New parents eagerly look forward to bringing their newborn home, so it can be frightening if your baby needs to be admitted to the Newborn Intensive Care Unit (NICU). Babies who need to go to the unit are often admitted within the first 24 hours after birth. Babies may be sent to the NICU for one of the following reasons:
- They are born prematurely
- Their delivery has difficulties
- They show signs of a problem in the first few days of life
Only very young babies (or babies with a condition linked to being born prematurely) are treated in the NICU — they're usually infants who haven't gone home from the hospital yet after being born. How long these infants remain in the unit depends on the severity of their illness. A baby's NICU stay can be difficult, but it can also be rewarding as you watch your child grow and progress day after day. At University of Utah Health Care we employ the latest in medicine and technology and use the healing power of caring and touch to give infants the best care possible.
The Neonatal Intensive Care Unit (NICU)
The birth of a baby is a wonderful yet very complex process. Many physical and emotional changes occur for mother and baby.
A baby must make many physical adjustments to life outside the mother's body. Leaving the uterus means that a baby can no longer depend on the mother's circulation and placenta for important physiologic functions.
Before birth, breathing, eating, elimination of waste, and immunologic protection all came from the mother. When a baby enters the world, many body systems change dramatically from the way they functioned during fetal life:
The lungs must breathe air.
The cardiac and pulmonary circulation changes.
The digestive system must begin to process food and excrete waste.
The kidneys must begin working to balance fluids and chemicals in the body and excrete waste.
The liver and immunologic systems must begin functioning independently.
Your baby's body systems must work together in a new way. Sometimes, a baby has difficulty making the transition to the world. Being born prematurely, having a difficult delivery, or birth defects can make these changes more challenging. Fortunately for these babies, special newborn care is available.
What is the neonatal intensive care unit?
Newborn babies who need intensive medical attention are often admitted into a special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced technology and trained health care professionals to provide specialized care for the tiniest patients. NICUs may also have intermediate or continuing care areas for babies who are not as sick but do need specialized nursing care. Some hospitals do not have the personnel or a NICU and babies must be transferred to another hospital.
Some newborn babies will require care in a NICU, and giving birth to a sick or premature baby can be quite unexpected for any parent. Unfamiliar sights, sounds, and equipment in the NICU can be overwhelming. This information is provided to help you understand some of the problems of sick and premature babies. You will also find out about some of the procedures that may be needed for the care of your baby.
Which babies need special care?
Most babies admitted to the NICU are premature (born before 37 weeks of pregnancy), have low birth weight (less than 5.5 pounds), or have a medical condition that requires special care. In the U.S., nearly half a million babies are born preterm, and many of these babies also have low birth weights. Twins, triplets, and other multiples often are admitted to the NICU, as they tend to be born earlier and smaller than single birth babies. Babies with medical conditions such as heart problems, infections, or birth defects are also cared for in the NICU.
The following are some factors that can place a baby at high risk and increase the chances of being admitted to the NICU. However, each baby must be evaluated individually to determine the need for admission. High-risk factors include the following:
Age younger than 16 or older than 40 years
Drug or alcohol exposure
Hypertension (high blood pressure)
Sexually transmitted diseases
Multiple pregnancy (twins, triplets, or more)
Too little or too much amniotic fluid
Premature rupture of membranes (also called the amniotic sac or bag of waters)
Fetal distress/birth asphyxia (changes in organ systems due to lack of oxygen)
Breech delivery presentation (buttocks delivered first) or other abnormal presentation
Meconium (the baby's first stool passed during pregnancy into the amniotic fluid)
Nuchal cord (cord around the baby's neck)
Forceps or cesarean delivery
Birth at gestational age less than 37 weeks or more than 42 weeks
Birth weight less than 2,500 grams (5 pounds, 8 ounces) or over 4,000 grams (8 pounds, 13 ounces)
Small for gestational age
Medication or resuscitation in the delivery room
Respiratory distress including rapid breathing, grunting, or apnea (stopping breathing)
Infection such as herpes, group B streptococcus, chlamydia
Hypoglycemia (low blood sugar)
Need for extra oxygen or monitoring, intravenous (IV) therapy, or medications
Need for special treatment or procedures such as a blood transfusion
Who will care for your baby in the NICU?
The following are some of the specially trained health care professionals who will be involved in the care of your baby:
Neonatologist. A pediatrician with additional training in the care of sick and premature babies. The neonatologist (often referred to as the attending physician) supervises pediatric fellows and residents, nurse practitioners, and nurses who care for babies in the NICU.
Neonatal fellow. A pediatrician currently receiving additional training in the care of sick and premature babies. He or she may perform procedures and direct your child's care.
