Clinicians in the neonatal intensive care unit (NICU) are charged with supporting the smallest of patients in their first days of life, and demands on their work have only increased in the past decade. In 2016, 8.7% of births resulted in NICU admissions, but that figure rose to 9.8% in 2023.
In fact, NICU rates for all maternal age groups and gestational birthweight categories have increased in the past ten years, requiring clinicians to meet growing needs. Supporting NICU clinicians with the right resources is key to alleviating some of their daily challenges, ultimately improving outcomes for their patients.
Key challenges for NICU clinicians
Nurses and clinicians in NICU units face a number of challenges on top of tending to their patients and their families.
Staffing shortages
Like many areas of the healthcare ecosystem, NICU units are understaffed, experiencing a 20% decline in new clinicians since 2022. Since infants are unable to care for themselves, they are highly dependent on consistent care from nurse and clinical teams, leading to additional strain on already understaffed teams.
Simultaneously, NICU clinicians report feelings of burnout on an average of 44% of their shifts, largely due to increasing workloads. Burnout, which quickly leads to staffing shortages, has been shown to impact clinical performance, decision-making, and, subsequently, patient outcomes. Conversely, capacity strain increases the risk of mortality and morbidity. Clinical leaders need to meet these challenges by equipping current staff with tools to help alleviate workload, improve access to information, and streamline workflows.
Care consistency for all patients
Another challenge is the need to provide consistent care across NICU teams and clinical staff.
One study found that variations in NICU locations, financial incentives, and accessibility significantly impact the consistency of utilization and care. The preterm birthrate for Black or African American populations is 14.7%, higher than the 10.4% nationwide average, and Black birthing people die at more than three times the rate of their white peers. These statistics emphasize the need to ensure bias-free, equitable care for all NICU patients and their families.
Low resourcing for clinical technology and information
Having access to modern technology and tools is key for clinicians to perform their job. Many clinical teams around the world struggle to integrate technology into their work, especially in low- and middle-income countries (LMIC). A 2025 study found that, while LMICs are using some newer technologies in NICU settings, the integration and sustainability of those technologies is limited by a lack of implementation infrastructure.
Not having standardized information and technology across teams can create inconsistencies in care and make decision-making more challenging. Successful adoption of advanced technologies, however, can help optimize clinical care and NICU follow-up treatment. Having easy access to clinical content with the latest evidence-based recommendations at the point-of-care can support better health outcomes.
How evidence-based clinical decision support can aid NICU clinicians
These challenges can’t be solved holistically with one or two solutions, but equipping NICU nurses and clinicians with the right evidence-based content to support decision-making can help standardize care across teams and improve outcomes for infants and their families.
Access to the latest clinical and drug information
With clinical evidence constantly updating and new drugs coming out on the market, NICU clinicians need access to the latest recommendations for their smallest patients. Having quick access to information about neonatal disorders and appropriate drug dosing can help improve outcomes and support nurses at the point of care. They can also provide patient information to families as they move on from the NICU to support care at home. Additionally, nurses need to understand not only when the clinical information was last updated, but also the original sources and studies that led to recommended procedures and dosing to feel confident in their decisions.
Accessible information across NICU teams
When this clinical decision support content is available at the point of care, NICU nurses can easily access recommendations in the midst of a busy, potentially understaffed shift. Having decision support easily accessible on mobile devices, in the EHR, and in rural locations can be key to providing neonatal information to families and clinicians, while improving equitable care for infants.
Opportunities to standardize processes
Cross-team clinical decision support can help standardize processes and care. By working with consistent sources of information, NICU teams can provide standardized levels of care staffing transitions, across diverse populations, and when the need for quick answers arises.
As leaders look to support their NICU units and staff, providing access to the latest evidence-based clinical information from decision support tools like UpToDate® and UpToDate® Lexidrug™ can help alleviate challenges and help improve outcomes for the smallest patients.
Similarly, UpToDate Enterprise Edition’s video package unites patient education and clinical decision-making in one central resource. Clinicians can search a library of more than 1,000 educational videos—all aligned with UpToDate’s evidence-based guidance—then deliver content to families without leaving their direct workflow. Families can elevate their understanding of their child’s specific condition via a format that matches their health literacy, while NICU clinicians can access actionable insights to ensure the materials are increasing patient engagement.
UpToDate Enterprise Edition is a trusted provider of patient education content for 60% of clinicians, delivering more than 2.6 million uses annually. Learn how UpToDate Enterprise Edition can support neonatal nurses and their patients by contacting our team.