Zero Separation Unit

Zero Separation – 100% Togetherness

At the Shamir Medical Center (Assaf Harofeh), we place a strong emphasis on giving every mother the freedom of choice.

• Newborns (Nursery)
• Neonatal Intensive Care Unit (NICU)
• Parents in the NICU
• Neonatal Jaundice
• Multiple Pregnancy Clinic
• Obstetric-Gynecological Ultrasound Institute

Newborns (Nursery)

The Newborn Department (Nursery) is one of the oldest and largest in Israel, specializing in the care and supervision of healthy newborns, from the moment of birth until discharge home. The department provides care and monitoring for healthy infants born from week 35 onward and weighing over 2 kg.

“From birth until the baby goes home, our medical and nursing staff are responsible for providing the most essential primary care, helping the newborn adjust to the outside world, and supporting parents in the challenging but rewarding journey of caring for their child at home,” explains Dr. David Batasch, Head of the Newborn Unit.

Procedures and Treatments Performed for Newborns

• Warming in an open incubator
• Weighing
• First bath
• Medical and nursing assessment
• Vitamin K injection
• Eye drops
• Hepatitis B vaccination
• Blood tests, if necessary
• Routine care
• Monitoring for jaundice and treatment if required
• G6PD screening
• Screening for metabolic diseases
• Hearing tests

Parent Guidance in the Department

• Daily parent training for newborn care
• Breastfeeding guidance
• Support for mothers after their first birth

Department Routine

Upon admission, the newborn undergoes identification by both the ward nurse and midwife.

The baby is then placed temporarily in a warming bed, followed by a first bath administered by a nurse.

Vaccinations and treatments are given according to Ministry of Health guidelines:

• Vitamin K injection – to support blood clotting and prevent bleeding
• Hepatitis B vaccine – to prevent viral hepatitis B
• Eye drops – a one-time dose to prevent eye infection from bacteria present in the birth canal

Parents who refuse vaccinations or treatments must inform staff in both the delivery room and the newborn department.

Each newborn undergoes a physical and nursing assessment by a physician and a certified nurse, and is then placed in a crib.

Nurses provide daily care, monitor the baby’s medical condition, and weigh the baby on a daily basis. A physician examines the newborn upon admission, again on the day of discharge, and as needed during hospitalization.

The mother’s partner can take an active role in the parenting experience. Therefore, immediately after birth, they receive an ID wristband that allows free entry to the newborn department to visit the baby for most hours of the day.

Part of the department’s nurses are also certified lactation consultants. They provide guidance, support, and encouragement to mothers who wish to breastfeed their babies.

There is a breastfeeding room, staffed by a lactation consultant each morning for several hours, offering both group and individual sessions. When not in the breastfeeding room, the consultant visits mothers in their rooms to provide additional help and advice.

Mothers who choose not to breastfeed receive counseling on milk suppression and proper bottle feeding. They may also choose a formula from the available options in the department.

Parents may consult with the pediatrician in the department daily between 10:30 and 14:00. In urgent cases, the ward nurse will refer them to the on-call physician.

Registration of the Newborn in the National Insurance & the Ministry of Interior

The registration process establishes the initial connection with the National Insurance Institute and the Ministry of Interior, ensuring that parents receive their rights. Registration is performed in the Admissions Office during mornings and early afternoons, in the presence of the parents. It is important to complete registration as soon as possible after birth. Parents must present valid ID cards for registration.

Rooming-In

At any time, the mother may choose rooming-in.

The department encourages strengthening the mother–baby bond by offering this option, i.e.,  the baby stays in their mother’s room. Mothers who choose it will receive training and equipment for newborn care and will sign a consent form.

The baby stays with the mother in her room and is under her responsibility throughout the day, according to her wishes and decision. At any point, the baby can be returned to the nursery. This approach allows mothers to care for their babies independently, under the guidance and support of the department’s staff. The primary advantage of this approach is gaining confidence and experience before discharge, as well as fostering early mother-baby bonding.

Mothers may also choose Zero Separation – click here

Whichever option the mother chooses, the staff of the newborn department ensures dedicated, essential care for the baby from birth until discharge from the medical center.

Neonatal Intensive Care Unit (NICU)

The Neonatal Intensive Care Unit (NICU) provides care for infants born before 35 weeks of pregnancy and weighing less than 2 kg, as well as for full-term newborns who require treatment, monitoring, and supervision.

The NICU is a specialized medical unit that combines the most advanced medical technologies and equipment with a multidisciplinary professional team. The professional staff includes pediatricians specializing in neonatology, nurses trained in neonatal and preterm intensive care, physiotherapists, occupational therapists, a psychologist, social workers, and a dietitian. These professionals collaborate to deliver the highest quality, up-to-date, and professional care for our youngest patients.

We believe in creating a safe and supportive environment for parents, accompanying them throughout their journey in the unit by providing a comprehensive, holistic framework that encompasses both medical and nursing perspectives, as well as emotional support, assistance in exercising social rights, and guidance in developmental care.

Admission and Reception Process to the NICU

Congratulations on the birth of your child!

Who is admitted to the NICU?

• Infants born before 35 weeks of pregnancy
• Infants with a birth weight under 2 kg
• Infants who require medical treatment and monitoring

Newborn admission takes place in “Room 2.”
At admission, you will meet the medical team that will care for your baby (doctor and nurse).

First, your baby will be weighed and examined. They will be connected to a monitor that records heart rate, oxygen saturation, blood pressure, and breathing rate.

We avoid procedures that may cause stress at this stage, such as bathing.

Most infants admitted to the NICU require blood tests shortly after admission. Parents are welcome to remain next to their baby during these tests. (How can parents help reduce and prevent pain? – see section “Parents in the NICU”).

After the physical examination, you will receive an explanation and update from the medical team about your baby’s condition, the treatment plan, and the planned tests.

This is the time to ask questions.

You will be asked to sign a blood transfusion form, as required by the Ministry of Health for all NICU admissions.

Routine newborn treatments (Hepatitis B vaccine, Vitamin K injection, and eye drops) are administered according to Ministry of Health recommendations. If you do not wish to receive them, please inform us at this stage.

We encourage you to stay with your baby from the time of admission and throughout the hospitalization. Stay close to your baby; we will approach you when available to answer your questions and provide assistance as needed.

Please remember to speak quietly and avoid using mobile phones. Do not bring visitors into the unit, and keep your baby’s environment clean and organized.

Kangaroo Care (Skin-to-Skin)

We encourage you to practice kangaroo care as early as possible and for as long as possible (even with ventilated infants).

Kangaroo care (skin-to-skin contact) is a natural caregiving method that provides non-medical touch to ease the newborn’s transition from the warm womb environment to the supportive but clinical NICU setting. This method has a positive effect on the preterm infant’s normal development and even survival.

Benefits of kangaroo care:

• Strengthens bonding between parent and infant
• Helps regulate heart rate and breathing, thus improving oxygen supply to the brain
• Regulates the infant’s body temperature   

The Role of the Social Worker in the NICU

Hospitalization of a newborn in the NICU can be a complex emotional experience for parents.
Feelings such as guilt, worry, anxiety, sadness, and fear may accompany parents throughout the newborn’s hospitalization in the NICU and sometimes even after discharge.

Therefore, the need for emotional support during this time is very significant.

The department’s social workers: Tamar David and Ruti Chechenitsky Cohen

The role of the social worker includes:

• Providing emotional support, guidance, and assistance to the family
• Giving information and support in utilizing social rights
• Serving as a liaison between NICU staff and community support services
• Providing information about adapting to life in the NICU

Parents in the NICU

The NICU staff regards you, the parents, as partners in the care of your baby.

