== Neonatal Intensive Care - East Tennessee Children's Hospital

Neonatal Intensive Care

Neonatal Intensive Care

More than 750 of East Tennessee Children's Hospital's smallest patients are treated in the Neonatal Intensive Care Unit (NICU) every year. The babies in the NICU were born before their due date or have breathing problems, neonatal abstinence syndrome or congenital birth defects. Your baby will have a nurse practitioner and doctor, plus a nurse each shift. Our staff members are here to answer your questions and help you feel comfortable in the NICU.

Safety, Quality and Expertise

Safety, quality and cleanliness are always the highest priorities of our work in the NICU and in all of Children's Hospital. The hospital is one of the top pediatric centers for safety and quality because of decreases in central line associated blood stream infections, surgical site infections and ventilator associated pneumonias. The Children's Hospital NICU has had zero ventilator-associated pneumonia cases for the last two years due to better practices and higher standards. Learn more about patient safety at Children's Hospital.

Children's Hospital has been recognized across the country for spreading awareness about the NAS issue and the methods it has adopted.

In 2011, Children's Hospital staff created a new way to treat NAS babies. The NICU now uses small doses of morphine to help the babies through their withdrawal. The infants cannot become dependent on the morphine.

Our NICU has adopted new technology such as cooling caps to help babies with hypoxic-ischemic encephalopathy rest and recover.

Children's Hospital has 57 very experienced cuddlers who calm babies in the NICU. These volunteers hold babies, rock them to sleep and give them a human connection when parents are not there.

In 2012, Children's Hospital built a brand new NICU with 16 private rooms for NAS babies. In 2014, a $75 million expansion began, which included the addition of 44 private NICU rooms to improve the environment for both babies and their families.

The NICU's location in Children's Hospital means that all staff members are highly trained to work with and understand the special needs of children and their families.

Neonatal Abstinence Syndrome (NAS)

Neonatal abstinence syndrome is a growing problem in Tennessee. NAS happens when babies are in contact with medications or illegal drugs in the womb. After birth, they experience withdrawal just like adults. They have a screech-like cry, claw their faces and squirm. The process is very painful. Babies can become dependent on:

  • Painkillers
  • Anxiety medicine
  • Sleep medicine
  • Illegal drugs
  • Prescription drugs

Children's Hospital developed a special treatment protocol for babies with Neonatal Abstinence Syndrome. NAS may be a tough subject for parents, so the NICU works with the Children's Hospital Social Work Department if needed. The hospital sets up follow-up care and safeguards for when you return home.

How Children's Hospital is Fighting NAS

Neonatal abstinence syndrome (NAS) is a growing problem in Tennessee. NAS happens when babies are in contact with medications or illegal drugs in the womb. These babies form a physical dependence on the drugs used by their mothers during pregnancy. After birth, they experience withdrawal just like adults. Withdrawal symptoms vary, but can include high-pitched crying, tremors, hyperactive reflexes and inconsolability. In some cases, drug-dependent babies suffer seizures as well.

In 2014, 265 of 774 babies admitted to the Children's Hospital Neonatal Intensive Care Unit (NICU) were suffering from NAS. The neonatal team also cares for drug-dependent newborns at Fort Sanders Regional Medical Center and Parkwest Medical Center; their symptoms are not severe enough to warrant NICU admission.

The most common form of drug dependence seen in the Children's Hospital NICU are opioids, a class of drugs commonly prescribed for pain management and addiction recovery. Babies become dependent on opioids and other drugs their mothers use during pregnancy because the drugs cross the placenta, and pass from mother to baby. When infants are born with drug dependence, they are at a higher risk for heart, spinal, and intestinal defects, as well as learning and behavioral problems as they reach school age.

Faced with the growing problem of NAS, the Children's Hospital NICU staff created a better protocol for treating babies suffering from the condition. The NICU staff implemented a new, multifaceted treatment protocol that involves doctors, neonatal nurse practitioners, bedside nurses, social workers, a case manager, the rehabilitation team, and a pharmacist to develop this approach that involves evaluating neonates with NAS by using the Finnegan Scoring System (which analyzes a range of central nervous system, metabolic, gastrointestinal and respiratory symptoms). The resulting score allows the NICU staff to adjust treatment as needed.

The next important step is to get the initial symptoms of withdrawal under control without medication. Children's Hospital accomplishes this by keeping babies swaddled in private rooms. The rooms are kept quiet and dark, avoiding overstimulation. A specialized diet, baby swings and a group of trained volunteer cuddlers are also key to soothing babies with NAS.

If withdrawal symptoms are severe enough, doctors and nurses will administer small amounts of oral morphine based on the severity of the symptoms. The final goal of the protocol is weaning the baby off the medication as he becomes less dependent on a drug.


Lifeline Ambulance

Children's Hospital's Lifeline ambulances are custom-made neonatal/pediatric transport vehicles equipped like mobile intensive care units in order to bring in premature babies from hospitals in surrounding areas. Enough supplies are on the ambulance that any size patient, from a premature infant to a 21-year-old, can be cared for upon transfer to the Children's Hospital NICU or PICU. Lifeline answers over 365 calls each year.

Neonatal Intensive Care Specialists

Learn about the Neonatal Intensive Care specialists who are part of East Tennessee Children's Hospital: