That agrees with my experience. DD was in a small NICU, xferred to a large children's hospital, xferred back to the small NICU, and sent back to the CH. She thrived in the large CH NICU, while at the small one she got very sick, very fast. They just didn't have the experience or the facilities to treat her appropriately. I'm certain her outcome would have been much different if she had not been sent to the CH. But that was just our experience with a surgical preemie. Maybe if she had simply been a feeder/grower, the small NICU would have been more than adquate to care for her.
It makes sense. A big NICU gets more experience and knows what to do. In my area, babies usually get transferred to the hospital I birthed Joshua at. There were babies from 2 hours away in there, and I think they were life flighted. This hospital is the "regional level 3 NICU", so it handles the northern part of the state. There's another NICU 2 hours' drive south that handles the central part of the state. There's another hospital in town that supposedly can handle 32+ weeks, but I think they only have like one isolette, and I imagine that if you do happen to deliver there (just because they don't get you to the other hospital 5 minutes away in time), they'd probably transfer the baby to the other hospital anyway, unless it's just a case of the baby needing a bit of O2 help for a couple days and then it's fine type of deal.
Hmmm...see, it's the word "small" that I find sort of confusing. Our sons were treated at a 15-bed Level III NICU. And they got really great care there. So it seems that the study is focusing on the level of NICU (II vs III), not really the "size" of the NICU. It seems obvious to me that Level III NICU is better equipped to take care of extremely premature babies...most Level II NICUs can't even intubate.
Maggie was born at a small community hospital where they were able to intabate her before transfering her about 5 miles away to the Level 4 nicu at Loyola Univeristy. I fully agree, we need the larger ones vs the smaller ones. The smaller community ones doing a level 4 have 20 or less beds and the treatment is sometimes 5 years behind than the university level.<br><br>
I have seen in my own experience some of the local area hospitals around here and what they are doing w micros and its not too great.
Oddly enough, I've been thinking about this all day <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/dizzy.gif" style="border:0px solid;" title="Dizzy">:<br><br>
DD was born at a hospital with a Lv3 NICU. She was xferred for surgery and then back to "home" to feed and grow. Her home Lv3 NICU did not have the 24hr staff available to do the emergent babygrams at 4am, did not have a surgeon available in house to respond immediately, simply did not have the resources available to respond in the manner that is unfortuantely necessary for so many neonates.
I guess I'll be the voice of contention. Emma was in a small nicu. I think the MOST babies we had was probably 25, when she was born their were 5. She got the utmost of care, and they had available staff and surgeons 24/7. Maybe because it was Kaiser. I don't think it's a matter of a small vs. large nicu so much as a level 11 vs level 111. Just more often smaller ones are level 11.
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<div>Originally Posted by <strong>munkeesmama</strong> <a href="/community/forum/post/8218592"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I guess I'll be the voice of contention. Emma was in a small nicu. I think the MOST babies we had was probably 25, when she was born their were 5. She got the utmost of care, and they had available staff and surgeons 24/7. Maybe because it was Kaiser. I don't think it's a matter of a small vs. large nicu so much as a level 11 vs level 111. Just more often smaller ones are level 11.</div>
I think your right. The title of the article is not correct in what the article says. I think it meant to say that Level III is better than a Level II as it states in the article. The Level III that Wendi and I were at is small compared to other Level III Nicu's but they do see alot of babies so I don't think its small. Does that make sense?
My NICU was small at a community hospital, but it was great. From what I've heard from other preemie moms that I know, she recieved better care than she would have if we had gone to Charlotte, NC which has several large NICUs. I really think that it depends on the level of the NICU, not the size.
As a nurse in a "small" NICU, I can honestly say that this article made me (and other RNs at my facility) very angry. My unit is a 12 bed intensive and 18 bed step-down unit....so 30 beds in all. The bigger hospilas here are about 25-30 intensive beds. About 90% of the time we send a baby to the childrens hopsitals, they return to us with infections. The FIRST thing we do when they return is run blood counts and a blood culture (sometimes a urine cultrue) to find the 'bugs' and start antibiotics so our other babies are safe.<br><br>
My hospital is the ONLY level III on the southside of our city. Just because we are half the size of the city hospitals does not make us any less efficent, safe, or competent as them. Since this article came out we actually had a parent say "you know, some of my family is asking if this is really where I want my baby to be." Do you know how this makes a nurse feel when we are doing everything we can to keep her child alive while her and the babys father come in a talk loud, open his isolette, shake his legs, bang on his isolette....the whole time his sats are dropping and then they get mad when we tell them why that is a bad idea!!!<br><br>
This just hits a nerve with me!! At the larger hospitals here, the mothers do not have as much hands on time with their infants. We have dark, quite rooms, we have a breastfeeding policy that after a certain weight and a certain gest age (32-34 weeks) mothers can breastfeed as much and as often as possible, we have 2 neonatologists that rotate their schedule and sleep in the unit in their rooms so they are right around the corner at any time during the day or night.....yea, we don't have a surgeon on duty, we don't have as many $25,000 beds as the larger hospitals but we give the same or better care as the larger places!<br><br>
We had a baby born 24 2/7 weeks that had to go to childrens for a possible trach. The mother begged them to let him come back and try to extubate one more time. The dr there wanted to trach anyway. After a few days he gave up and sent him back to us thinking that when it didn't work he would get his trach . She wanted him at OUR hopsital....when they came back, she came in and said "Finally we are 'home'!!" We were able to extubate him within 2 1/2 weeks of returning to us (he was 4 months old) and get him to eat from the bottle. He went home at 5 months and is now 10 pounds and eating baby food. This was just 2 weeks ago!!<br><br>
Sorry, this is soooo much longer than I anticipated. I just hate to hear things said about small places in such a general statement when there are great small NICUs out there.<br><br>
Edit**** Thank you to those who clarified the level and not the number of beds!! We are a level III with a few less 'perks' that the city hospitals have but we are a wonderful unit!! WE WE NAMED THE BEST NURSING TEAM OF 2006 IN THE 'ADVANCE FOR NURSES' MAGAZINE!!!!
Riki- thats awsome about your unit!!<br><br>
OTH, in my situation, I wanted to be in a large university setting for care of my micro. They get more micros in than some of the smaller units and its routine compared to one of the smallest delivered at another nicu in a community hospital only get like 3 a year.<br><br>
My Maggie was born and transferred and then for Feed/Grow was transferred back to the community hospital. But there were a few moments when I sort of wished she was at the larger nicu still but mainly I liked the one on one care she received those last few weeks. Of course, the neos also rotated out of the nicu she was at so it helped.
Just for comparison.....right now in our unit we have: 25 weeker, 24 weeker, 26 week twins, 28 weeker, 29 weeker, 25 weeker, 27 weeker, 24 weeker. At one point last week 9 out of our 12 intensive beds had a HFOV!!
IIRC... in Utah, Primary Childrens has the only "level 4". The University of Utah, Ogden Regional, McKayDee, North Davis, St. Marks, LDS, and the big hospital in Provo, among others are all Level 3's.<br><br>
When we went for a second opinion and a neo consult at the U, the Neo said there was no difference between the U and the hospital that DD was born at (As well as nathansmom's children). The U's NICU is much larger, but he said there were no differences. Children who need surgery usually go to primaries, otherwise they stay put. He said we should select where we would be most comfortable. As the driving time is an hour to the U or 20 minutes to the hospital DD was born at, we stayed at our local hospital.