Nemours neonatologists offer comprehensive, around-the-clock newborn care in our technologically advanced Neonatal Intensive Care Units (NICUs). Every single NICU team member strives to give babies the very best chance at a healthy future, from the start.
At Nemours, we treat every baby as we would our own. We emphasize personalized, compassionate care in the service of our tiny patients. Safety and teamwork are essential to successful newborn care — and we consider you, the family, a critical part of our team.
Why Measuring Results Matters
To provide pediatric care that's among the safest and most effective, we measure our results and compare them to national pediatric rates. Why? So we can:
- help you make decisions about your child’s care
- be clear about our results
- improve and consistently deliver better, safer care
Here are some of the neonatology outcomes we track to improve the experience for both you and your baby.
Catheters (long, thin, flexible tubes) are a common part of care in any NICU. Babies may have central venous catheters (or “central lines”) and/or urinary catheters. Unfortunately, infections can happen if bacteria enter the catheter, which can affect infants’ health and comfort, increase their length of stay in the hospital, and add medical costs. At Nemours, we take every precaution to ensure that our tiny patients don’t get an infection. We’re able to prevent catheter infections by:
- keeping hands, instruments and the skin around the area sanitized
- reviewing, daily, the need for urinary catheters and central lines — and removing them right away if they’re no longer essential to a baby’s care
- meeting regularly to review our monthly data and the latest guidelines, and improve our processes as needed
Reducing Central Line Infections in Newborns
Keeping Babies From Getting Infections in Their Central Line
For critically ill newborns, it’s common to get a central line (a catheter that’s placed into the larger veins of the arms, legs or scalp, and travels to a large blood vessel near the heart). Having a central line allows doctors and nurses to draw blood, give fluids and nutrition, and deliver medications to babies for as long as medically necessary, sparing them from repeated needle sticks. But bacteria can potentially travel through the central line and into the bloodstream and cause infections. At Nemours Children’s Hospital, we’re proud to say that our NICU had zero central line-associated bloodstream infections in 2016.
Rate of Central Line-Associated Bloodstream Infections, Nemours Children’s Hospital NICU (Orlando)
Number of infections, 2016
National average (benchmark)
Data source: Nemours data collected electronically with manual verification within the NICU, looking at the number of infections per 1,000 — or every 1,000 days that all patients in the NICU had a central line, January–December 2016.
Benchmark: Centers for Disease Control and Prevention (CDC) National Health Surveillance Network (NHSN) data for level III NICUs, DA module, 2013.
Preventing Urinary Catheter-Associated Infections in Newborns
Keeping Babies From Getting Urinary Tract Infections
To monitor urine output in certain postoperative (after surgery) patients or critically ill newborns, doctors and nurses may use a urinary catheter. The catheter is inserted into the bladder through the urethra, which carries urine from the bladder out of the body. Without proper precautions, bacteria could travel through the urinary catheter and cause infections in the urinary tract. At Nemours Children’s Hospital, our NICU had no urinary tract infections at all in 2016.
Rate of Catheter-Associated Urinary Tract Infections, Nemours Children’s Hospital NICU (Orlando)
Number of infections, 2016
National average (benchmark)
Data source: Nemours data collected electronically with manual verification within the NICU. Measured number of infections per 1,000 — or every 1,000 days that all patients in the NICU had a urinary catheter, January–December 2016.
Benchmark: CDC’s National Health Surveillance Network (NHSN) data for pediatric medical/surgical critical care units, DA module, 2013.
Consistent Communication After Surgery for Streamlined Care
Making Sure Everyone’s Informed, Especially When Your Baby Needs an Operation
When doctors change shifts or are no longer on call, they have to transfer their tiny patients’ care to another provider. That means they need to share crucial information and provide updates so that the doctor taking over your baby’s care will know exactly what’s going on. This is called the “physician hand-off” (or “physician sign-out”).
This exchange of a patient between providers is a critical time in a child’s care. A significant amount of research shows that most medical errors and mistakes are most likely to happen during the hand-off of information between two care providers. The hospital, NICU and operating rooms can be busy places with complicated, competing distractions. So it’s critical to make time for exchanging patient care. It’s especially important after a child has surgery.
As Delaware's only Level IV NICU, patient safety is our highest goal, as we provide care for the most critically ill infants at Nemours/Alfred I. duPont Hospital for Children. That’s why we’re developing a safe hand-off script to help share information from provider to provider. To develop the script, we extensively reviewed hand-offs at other level IV NICUs around the country. We then worked together as a team to develop a script and commit to the structure of the hand-off. Our leaders in nursing, neonatology, surgery and anesthesia prioritized safety above other competing interests in order to fully commit to a safe and efficient exchange of information. Other NICUs in our community have even adopted our hand-off tool.
Use of Structured Handoff Tool and Process for Postoperative (After Surgery) Handoffs, Nemours/Alfred I. duPont Hospital for Children NICU (Wilmington, Del.)
Percentage of transfers of care back to the NICU for patients undergoing surgery
Data source: The NICU at Nemours/Alfred I. duPont Hospital for Children collected data by looking at the postoperative hand-off process completion and NICU surgical timeframes. The NICU has recently completed the sustain portion of an intensive QI project with one SMART-AIM being to implement a standardized communication process for postoperative handoff for over 90 percent of transfers of care back to the NICU for patients undergoing surgery.
