Subsequent inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger
CPT4 code
Name of the Procedure:
Subsequent Inpatient Neonatal Critical Care, Per Day (NICU Care)
Summary
This ongoing medical care involves daily treatment and monitoring of critically ill newborns (neonates) who are 28 days old or younger. It includes comprehensive evaluations and management to address their critical health needs while they stay in a hospital's Neonatal Intensive Care Unit (NICU).
Purpose
The procedure addresses life-threatening conditions in newborns such as premature birth, respiratory distress, infections, and congenital anomalies. The primary goal is to stabilize and improve the neonate's health condition, ensuring their survival and promoting normal development.
Indications
- Prematurity (born before 37 weeks of gestation)
- Severe respiratory distress or failure
- Life-threatening congenital anomalies
- Sepsis or severe infections
- Intrauterine growth restriction (IUGR)
- Birth asphyxia
- Major surgical conditions requiring intensive monitoring
Preparation
- Parents may be given instructions on what to expect and how to participate in their neonate's care.
- Diagnostic assessments like blood tests, imaging studies, and monitoring of vital signs are regularly performed to tailor the care plan.
- No specific fasting or medication adjustments are required for the newborn, but the healthcare team continuously prepares and adjusts care based on the neonate’s condition.
Procedure Description
- Continuous monitoring of vital signs (heart rate, respiration, oxygen saturation, blood pressure)
- Mechanical ventilation or oxygen therapy if needed
- Administration of medications, including antibiotics, surfactants, and other critical drugs
- Nutritional support via intravenous feeding or specialized neonatal formulas
- Regular blood tests and imaging studies to monitor condition and progress
- Syringe pumps and infusion pumps for precise medication delivery
- Family-centered care, involving parents in the care process, as much as the baby’s condition allows
Duration
The duration is indefinite and depends on the severity of the neonate’s condition. Each "per day" signifies a daily assessment and adjustment of the care plan.
Setting
Hospital-based Neonatal Intensive Care Unit (NICU)
Personnel
- Neonatologists
- Pediatricians
- NICU nurses
- Respiratory therapists
- Pharmacists
- Nutritionists
- Social workers and family support staff
Risks and Complications
- Infection
- Complications from mechanical ventilation (lung damage)
- Medication side effects
- Long-term developmental issues due to prematurity or critical illness
Benefits
- Stabilization of the neonate's condition
- Improvement in critical health parameters
- Increased survival rates
- Early identification and management of complications
Recovery
- Ongoing monitoring and gradual reduction in critical supports as the neonate stabilizes
- Preparation for transition to lower-intensity care or discharge home
- Parent education on infant care and follow-up appointments for continued monitoring
Alternatives
- Less intensive neonatal care for less critically ill infants
- Transfer to specialized pediatric centers if specific expertise is required
- Supportive care in community hospitals with neonatology consultation
Patient Experience
- The neonate will be in an incubator or crib with cardiorespiratory monitors and IV lines.
- Parental involvement is encouraged, including skin-to-skin contact when possible.
- Pain management includes careful handling, use of pain relief measures before procedures, and minimizing disturbance.
Parents can expect ongoing updates from the medical team and will be supported in understanding and participating in their neonate's care as much as possible.