often that’s not the case,” he said. “So when they enter the unit they’re frightened, they’re frustrated and they feel powerless.”

NICU staff members are passionate about facilitating bonding between babies and their parents. Dr. Wolf is part of a group of 18 neonatologists, but the doctor who admits a particular baby becomes that infant’s primary care physician for the duration of his or her stay in the NICU.

Maintaining a welcoming environment is important, Dr. Wolf said, particularly because the parents of NICU patients are often in crisis.

In addition, nurses’ schedules are adjusted so that as much as possible the same nurse deals with the same baby on each of his or her shifts. A medical social worker and psychologist are on hand to help parents deal with anxiety and other issues that may arise, and staff is committed to helping parents learn to care for their babies, particularly as they get ready to go home as a family. If a baby needs a monitor, staff are vigilant about making sure parents are confident using it, and lactation consultants help mothers with breastfeeding, which Dr. Wolf said is particularly important.

“One of the aspects of family-centered care is to promote breastfeeding, and we encourage mothers to pump milk if they choose,” he said.

That encouragement seems to be working. “At one point,” Dr. Wolf said, “every baby in the NICU and the newborn nursery was breastfed.”

Needs of premature babies
Babies born prematurely need special care, care which can make it hard for parents to hold their child immediately after birth.

Often, premature babies’ lungs aren’t developed enough for them to breathe independently, so they go on a ventilator. They’re also given oxygen and may have catheters placed in the umbilical vessels to provide nutrition, allow for blood pressure monitoring and infusion of medication, and facilitate the drawing of blood work.

A baby born at 27 weeks may only need to be on a ventilator for a few days or weeks, a baby born at 23 weeks could need the ventilator for months.

The timeline of developmental milestones associated with term infants are not applied to preemies, who are evaluated on a different scale than their 40-week counterparts.

“The time it takes them to catch up depends on how early they were,” Dr. Wolf said. “Sometimes they never catch up. Sometimes they’ll be developmentally delayed or have long-term neurological problems. It’s very difficult to predict that ahead of time, which makes it very hard, especially for the parents.”

Term babies in NICU
Term babies admitted to the NICU may have had mothers with diabetes, resulting in the baby having trouble maintaining blood sugar levels, or the infants may have birth defects, Down’s Syndrome, congenital heart disease, infections or were born addicted to drugs.

We Have Answers Do you have medical questions or need help finding a doctor? The experts at Columbia St. Mary's and Advanced Healthcare can help. Click here.