Neonatal Intensive care unit is a special ward where premature babies and babies less than 1 month are treated. This ward is specially designed to prevent infection and create an environment which is very similar to mother’s womb. Such babies are treated by Neonatologists (Pediatricians with additional qualification in Neonatology).

Following group of babies are usually admitted to the NICU

• Premature and low birth weight (BW < 2000 grams) babies
• Babies with breathing problems after birth
• Baby with high jaundice – needing phototherapy or exchange transfusion
• Babies with feeding difficulties
• Babies with infection and pneumonia
• Any baby who needs extra medical care after birth

When a woman becomes pregnant, she consults an Obstetrician to plan her pre-pregnancy care and delivery of the baby. If the pregnant woman has certain high risk factors then the wellbeing of the baby may be affected. In such situations it is helpful to consult a neonatologist. The neonatologist then reviews the case records and guides in planning the delivery of baby. This is called an antenatal consult. Here, the advice of Neonatologist does not replace the consultation by the obstetrician, but gives an additional dimension for maintaining fetal wellbeing. The emphasis is on team effort (obstetrician and Neonatologist) in order to give the best outcome to both mother and baby.

During this consultation the parents get a chance to interact with the neonatologist who would be looking after their baby. They also get familiar with the team/environment/equipment where the baby would be observed. This helps in relieving the stress during these difficult times. Following pregnant women may benefit from antenatal consultation

• Those likely to deliver a premature or low birth baby
• New Mothers with very high blood pressure, diabetes or any other condition due to which the baby is not growing properly inside the womb.
• IVF pregnancy, Twin pregnancy
• Possibility of certain anomalies in the baby
• Those with abnormal findings on ultrasounds during pregnancy.

Usually parents take their children to a doctor only if they are sick. However, this is only one aspect of care. Children need to be assessed periodically even if there is no medical problem. During these health care visits, various conditions such as hearing, visual, dental, learning problems, etc can be diagnosed which otherwise might go un-noticed. Also, certain blood and urine tests may be ordered to look for general well being. The preventive care visit schedule is available with the Pediatrician.

Pediatric Intensive care Unit (PICU) is a special ward in the hospital where the sicker children are admitted. It is a step above high dependency unit and pediatric ward in the sense that the children are monitored using latest advanced technology and various life saving treatments are provided. This is a new speciality in Pediatrics in India which although very well established in Western countries is only recently developed in India.

Pediatric intensivist is a pediatrician who has been trained to treat very sick children using modern equipment. Successful completion of a training course in pediatric intensive care is mandatory for certification as a pediatric intensivist. It has been shown that outcome of children is better in PICU supervised by trained Pediatric Intensivist than in ICUs where a trained pediatric intensivist is not available.

Following accident, trauma, drowning, etc

• Various breathing disorders (asthma, pneumonia, bronchiolitis, etc) which do not respond to standard treatment and need additional respiratory support.
• Children with very high or low blood pressure.
• Convulsions not responding to treatment, children with markedly decreased level of consciousness.
• Children needing dialysis.
• Suspected ingestion of toxic substances.
• After various operations
• Severe infections
• This list is by no means comprehensive and a decision to admit a child to the PICU has to be taken by a responsible doctor.

Majority of the admitted children do well. The outcome is even better for those who are otherwise constitutionally healthy. Various conditions which would have been considered fatal in the past are now amenable to cure and complete recovery. Advances in pediatric critical care have increased the life expectancy of children and has also improved the quality of life.