Our approach to care is based on the “Supportive Developmental Care” model, following the principles of NIDCAP (Neonatal Individualized Developmental Care and Assessment Program).

This method was developed at Harvard University by the preterm-infant psychologist Heidi Als.
For more information, please visit NIDCAP.org.

We view you as your child’s primary source of strength, and therefore, we invite you to be present during medical rounds, stay with your baby during treatments, and spend time with your baby throughout the day and night, as you prefer.

The NICU at the Shamir Medical Center is open to parents 24/7.

We will help you understand the “language of infants” so that you can recognize when your baby is calm and relaxed, and when they need support to return to a peaceful state.

We will also teach you a variety of strategies to help your baby (even the very smallest) achieve calmness, relaxation, and sleep, allowing you to choose the methods most suitable for you and your baby according to their developmental stage.

Young babies learn about the world through their senses: touch, hearing, smell, and sight. These abilities develop during sleep. We protect sleep and avoid examining babies while they are sleeping. Additionally, we strive to minimise stimuli that can cause stress, including noise, light, and pain.

The NICU is kept dim, cribs and incubators are covered, and monitors are muted.

One of the important methods is kangaroo care / skin-to-skin contact, therefore, we encourage you to practice kangaroo care as early as possible and for as long as possible (even with ventilated infants).

Parental speech directed at the baby has been shown to be extremely important for later cognitive development. Together, we will learn how and when to talk to your baby.

The nursing staff and the health professionals team (physiotherapists and occupational therapists) will gradually teach you all of these practices step by step.

Research shows that preterm infants and babies whose parents were present, cared for them, and felt confident in their caregiving, had developmental advantages later in life, including at age 20 and beyond.

We strongly believe in the importance of the parent–infant bond from the very beginning of life and will support you in enjoying this bond throughout your stay in the NICU.

Breastfeeding Preterm Infants

Dear Mother, along with the joy of your baby’s birth, come natural concerns about the health of a baby born a little earlier than expected, and uncertainty about the length of hospitalization (which is usually longer than for babies born at term).

Breast milk is even more important for premature infants than for full-term infants:

• It is the most suitable nutrition for preterm babies.
• It is always available and fresh.
• It helps prevent infectious diseases.
• It supports healthy retinal development.
• Enzymes in breast milk help the preterm infant absorb nutrients and benefit from them more effectively.
• It protects against necrotizing enterocolitis.
• Breastfeeding helps prevent ear infections and reduces allergies and asthma.
• Breastfeeding lowers the risk of blood and lymphatic diseases.
• Breastfeeding reduces the risk of developing Type 1 diabetes by 40%.

Many mothers choose to breastfeed their preterm babies or provide expressed breast milk. However, in the first days, some mothers may face breastfeeding challenges. Reasons may include:

• Muscle tone issues in the infant make proper latch and effective sucking difficult.
• Infant sleepiness.
• Vigorous but ineffective sucking.
• Disorganized sucking patterns.

As a result, some mothers may experience reduced or insufficient milk production, which can lead to:

• Hypoglycemia (low blood sugar).
• Hyperbilirubinemia (tendency to develop physiological jaundice).
• Dehydration.
• Excessive weight loss.
• More frequent respiratory instability.
• Slow weight gain.

Therefore, it is very important to:

• Maintain milk supply – express colostrum or pump breast milk at least 8 times a day.
• Seek breastfeeding guidance and support from a lactation consultant in the hospital starting from the first day.
• Practice skin-to-skin contact (kangaroo care).
• Ensure preterm infants are fed at least 8 times in 24 hours.
• Continue pumping until the baby can nurse at least 8 times a day and is gaining weight.

And most importantly:

To achieve full or partial breastfeeding, you will need patience, persistence, and effort that may not always be easy; however, it is extremely important for the health of both you and your baby.

Neonatal Jaundice

What is jaundice?

