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At risk: New report urges preparedness planning for NICUs :

April 17, 2017

A new AAP clinical report can help health care providers and hospitals better prepare for disasters that could impact neonatal intensive care units (NICUs). The report reviews disasters that have affected NICUs in the U.S. and examines how organizing concepts of mass critical care in pediatrics can be applied to the NICU.

The report Disaster Preparedness in Neonatal Intensive Care Units, from the AAP Committee on Fetus and Newborn and the Disaster Preparedness Advisory Council, is available at and will be published in the May issue of Pediatrics.

Information is provided to help neonatologists and other NICU care providers and administrative leaders apply organizing concepts to develop response plans within their units, hospitals, health care systems and geographic regions. The guidance builds on AAP policies concerning children in disasters, with a focus on the extremely vulnerable NICU population. It reviews ethical issues related to surge capacity, altered care standards, and atypical locations of care, evacuation, triage and transport.

Key points include the following:

1. Preparation prior to a disaster event is critical to optimizing outcomes of NICU patients during public health emergencies and disasters. Institutions and providers are encouraged to be aware of and prepare for the most likely scenarios in their communities and also to consider unanticipated events that could impact their facilities.

2. It’s important for NICU teams to fully participate in the emergency and disaster planning activities within their facility, health care system, and regional, state and local emergency management agencies. NICU teams should participate in disaster drills and design drills that address the unique needs of NICU patients in scenarios involving “shelter in place,” relocation and/or evacuation.

3. Neonatal care systems can develop appropriate staffing support for safe and effective operations during disasters. Leaders should anticipate generating sufficient surge capacity to provide three times’ baseline critical care resources and to sustain this for 10 days during a major public health disaster.

4. During a disaster, neonatal care providers can maintain situational awareness for decision-making, including patient volume and severity of illness, available equipment and medications, staffing, transport, evacuation, recovery and crisis standards of care. A process of ethical decision-making and altered standards of care needs to be included in the planning.

5. In addition to needs of patients,NICU providers will need to consider the medical and psychosocial needs of postpartum mothers and families. To the extent it is feasible, parents and families should remain in contact with their hospitalized children. In addition, plans must recognize and respond to NICU staff needs, including self-care and support during a disaster.

6. Because preparedness is an ongoing process that changes with experience and evidence,NICU providers should continue to research best practices as well as the effects of altered standards of care in disasters.

Disasters disproportionately affect vulnerable, technology-dependent people, including — and, perhaps, especially — preterm and critically ill newborns in NICUs. Thus, it is vital that health care providers be aware of and prepared for the potential consequences of disasters for NICUs. NICU personnel can provide specialized expertise for their hospital, community and regional emergency preparedness plans and help develop institutional surge capacity for mass critical care, including equipment, medications, personnel and facility resources.


Drs. Barfield and Krug are co-authors of the clinical report. Rear Adm. Barfield is a liaison from the Centers for Disease Control and Prevention to the AAP Committee on Fetus and Newborn, and Dr. Krug is chair of the AAP Disaster Preparedness Advisory Council.

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