Fetal and Neonatal Neurocritical Care

If your baby is born with a condition affecting the brain or spinal cord, has a neurological complication due to prematurity, or has an injury or infection around the time of delivery, you want the best possible care for them. The Fetal and Neonatal Neurocritical Care program at Children’s Hospital Los Angeles is one of the only fetal-neonatal neurology centers in the region. 

Fetal and Neonatal Neurocritical Care: How We Stand Out

We offer compassionate and comprehensive care to all newborns in the Newborn and Infant Critical Care Unit (NICCU). Our neurocritical care and neonatal neurologists have extensive fellowship training in neurocritical care, stroke, neonatal neurology and fetal neurology.

Highlights of our program include:

  • Family-centered accommodations: Our NICCU is a comfortable, safe place for newborns, infants and their parents. There is enough space for one parent to stay overnight in the same room as their baby.
  • Around-the-clock monitoring: Newborns are some of our most fragile patients, which is why we pay close attention to their every need. Our NICCU has 24/7 neonatology coverage and a 1:2 nurse-to-patient ratio. For critically ill infants, this ratio may be 1:1 or 2:1. The team also includes pediatric neurosurgeons and pediatric neuroradiolologists.
  • State-of-the-art care: Our NICCU is a Level IV NICU, the highest designation neonatal intensive care units can achieve. Our Extracorporeal Membrane Oxygenation (ECMO) program for babies has achieved recognition as a Center of Excellence — Gold Level designation from the Extracorporeal Life Support Organization (ELSO). These certifications recognize our expert treatment for the most complex patients.
  • Specialized mental health support: Research shows that high-risk infants who receive mental health services experience less stress and better long-term outcomes. Children’s Hospital offers unique infant mental health services that are not widely available. We use Child-Parent Psychotherapy (CPP) to strengthen infant-caregiver relationships.
  • Fetal neurology consultation services: We offer prenatal neurologic consultations through the Fetal-Maternal Center. When there is a concern for a neurological disorder in the fetus, expectant mothers will meet with physicians from maternal-fetal medicine, fetal neurology, and other appropriate specialties including neonatology, pediatric neurosurgery and medical genetics.

Expert Neonatal Neurocritical Care 

Babies in the Fetal and Neonatal Institute have access to the most advanced treatments for all types of neurological conditions, including:  

Brain Malformations

Brain malformations occur when a baby’s brain does not form properly while in the womb. Brain malformations may affect growth and development. They can also cause vision problems, speech problems, movement disorders and seizures.

Hydrocephalus

Hydrocephalus is a buildup of cerebrospinal fluid (CSF) in the brain. CSF in the brain and spinal cord cushions your baby’s brain.  

CSF buildup puts extra pressure on the brain and can cause infants to have an enlarged head. Without treatment, this pressure may lead to vomiting, irritability and seizures. Babies can be born with hydrocephalus or develop it as a complication of bleeding or infection after birth.

Hypoxic-Ischemic Encephalopathy

Hypoxic-ischemic encephalopathy (HIE) occurs when babies don’t get enough blood and oxygen to their brains. Treatment can help minimize damage to the brain.

Complications of Prematurity

When a baby is born early, the brain is fragile and at high risk for injury, including bleeding. If this occurs, the baby’s brain will be regularly monitored with cranial ultrasounds, and if the bleeding is severe, surgery may be necessary. Premature babies are also at risk for injury to nerve fibers in the brain called periventricular leukomalacia (PVL). This can result in cognitive problems and difficulties with motor control. Your baby will receive additional services in the NICCU, including physical therapy, occupational therapy and feeding therapy.

Stroke

Strokes occur when there is an interruption of blood flow in the brain. There are two types of strokes:  

  • Hemorrhagic strokes: These strokes occur when a blood vessel in the brain leaks blood.  
  • Ischemic strokes: These strokes occur when there is a lack of blood flow to a part of the brain.    

Brain injuries can lead to cognitive problems, difficulty speaking, or challenges with motor control. Find out more about our Stroke Program.  

Hypotonia and Hypertonia

Tone is the ability of the body to maintain posture. If your baby has hypotonia, they are floppy and have difficulty developing basic motor skills. If your baby has hypertonia, the muscles are too, stiff making movement difficult. Both need a comprehensive evaluation to understand the cause of their hypotonia or hypertonia. These infants also need therapy to help them develop motor skills, including feeding. Babies with hypertonia may need medications to relax the muscles.

Epilepsy and Seizures

Epilepsy refers to having recurring seizures that are typically unprovoked. Seizures are caused by surges in the electrical activity of the brain. Sometimes, seizures in babies may be due to a stroke, including bleeding in the brain, infection, congenital brain malformations or a genetic difference that puts babies at increased risk for seizures. Evaluation includes an electroencephalogram (EEG), where the electrical activity of the brain is monitored, brain MRI, lumbar puncture, or blood tests including genetic tests. The seizures are treated with various anti-seizure medications.

Metabolic and genetic disorders

When babies are born with metabolic or genetic disorders, they can have symptoms including seizures, sleepiness, movement disorders, difficulties breathing or poor feeding. These babies need an early evaluation that may include a brain MRI, EEG, lumbar puncture and genetic studies. Some of these disorders have time-sensitive treatments.

Infection

Babies can have infections that involve the brain (encephalitis) or the coverings around the brain (meningitis). When this occurs, babies can have irritability, vomiting, sleepiness or seizures. Evaluation includes brain MRI, EEG and lumbar puncture. Based on the cause of infection, your baby may receive antibiotics, antivirals or antifungals. If there is injury to the brain as a result of infection, your baby may develop complications including hydrocephalus or abscess formation. Injury to the brain from infection can result in lifelong epilepsy, hearing loss or developmental disabilities.

Comprehensive Neurological and Neurosurgical Services for Children

Fetal and neonatal neurocritical care are one of many ways we help children achieve their full neurologic potential. As one of the nation’s premier pediatric neurological institutes, we offer services your child needs to recover. Find out more about our Neurological Institute.

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