What is the Neuro-Intensive Care Nursery (NICN)?

The UCSF Benioff Children’s Hospital Neuro-Intensive Care Nursery (NICN) was founded in 2008 by Drs. David Rowitch and Donna Ferriero with the mission of improving neurodevelopmental outcomes in newborns at risk for brain injury. It is the first program of its kind in the United States. The NICN provides a unique model of brain-focused care that incorporates the combined expertise of board-certified neonatologists, neonatal neurologists, neonatal epileptologists, pediatric neurosurgeons and neuroradiologists, and specialized nurses. The NICN team provides round-the-clock, brain-focused care for newborns at high risk for short-term brain injury and long-term disability. The NICN is directed by Dr. Sonia Bonifacio and is supported by a highly trained, multidisciplinary group of physicians, nurses, pharmacists, physical therapists, and occupational therapists.

We provide inpatient care for infants born at our hospital, as well as children who are transferred from other centers in Northern California and Southern Oregon. After being discharged home, NICN patients may qualify for comprehensive examinations performed in the Child Neurology Clinic and High Risk Infant Follow-Up Program to assess neurological development, identify potential needs, and facilitate additional services to ensure the best possible outcomes for our patients.

Neonatal Neurology at UCSF

The NICN includes a team of pediatric and neonatal neurologists. Led by Dr. Donna Ferriero, Chair of Pediatrics and Physician-in-Chief of UCSF Benioff Children’s Hospital and Dr. Hannah Glass, Director of Neonatal Neurocritical Care Services, the neonatal neurological team members assess neurological function in critically ill newborns. The role of the Neonatal Neurologist is to perform a comprehensive clinical evaluation, including medical history, clinical examination, evaluation of ancillary testing such as brain monitoring and brain imaging to diagnose and treat neurological conditions. The neonatal neurology team works in close collaboration with the neonatologists and neonatal nurses to customize care.

Neuroimaging

Newborns at risk for or diagnosed with brain injury are evaluated with magnetic resonance imaging (MRI), often within the first days of their admission. MRI allows clinicians to view the brain in great detail, increasing the ability to diagnose the existence, location, and extent of injury and developmental disorders. Using innovative technology pioneered by A. James Barkovich, MD, chief of Pediatric Neuroradiology at UCSF, premature and critically ill newborns are transported safely in an MRI-compatible incubator.

Neuromonitoring

Newborns may be monitored using three complementary non-invasive (external) brain monitors: Electroencephalogram (EEG), Amplitude Integrated EEG (aEEG), and Near-Infrared Spectroscopy (NIRS). These monitors allow the NICN team to monitor brain electrical activity and regional brain tissue oxygen saturation. Brain monitoring is the only way to accurately identify neonates with seizures and can help guide treatment if seizures are identified.

  • Electroencephalogram (EEG) is the gold standard tool to study brain function and for diagnosis and treatment of seizures in high-risk newborns. It is non invasive and allows for continuous monitoring. Continuous, video-EEG recording is available 24/7 in the NICN, and our team includes experts in interpretation of neonatal EEG, and in the diagnosis of seizures and neonatl onset epilepsies.
  • Amplitude Integrated EEG (aEEG) provides a “big picture” view of brain function, and is read in real-time by the NICN nurses and doctors at bedside. Careful bedside monitoring compliments gold-standard EEG and allows the team to administer medical treatment in response to changes in brain activity.
  • Near-Infrared Spectroscopy (NIRS) is a specialized monitor that allows the bedside team to assess brain oxygenation.

Neurotherapy

Infants who suffer from loss of oxygen or blood flow around the time of delivery, may develop hypoxic ischemic encephalopathy (HIE). Newborns with suspected HIE undergo a specialized form of therapy, called therapeutic hypothermia. Research shows that therapeutic hypothermia, if initiated within 6 hours after birth can help reduce neurological damage in these babies. This is becoming standard of care for babies with HIE. We gradually lower the baby’s temperature to 33.5°C (92°F) using a specialized blanket for 72 hours, and monitor vital signs and brain activity with EEG, aEEG, NIRS throughout therapy. Babies are then imaged, using MRI, to assess for brain injury.

Some neonates with HIE may also qualify for investigational therapies that are added to hypothermia and are available under a research protocol.

Additional Inpatient Neurological Services

The UCSF Department of Neurological Surgery provides treatment for congenital disorders including myelomeningocele (spina bifida), hydrocephalus and other conditions identified in the newborn period. IF myelomeningocele is identified during pregnancy, some fetuses may qualify for in utero treatment (link to fetal therapy website).

The Neuro Interventional Radiology team at UCSF is world renowned for developing and perfecting new techniques to treat life threatening conditions of the central nervous system, including congenital arteriovenous malformations (AVM) and vein of Galen malformations, through endovascular approaches. Neonates with these malformations are often critically ill and at risk for having suffered brain injury while developing in utero as well as acquiring brain injury after birth. These neonates are managed by our multi-disciplinary team and are monitored for seizures.

Follow-Up Clinics

The High Risk Infant Follow-Up Program assesses the growth and development of infants discharged from the ICN, including most NICN patients. The program provides parent support after discharge, early identification of developmental disabililties and referral for service if indicated, as well as liaison with community physicians and agencies. Infants and children are seen in San Francisco as well as in satellite clinics in Clear Lake, Eureka, Salinas, Santa Rosa, Ukiah and Willits, with clinics at other sites as needed. Dr. Elizabeth Rogers leads the HRIF team.

The Child Neurology Clinic treats children with neurological conditions that are identified in the newborn period, including hypoxic-ischemic encephalopathy, stroke and seizures, as well as brain injury following preterm birth. Infants and children are seen in the Neurology Clinic at the UCSF Benioff Children’s Hospital. Dr. Hannah Glass works closely with children and families to ensure that NICN graduates are receiving optimal interventional services through state programs such as the state Regional Centers and California Children’s Services Medical Therapy Program. The Neurology Clinic accepts referrals for children with neurological conditions that were identified in the newborn period. Request an appointment.

The High Risk Infant Follow-Up Program and Child Neurology Clinic work together to optimize care and recommend therapies and evaluations, which may include:

  • Physical therapy
  • Occupational therapy
  • Early intervention
  • Nutritional assessment
  • Feeding evaluation
  • Genetic evaluation

New Directions in Research

Drs. Rowitch and Ferriero, co-directors of the UCSF Newborn Brain Research Institute (NBRI), lead efforts in clinical and translational research to learn about the structure and function of the newborn brain. This “translational” approach will streamline the development and testing of new neuroprotective therapies. “Our goal is to offer patients and their families real therapeutic options when faced with neurological injuries,” says Dr. Rowitch.

Neonatal Brain Research at UCSF: