Neonatology

USNWR Best Children's Hospital - Neonatology | Children's Hospital Los AngelesHaving a baby that requires special medical attention can be very stressful for parents. As part of the Fetal and Neonatal Institute, the Division of Neonatology offers an integrated team that provides compassionate, advanced, evidence-based care for critically ill newborns and infants.

At our hospital, your infant will have access to state-of-the-art diagnostic and treatment services, consultations from virtually all existing pediatric subspecialties, and compassionate care provided by a world-class education and training center on the leading-edge of neonatal and perinatal research. 

Newborn and Infant Critical Care Unit (NICCU)

In the Steven & Alexandra Cohen Foundation Newborn and Infant Critical Care Unit at Children's Hospital Los Angeles, your infant will have access to: Level IV, state-of-the-art diagnostic and treatment services, consultations from faculty of virtually all existing pediatric subspecialties, and compassionate care provided by a world-class education and training center on the cutting-edge of neonatal and perinatal research.

Programs and Services

  • Advanced Ventilation Program
  • Extracorporeal Membrane Oxygenation (ECMO)
  • Fetal Maternal Center (prenatal diagnosis)
  • Neonatal Network Hospitals
  • Neonatal Surgery
  • Newborn and Infant Critical Care Unit (NICCU)
  • Specialized Cardiovascular Services
  • Virtual Neonatal Intensive Care Unit (vNICU)

This program utilizes the latest advances in ventilator management. The highly specialized, advanced support systems offered include, but are not limited to:

  • Sophisticated Conventional Mechanical Ventilation Modalities
  • High-Frequency Jet Ventilation 
  • High-Frequency Oscillatory Ventilation

Children’s Hospital Los Angeles houses one of California’s largest Extracorporeal Membrane Oxygenation (ECMO) programs. Initiated in 1987, the ECMO program has supported more than 1,280 newborns with ECMO. The program has remained the largest referral center in Southern California and surrounding states for the treatment of neonatal conditions requiring ECMO support. This extracorporeal life support system is a modified heart-lung bypass machine takes over circulatory and respiratory functions in infants whose systems fail due to underlying acquired or congenital conditions. ECMO, considered a “last resort” treatment, improves the chances for survival, in many cases up to 80 percent. Learn more.

The Fetal Maternal Center is a unique center among its peers in the nation. It is one of only a handful of comprehensive fetal and maternal diagnostic and treatment centers in the United States. Read more.

Children's Hospital Los Angeles

4650 Sunset Blvd., #31
Los Angeles, CA 90027
Phone: 323-361-2531
Fax: 323-361-1109

This tertiary center provides care for high acuity patients. There are 13-20 ventilators at all times and around 25 ECMO runs every year.

Hollywood Presbyterian Medical Center

1300 N. Vermont Avenue
Los Angeles, CA 90027
Phone: 323-913-4804
Fax: 323-644-4459

Providence Saint John's Health Center

2121 Santa Monica Blvd.
Santa Monica, CA 90404
Phone: 310-829-5511

The CHLA Department of Surgery performs over 15,400 surgical procedures annually for children ranging in age from newborns to adolescents. Often, the procedures we provide are more complex than those at any other hospital in Southern California. Learn more about the department.

The Steven & Alexandra Cohen Foundation Newborn and Infant Critical Care Unit is a state-of-the-art 58-bed intensive care unit designed to address the needs of critically ill infants. Learn more.

Functional Echocardiography for the Neonatologist

The purpose of this program is to train neonatal-perinatal fellows and attending neonatologists the technique of performing “functional echocardiography”¹ to evaluate cardiac function during neonatal period in infants with normal cardiac structure. Although being competent at performing functional echocardiography requires the acquisition of skills to differentiate normal cardiac anatomy from abnormal cardiac structure, completion of this training does not prepare the trainees to diagnose congenital (structural) heart disease¹, ².

To obtain skills to diagnose congenital (structural) heart disease one needs to complete fellowship training in pediatric cardiology.  Rather, skills expected to be achieved by completion of the functional echocardiography training include the ability to identify the presence, size and clinical significance of a patent ductus arteriosus (PDA) in premature neonates, recognize the presence of hypertrophic cardiomyopathy in infants of diabetic mothers, etc (see fECHO curriculum). Accordingly, throughout the training, the need for immediate consultation with pediatric cardiologist in case of a suspicion of the presence of congenital cardiac defects on clinical, laboratory or echocardiagraphic evidence is emphasized.  In addition, within the clinical structure of the USC Division of Neonatal Medicine, any infant being followed by fECHO requires a clearance from a pediatric cardiologist ensuring the absence of congenital structural cardiac anomalies.

This is the only structured program in the US and around the world providing training in a novel area of point-of-care hemodynamic testing in a comprehensive manner using both didactic and direct, one-on-one educational activities.

¹ Kluckow M, Seri I, Evans N. Functional echocardiography – An emerging clinical tool for the neonatologist. Medical Progress Article; J Pediatr 150:125-30, 2007
² Kluckow M, Seri I, Evans N. Echocardiography and the neonatologist. Pediatr Cardiol, Jul 29. [Epub ahead of print] PMID: 18663511; 2008

Developmental Cardiovascular Services and Bedside Monitoring and Imaging

The clinical and research experience of the members if the division in the area of developmental cardiovascular physiology and diseases combined with novel bedside monitoring of cardiovascular function using ultrasound, near-infrared spectroscopy, magnetic resonance imaging and other technologies enables us to provide unique clinical services for patients with cardiovascular compromise such as seen in neonatal shock of different etiologies or with persistent pulmonary hypertension of the neonate, patent ductus arteriosus and abnormal hemodynamic transition of preterm and term neonates after birth.

Children's Hospital Los Angeles and the Center of Fetal and Neonatal Medicine are in the process of developing and implementing a virtual neonatal intensive care unit (vNICU) structure that allows for the delivery of highly specialized neonatal and perinatal care to patients located far away from our hospital. 

Virtual medicine presents opportunities for patients to receive specialized care even while they are in remote locations far from medical experts and care specialists. In many cases, the ability to deliver care virtually allows patients in highly fragile conditions the option of foregoing a transfer from one hospital to another. It can also allow high quality care to be made available to patients in rural or remote locations. 

Our vNICU will initially link two sites, with the long-term goal of establishing a network of hospital NICUs across Southern California, connected via telemedicine. Given the national shortage in neonatologists, a vNICU network would allow specialists at our hospital to address the gaps in care experienced at remote hospitals and clinics.

Our goals are to:

  1. Increase patients’ access to the appropriate level of acute care
  2. Enhance health outcomes for patients
  3. Improve families’ quality of life by preventing the child’s unnecessary removal from its community
  4. Utilize scarce healthcare resources more efficiently
  5. Create a model of telemedicine care that can be replicated nationwide

Research Phase

Research on telemedicine delivery has indicated that it enhances care and health outcomes for adult patients. However, as no data exist for the neonatal patient population, the neonatologists at our Center and hospital have set out to ensure that telemedicine represents the very best choice for infants and neonates prior to fully implementing the vNICU network.

With generous support from the UniHealth Foundation, the Division of Neonatal Medicine is engaged in a multi-year study, researching whether the use of telemedicine in a NICU environment results in care that is safe, effective, and provides the best standard of practice. Data for the first phase of the research has been published and plans for two additional phases are in place.

Phase one results indicate that the use of a remote-controlled, robotic telemedicine system in a NICU is feasible and safe. Telemedicine technology aptly provides off-site neonatologists with direct visual and auditory information about the patient and the clinical scenario in real-time in order to facilitate decisions about clinical care.

More about the Research Phase

Development of the vNICU Program

Although telemedicine has proven to be an effective method of bringing the expertise of pediatric and adult intensive care specialists to underserved communities, this technology has not yet been formally studied for use in the fragile neonatal population. 

Once our research has been completed, we plan to develop the world’s first v-NICU program that will reach distant and underserved NICUs. 

Plans are already underway for providing care in Antelope Valley, where our team will supply the expertise of a Regional Level IV Care Center. 

Future Activities

Plans are underway to establish a vNICU system for providing care in more remote regions in Southern California.

Other Resources

  • Neonatal Nurse Practitioners
  • Teaching Activities
  • Research Activities

Under the supervision of a neonatology attending and a neonatology fellow, your baby’s day-to-day care in our Newborn and Infant Critical Care Unit (NICCU) may be provided by one of our Neonatal Nurse Practitioners.

Neonatal Nurse Practitioners have received special training in nursing, and each of them has obtained a:

  • Registered Nurse certification
  • Master’s degree in nursing
  • Nurse practitioner specialization in neonatal care

Under the direction of the attending neonatologist and in accordance with best practices in care, the neonatal nurse practitioners who care for your child will:

  • Assess, diagnose and develop treatment plans
  • Write orders for care
  • Perform procedures such as lumbar puncture, endotracheal intubation, chest tube insertions and more

We recognize the enormous potential of technology in our field, especially when tapped for research, clinical, educational and training purposes.

Initial work resulted in the building, expansion, and cataloguing of the division's intellectual assets.  Clinicians, academicians, researchers, trainees, Neonatal and Infant Critical Care Unit staff members, ancillary staff, and parents assisted in assembling resources that are available to the public and that can be applied to neonatal research publications and neonatal grant applications.

Education & Training

Education and training continues to be an extremely high priority of the neonatal faculty, including the continuing education of faculty members themselves through lecture profiles, evidence-based faculty-consensus clinical practice meetings, and serving as invited or key-note speakers or being in attendance at multiple national and international conferences and symposia. In addition, the scope of postgraduate medical and nursing education continues to broaden with structured pediatric resident neonatal intensive care unit rotations at the NICCU at Children's Hospital Los Angeles and the NICU at the LAC+USC Medical Center, training of neonatal fellows (our Neonatal Fellowship Program is the largest one in Southern California), and training sessions for neonatal nurses, respiratory therapists and ECMO specialists. All of these activities involve core academic responsibilities for the division’s faculty.

Timely and thorough parent education is an integral part of the responsibilities of the faculty while providing clinical service and is fundamental in providing state-of-the-art, compassionate and family-centered clinical services at the bedsides of our tiny patients.  We believe that our unwavering commitment to serve our patients and their families combined with the experience and knowledge that continues to evolve from our participation in postgraduate medical education and cutting-edge basic, translational and clinical research enables us to provide the best possible care for all critically ill neonates and infants admitted to our intensive care units.

The Fetal and Neonatal Institute team strives to advance the ability to diagnose and effectively treat fetal and neonatal conditions to improve outcomes, ensuring babies achieve the best possible developmental and cognitive potential. Our team participates in interdisciplinary epidemiology/outcomes, translational, and clinical and research in partnership with colleagues at Children’s Hospital Los Angeles, the University of Southern California, and with scientists throughout the US and internationally. Learn more.

Awards and Recognition

The Fetal and Neonatal Institute is nationally recognized for exceptional, groundbreaking care for babies and their mothers. 

  • U.S. News & World Report ranked CHLA among the top hospitals in the nation for neonatology care for 2018-19.
  • The Extracorporeal Membrane Oxygenation Program at the Newborn and Infant Critical Care Unit at CHLA was designated as a Center of Excellence by the Extracorporeal Life Support Organization.
  • The NICCU at CHLA received the 2014 ICU Design Citation Award, which is co-sponsored by the Society of Critical Care Medicine, the American Association of Critical Care Nurses and the American Institute of Architects Academy on Architecture for Health.