A medical condition caused by the accumulation of a substance called bilirubin in body tissues.
Neonatal jaundice is common in healthy full-term newborns (~60%) and even more common in preterm infants (~80%). In most babies, it is physiological jaundice (not requiring treatment). It usually appears on days 2–5 of life and resolves within about two weeks.

What is bilirubin?

Bilirubin is a byproduct of hemoglobin breakdown (a substance found in red blood cells). Bilirubin is processed in the liver and excreted from the body in the stool.

Bilirubin levels gradually rise after birth and peak between days 2 and 5 of life. Various factors may contribute to this, most commonly increased production (hemoglobin breakdown) compared to elimination (by the liver): insufficient feeding, reduced stool output, blood type incompatibility between baby and mother, enzyme deficiency (G6PD), bleeding in the newborn, history of jaundice in siblings, and, in some cases, breastfeeding-related jaundice.

Extremely high bilirubin levels may damage the infant’s health by entering the brain, which can lead to neurological injury.

Such complications are rare today, thanks to early detection and the availability of effective treatments.

How is jaundice diagnosed?

Bilirubin levels are determined in two main ways:

1. Transcutaneous measurement – a bilirubin meter is briefly placed on the infant’s forehead (Not reliable after phototherapy treatment)
2. Blood test – heel prick with a sample sent to the lab.

All newborns are screened before hospital discharge. Additionally, babies with risk factors or visibly yellowish skin are tested during hospitalization.

Treatment of Neonatal Jaundice – “Phototherapy”

The main principle of treatment is to enhance bilirubin elimination from the body via urine.

Exposing the baby’s body to blue light (“phototherapy”) changes the bilirubin molecule, allowing it to be excreted in urine. In cases of very high bilirubin levels, more rapid reduction may be required, and additional treatment options may be considered.

The bilirubin threshold requiring treatment depends on the newborn’s age (in hours) and changes (threshold rate increases) in the first 5 days of life. If bilirubin exceeds the threshold, a laboratory evaluation is performed (including infant blood type, blood count, and chemistry), and the infant is placed in a special treatment station. At this station, the infant is undressed, with their body exposed to blue light while their eyes are covered with protective shields. Bilirubin levels are checked every 2–12 hours, as determined by the physician. The duration of treatment varies depending on the cause of jaundice. A small number of infants may need several “rounds” of phototherapy. Feeding and caring for the baby are possible during treatment. The eye shield is removed during feeding.

What level of Bilirubin requires treatment?

The bilirubin level requiring treatment varies according to the newborn’s age (in hours), the rate of increase, the week of gestation at birth, and the blood types of the mother and infant. Therefore, different newborns will begin treatment at different levels, depending on their degree of risk.

Jaundice and breastfeeding

Except in rare, exceptional cases, there is no justification for stopping breastfeeding or breast milk during jaundice.

For more information, please consult the nursery staff.

Congratulations and best wishes for good health!
The Nursery and NICU Team at the Shamir Medical Center

How Can Pain Be Reduced During Tests?

Medical care for infants hospitalized in the NICU requires frequent monitoring and follow-up.

In addition to advanced monitors and close medical and nursing supervision, we monitor additional parameters that can be assessed with blood tests, such as blood sugar levels (“Dex test”), liver and kidney function (“chemistry tests”), jaundice levels, inflammation markers (“blood count”), acid–base balance, and respiration (“blood gases”).

To reduce the number of needle sticks, the department is equipped with a wide range of devices that allow for evaluation and measurement without the need for punctures, including a subcutaneous glucose monitor, a transcutaneous carbon dioxide monitor, an oxygen saturation monitor, and a transcutaneous jaundice meter. Nevertheless, sometimes blood tests requiring a needle stick are unavoidable, which may cause pain.

To minimize exposure to pain, we use various therapeutic methods in which parents are invited to participate: parental presence during tests, talking to the baby, swaddling and comforting touch. These have been proven to be soothing; therefore, we will guide you and encourage you to be with your child and practice these techniques.