Benchmark: There are no published benchmarks for the use of a postoperative handoff in the care of the neonatal surgical patient. A recent nationwide collaborative of level IV NICUs has sought to demonstrate that development of a systematic handoff would improve patient care outcomes,
Preventing an Unnecessary Complication
Keeping Babies From Having Unplanned Extubation
Babies in the NICU sometimes need extra help to breathe. So an infant may be connected to a ventilator (or breathing machine) via an endotracheal tube (a long, thin tube placed into the windpipe through the mouth or nose). Inserting an endotracheal tube is called “intubation.” Removing the tube is called “extubation.” When the tube has to be removed unexpectedly, it’s considered an “unplanned extubation.” Unplanned extubation can affect the health and comfort of newborns who are already so fragile.
Every NICU team member at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., is dedicated to minimizing the risk of unplanned extubation. We make sure to understand the factors that contribute to unplanned extubation and take personal responsibility to make sure each and every one of our patients is protected. We also work hard to avoid unplanned extubation by developing reliable methods involving all staff members and disciplines that come into contact with infants on a ventilator in our NICU. That includes things like:
- providing ongoing education for the whole staff about how to correctly secure the breathing and ventilator tubes
- properly positioning the baby’s head
- paying close attention to the infant’s comfort level to make sure they aren’t agitated or uncomfortable
- confirming, by X-ray, the ideal breathing tube position in the baby’s airway
- using closed-loop communication techniques to avoid misunderstandings and make sure all members of the team know exactly which breathing tube position is ideal in the baby’s airway. With closed-loop communications, one person (the sender) gives information, the other (the receiver) repeats it back, then the sender confirms that the receiver understood correctly by saying "yes."
If an unplanned extubation does happen, we gather together as a team to review what happened and learn — from every case — then share what we’ve learned with all members of the NICU team. We also regularly meet to review our monthly data and make process changes if needed.
Unplanned Extubation, Nemours/Alfred I. duPont Hospital for Children NICU (Wilmington, Del.)
Number of unplanned extubations
National average (benchmark)
Data source: Data obtained from electronic medical record, unit-level data collection, NICU quality dashboard, unit historical rates of unplanned extubation (UE) per 100 intubated patient days — or every 100 days that all patients in the NICU had an endotracheal tube, January–December 2016.
Benchmark: No published benchmark data exist for NICUs. The Vermont Oxford Network has suggested that an upper limit of acceptable rate in the NICU should be 2.0 UE per 100 patient-ventilator days (iNICQ Intensive 2012: Controversies in Respiratory Care). A benchmark rate of 1.0 has been identified for PICUs, where children are intubated for significantly shorter durations, and larger children have longer tracheas (greater room for movement without dislodgement) and are typically intubated with cuffed endotracheal tubes, which are more likely to stay in place. Therefore, a reasonable benchmark for successful unplanned extubation mitigation in NICUs is 2.0 per 100 intubated patient days.
Our Differentiators: What Sets Us Apart
Why Choose Nemours Neonatology
Here are just some of the reasons families entrust us with their precious babies:
- “Evidence-based care.” That just means all of our equipment, methods and care are based on what’s been proven over time in health care systems all across the country to work best for infants. And our efforts are making a real difference in the health and safety of the babies we treat.
- Private, quiet spaces for babies — and their parents. Our modern, state-of-the-art NICUs at Nemours/Alfred I. duPont Hospital for Children and Nemours Children’s Hospital are single-patient rooms, with whisper-quiet rooms for babies and private space and sleeping accommodations for family members.
- Delaware's only Level IV NICU. At Nemours/Alfred I. duPont Hospital for Children, we provide care for the most critically ill infants, with onsite cardiothoracic surgery and the state’s only neonatal extracorporeal membrane oxygenation (ECMO) center.
- Direct on-site access to experts in all medical and surgical pediatric subspecialties. Our hospitals offer the full spectrum of pediatric care for babies and children with any kind of medical need. Our NICU doctors and nurses work closely with other subspecialists and disciplines to give your baby the most coordinated, safest care.
- Critical care transport. If your newborn needs to be transported from other hospitals to our NICUs, our specialized critical care transport team provides children throughout our hospital’s regions with safe, urgent transfer.
- “Family-centered care.” At Nemours NICUs we want you to participate in your child’s care. Our family-centered multidisciplinary rounds allow you to engage with the entire medical team and participate in your baby’s care plan — every day. We encourage you to ask questions and be a participating member of the care team, not just an observer. And we know how stressful and overwhelming having a baby in the NICU can be. So we keep you fully informed — explaining your little one’s diagnosis and treatment in understandable terms, providing reading materials, and discussing care options.
- Planning before your baby is even born. We can work with you and your doctor(s) to help diagnose congenital conditions in the womb and develop a plan of care for after your baby is born. That way, if you know your baby might need care from our neonatologists, surgeons or other specialists after birth, you’ll be prepared ahead of time.
We ask for your honest feedback so we can make improvements for all of our patients.
Nemours/Alfred I. duPont Hospital for Children (Wilmington, Del.)
Our NICU received the coveted Press Ganey Guardian in Excellence Award for 2016. This honors hospitals and medical care providers that are consistently rated greater than 95 percent by families and patients for patient experience, engagement or clinical quality performance throughout the year.
Nemours Children's Hospital (Orlando)
Recent patient satisfactions scores show that 93 percent of our families would recommend us.
- Catheter-Associated Urinary Tract Infections (CAUTI)
- Central Line-Associated Bloodstream Infections (CLABSI)
- Children’s Hospitals’ Solutions for Patient Safety Network (SPS)
- Frequently Asked Questions About Catheter-Associated Bloodstream Infections
- Frequently Asked Questions About Catheter-Associated Urinary Tract Infections
- National Healthcare Safety Network (NHSN) of the Centers for Disease Control and Prevention (CDC)