The Neonatal Intensive Care Unit (NICU) is a critical unit equipped with high-technology hardware and an experienced neonatology team, where infants requiring life support and specialized medical care immediately after birth are monitored. The Koru Hospital Neonatal Intensive Care Unit provides level III intensive care services to a wide spectrum of neonatal patients, ranging from premature infants to those with congenital anomalies.
Conditions Treated in the Neonatal Intensive Care Unit
The primary neonatal conditions followed and treated in the unit are as follows:
- Prematurity (Preterm Birth): Protocols for lung maturation, thermoregulation, nutritional support, and developmental care are implemented for infants born before thirty-seven weeks. Active resuscitation and life support are provided for births from twenty-four weeks onwards.
- Respiratory Distress Syndrome (RDS): Exogenous surfactant administration, mechanical ventilation, and CPAP support are provided for respiratory distress due to surfactant deficiency.
- Neonatal Sepsis: Rapid diagnosis, appropriate antibiotic therapy, and supportive treatment protocols are conducted for early and late-onset neonatal sepsis.
- Hypoxic Ischemic Encephalopathy (HIE): Therapeutic hypothermia (cooling therapy) is applied to minimize neurological damage in cases of brain injury due to oxygen deprivation during birth.
- Neonatal Jaundice: Intensive phototherapy and, when necessary, exchange transfusion procedures are performed in cases of severe hyperbilirubinemia.
- Congenital Anomalies: Preoperative stabilization and postoperative intensive care are provided for congenital anomalies requiring surgical intervention, such as congenital heart diseases, diaphragmatic hernia, esophageal atresia, gastroschisis, and omphalocele.
- Metabolic Disorders: Management of neonatal hypoglycemia, hypocalcemia, inborn errors of metabolism, and endocrine emergencies is provided.
- Necrotizing Enterocolitis (NEC): Early detection of intestinal inflammation in premature infants, medical treatment, and coordination of surgical consultation when necessary are provided.
Respiratory Support and Ventilation Strategies
Respiratory support in the neonatal intensive care unit requires a specialized approach that differs fundamentally from adult intensive care:
- Nasal CPAP and NIPPV: Non-invasive respiratory support is preferred as the first-line treatment in the management of RDS and apnea attacks.
- Conventional Mechanical Ventilation: Lung-protective strategies are implemented using volume-guaranteed, pressure-controlled ventilation modes.
- High-Frequency Oscillatory Ventilation (HFOV): Used in cases of severe respiratory failure that do not respond to conventional ventilation.
- Inhaled Nitric Oxide (iNO): Administered as a selective pulmonary vasodilator in the treatment of pulmonary hypertension.
- Surfactant Therapy: A minimally invasive approach is adopted using INSURE (Intubate, Surfactant, Extubate) and LISA (Less Invasive Surfactant Administration) techniques.
Premature Infant Care
The care of premature infants is one of the most comprehensive areas of neonatal intensive care requiring long-term follow-up. The core components of the premature care protocols applied in our center are:
Thermoregulation
There is a high risk of hypothermia in low birth weight and premature infants. Body temperatures are maintained within the optimal range using servo-controlled incubators and radiant warmers. Polyethylene wrapping and heated transport incubators are used to prevent heat loss during transfer from the delivery room to the intensive care unit.
Nutritional Support
Breast milk is the gold standard for premature infant nutrition. For infants whose suck-swallow coordination has not yet developed, minimal enteral feeding is initiated early via orogastric or nasogastric tube. Protein, lipid, and carbohydrate requirements are met through Total Parenteral Nutrition (TPN), and parenteral support is gradually reduced as enteral feeding is tolerated. Through our breast milk bank service, donor breast milk can be provided to premature infants who do not have access to their mother's milk.
Developmental Care
In accordance with NIDCAP (Newborn Individualized Developmental Care and Assessment Program) principles, environmental stimuli (light, sound, touch) are controlled. Kangaroo care (skin-to-skin contact) makes a significant contribution to both the infant's physiological stabilization and mother-infant bonding.
Neonatal Monitoring
Continuous cardiorespiratory monitoring, pulse oximetry, transcutaneous blood gas monitoring, and temperature tracking are performed at every bedside. Weight, head circumference, and height measurements are recorded at regular intervals to create growth curves. Screening for intraventricular hemorrhage and periventricular leukomalacia is routinely performed via cranial ultrasonography.
Family-Centered Care
The neonatal intensive care process is an emotionally challenging period for families. A family-centered care approach is adopted in our center. The adaptation of parents to the intensive care environment, their active participation in their baby's care, and the discharge preparation process are managed with the support of neonatology nurses and psychologists. Lactation consultants provide guidance to mothers on maintaining milk production and preparing for the breastfeeding process.
Discharge and Follow-up
The discharge of premature and NICU graduate infants is planned after specific physiological criteria are met. Before discharge, families are provided with comprehensive information on basic life support training, nutrition plans, medication administration, and emergency management. Following discharge, infants are included in regular developmental follow-up, retinopathy screening, hearing tests, and neurodevelopmental assessment programs at the neonatology outpatient clinic.
Within the Koru Hospital Neonatal Intensive Care Unit, our expert staff provides reliable support in the life struggle of our most fragile patients, newborn infants, using evidence-based medical practices and advanced technological equipment.