During tests, giving a pacifier dipped in a sweet solution or breast milk can also contribute to comfort and calmness, and you may help with these as well. During procedures, the baby’s eyes are covered to protect them from direct light.

Medical Team

• Prof. Iris Morag – Head of Department
• Dr. Rimona Keidar – Deputy Head of Department
• Dr. Eilat Livneh – Senior Physician
• Dr. David Batsch – Head of Newborn Unit
• Ms. Mazal Shemer – Specialist Nurse

Nursing Team

• Oksana Miloslavsky – Head Nurse
• Izabel Yagudaev – Deputy Head Nurse
• Hiba Elias – Deputy Head Nurse

The nursing staff of the NICU at the Shamir Medical Center (Assaf Harofeh) includes about 60 nurses, certified in the care of preterm and newborn infants requiring special care or monitoring. All NICU nurses are graduates of the advanced Neonatal and Preterm Intensive Care course – a prestigious program designed to train them in admission and assessment of preterm and newborn infants, identifying emergency situations, and comprehensive care for preterm infants and their families.

The department’s nurses responsible for your child are here to assist you in care and guide you step by step – from changing a diaper to using complex medical support equipment if your baby requires it at discharge. Our department encourages maximum parental involvement in the care of their infants; therefore, parents are welcome to come at any time of day or night, or contact us by phone if needed.

We are always available to answer questions and provide help.

In addition to routine care, NICU nurses also provide parent education, including regular weekly workshops on infant resuscitation and discharge preparation. We strongly recommend that all parents participate in these important workshops to gain tools that will give them the confidence they need before discharge.

Among our nurses, there are also those who are certified lactation consultants, qualified to provide full and comprehensive support in this crucial area, including expressing colostrum (first milk), designing a pumping schedule and guiding mothers of preterm infants on the safe path to full breastfeeding, and supporting mothers of full-term infants with breastfeeding

Physiotherapy and Occupational Therapy Team

Michal Levy, Physiotherapist

Tova Shotten, Head of Occupational Therapy

Dganit Froimovitz, Head of Physiotherapy Team in the NICU

Yael Katan, Physiotherapist

Multiple Pregnancy Clinic

The safest place for you and your twins-to-be!

Background

In recent years, there has been an increase worldwide and in Israel in pregnancies with twins or multiple fetuses.
In Israel, about 7,000 pairs of twins are born each year.

What are the chances of becoming pregnant with twins?

1. Fertility treatments – In recent decades, we have seen a rise in twin pregnancies as a result of fertility treatments. In fertility treatments, ovulation is stimulated, which increases the likelihood of conceiving twins.
2. Age – Women over the age of 35 have a higher chance of conceiving twins.
3. Heredity – If there are first-degree relatives with twins, the chances of conceiving a similar pregnancy increase.
4. Weight – Women who are overweight have a greater chance of becoming pregnant with twins.
5. Maternal origin – Women of certain ethnic backgrounds have a higher probability of conceiving twins.

What are doctors’ concerns during a twin pregnancy?

A twin pregnancy is a joyous event, but it also carries greater challenges than a single pregnancy and requires close medical monitoring from the earliest stages, often in the high-risk pregnancy unit. Because there are various risks to the normal development of the pregnancy, different processes are performed compared to single-fetus pregnancies. Some of the medical risks include: gestational diabetes, preterm birth, growth restriction of one fetus at the expense of the other, low birth weight, and risks to the lives of the mother and the babies.

At the medical center, we have developed new methods of diagnosis, and in some cases, early detection and prevention of complications, with a focus on twin pregnancies:

• Early detection of placenta accreta and its complications, with close monitoring throughout pregnancy and delivery
• Early detection of preterm labor and prevention using a cervical pessary (Arabin pessary)

If you have received the news that your pregnancy includes two or more babies, you are welcome to our Twin Clinic. Our team of specialists will be happy to accompany you through all stages of the pregnancy, up until delivery.

We are here for you – and congratulations!

Obstetric-Gynecological Ultrasound Institute

The Obstetric-Gynecological Ultrasound Institute is part of the Women and Maternity Division at Shamir Medical Center (Assaf Harofeh). In addition to serving patients of the Women and Maternity Division, the institute also supports the entire medical center and serves as a national referral center for complex cases in obstetrics and gynecology referred by community physicians.

Message from the Director

“The latest developments in ultrasound (‘sonographic imaging’) allow us to gain a deeper look at the female reproductive organs as well as at what takes place in the uterus during pregnancy. Beyond the extraordinary experience of observing the fetus for the expectant parents, this represents a scientific breakthrough which, combined with the expertise of our physicians, enables detailed and accurate identification of a wide variety of conditions and findings, and, when necessary, the provision of appropriate treatment,” says Prof. Maimon, Head of the Department.

The institute is situated in a new, spacious, and modern facility, equipped with state-of-the-art, high-quality equipment.
It includes a waiting room equipped with a television and cold drinks for patients’ comfort, as well as a seminar room where examinations can be viewed while preserving patients’ privacy. The setting allows partners to be present during examinations and to receive a concluding consultation in a separate room.

Equipment and Facilities

The institute was recently renovated and now features five modern, well-designed treatment rooms, all equipped with advanced technology, including color Doppler and cutting-edge 2D and 3D ultrasound imaging systems. The equipment includes abdominal probes and vaginal probes with needle-guidance systems for transvaginal procedures. There is also the option of recording complex examinations for further data analysis and interpretation.

The Team

The institute’s staff includes specialist physicians in obstetrics and gynecology with expertise in ultrasound imaging, a pediatric cardiologist, and a midwife nurse. Alongside them work licensed ultrasound technicians, certified by the Ministry of Health, and medical secretaries.

The physicians work as part of a multidisciplinary team, in close and fruitful collaboration with specialists from the Women’s Division across all subspecialties, and with experts in other medical fields, such as genetics, pediatrics, pediatric surgery, pediatric urology, pediatric orthopedics, radiology, and more.

Treatments and Procedures

In Obstetrics, the institute performs diagnostic ultrasound examinations at all stages of pregnancy, including basic obstetric ultrasound, nuchal translucency scan to assess the risk of Down syndrome, anomaly scans, and fetal evaluation using blood flow Doppler studies. The Shamir Medical Center Ultrasound Institute was the first in Israel to perform the nuchal translucency screening test for Down syndrome, leading to the detection of numerous chromosomal abnormalities and congenital anomalies. In addition, the institute performs invasive procedures, such as amniocentesis for genetic diagnosis, chorionic villus sampling, umbilical cord blood sampling, fetal reduction in multiple pregnancies, and fetal heartbeat termination in late-term pregnancy terminations.

The institute also offers fetal echocardiography and fetal MRI, as part of its multidisciplinary care.

In Gynecology, the institute performs diagnostic ultrasound of the uterus, including 3D ultrasound for the detection of uterine malformations, as well as saline sonohysterography and hydrosalpingosonography for visualizing tubal patency.

Invasive procedures performed in the institute include needle aspiration of cysts, abscesses, and pelvic masses via abdominal or transvaginal approach, diagnosis and management of ectopic pregnancies, and fluid aspiration from the pelvis and abdominal cavity.

Women with a history of cesarean delivery are invited for scar assessment, as cesarean scars can affect future pregnancies, fertility treatments, and intermenstrual bleeding.

The institute team works closely with specialists in gynecology, oncology, and minimally invasive surgery for the diagnosis and management of reproductive system conditions, such as endometriosis, benign and malignant tumors, biopsies, as well as decision-making regarding continued treatment for each patient.