Pediatric resident. A physician currently receiving additional training in the care of children. He or she may perform or assist in procedures and help direct your child's care.
Neonatal nurse practitioner. A registered nurse with additional training in the care of newborn babies. He or she can perform procedures and help direct your child's care.
Respiratory therapist. A person with specialized training in providing respiratory support including managing breathing machines and oxygen.
Physical, occupational, and speech therapists. Physical and occupational therapists make sure a baby is developing appropriately and help with developmental care including positioning and soothing techniques. Speech therapists assist with helping babies learn to eat by mouth.
Dietitians. Dietitians ensure the babies are growing appropriately and receiving appropriate nutrition including calories, protein, vitamins, and minerals.
Lactation consultants. Lactation consultants are health care providers with additional training and certification in helping women breastfeed. They can help with pumping, maintaining milk supply, and initiating breastfeeding.
Pharmacists. Pharmacists help in the NICU by assisting the care providers in choosing the best medications, monitoring drug dosing/levels, and keeping the team aware of possible side effects and necessary monitoring.
Social workers. Social workers assist families with dealing with a wide range of emotions they face when a child is ill, help families obtain needed information from physicians, and support the family with other more basic care needs such as financial problems, transportation, or arranging home health care.
Hospital chaplains. The hospital chaplain might be a priest, minister, lay pastor, or other religious advisor who can provide spiritual support and counseling to help families cope with the stressors of the NICU experience.
The members of the NICU team work together with parents to develop a plan of care for high-risk newborns. Ask about the NICUs parent support groups and other programs designed to encourage parental involvement.
Dr. Adelman is a women's health doctor that works as a minimally invasive gynecologic surgery consultant and obstetrician for the institution. Dr. Adelman’s clinical interests include cervical dysplasia, dysfunctional uterine bleeding, symptomatic fibroid uteri, adnexal masses, and chronic pelvic pain. She provides medical and surgical treatments f... Read More
Robert L. Andres, MD is an Associate Professor of Obstetrics and Gynecology at the University of Utah Health Sciences Center. Dr. Andres serves as an attending physician at McKay-Dee Hospital Center in Ogden, Utah, as well as the University of Utah Health Sciences Center . He completed his Maternal-Fetal Medicine Fellowship at the University of Cal... Read More
Dr. Branch is a Maternal-Fetal Medicine specialist who treats high-risk pregnancy patients. He is internationally recognized for his research and focus on special interests within his specialty, including antiphosphilipid syndrome (APS), thrombotic disorders in pregnancy, and recurrent pregnancy loss. He has been in practice as a high-risk pregna... Read More
Janice L.B. Byrne, MD is a Professor of Obstetrics and Gynecology at the University of Utah Healthsciences Center. Dr. Byrne is on the Steering Committe for the Utah Fetal Care Center at Primary Children's. She is on the faculty of the University of Utah Graduate Program in Genetic Counseling and serves as a clinical case reviewer for the Utah Bir... Read More
Erin Clark, MD has been an Assistant Professor of Obstetrics and Gynecology at the University of Utah Health Sciences Center since she completed her Maternal-Fetal Medicine Fellowship at the University of Utah in 2009. She is board certified in Obstetrics and Gynecology, as well as the subspecialty of Maternal-Fetal Medicine. She initiated the Pret... Read More
Mark W. Dassel, M.D. is an Assistant Professor and women's health provider, with a special interest in Minimally Invasive Gynecology. Dr. Dassel received two B.S. degrees and an M.D. degree from the University of Kentucky. He completed an Obstetrics & Gynecology residency program at the Phoenix Integrated Residency in OB/GYN and a 2 year fello... Read More
|Madsen Health Center||(801) 213-2995|
|South Jordan Health Center||(801) 213-4500|
|University Hospital||(801) 213-2995|
Donna S. Dizon-Townson, MD is an Associate Professor of Obstetrics and Gynecology and serves as the Medical Director of Clinical Programs for the Southern Region of Intermountain Healthcare. Dr. Dizon-Townson is a renowned authority on thrombophilic disorders in pregnancy, having published several pioneering papers on Factor V. Leiden. Dr. Dizon-To... Read More
Michael L. Draper, MD is an Associate Professor of Obstetrics and Gynecology. He is board certified in Obstetrics and Gynecology, as well as the subspecialty of Maternal-Fetal Medicine. He has been with the University of Utah Maternal-Fetal Medicine Division since 2002. He is currently the Residency Program Director for the Department of Obstetrics... Read More
Alexandra Grosvenor Eller, MD, MHP is an Assistant Professor of Obstetrics and Gynecology at the University of Utah Health Sciences Center. She is board certified in Obstetrics and Gynecology. Dr. Eller completed her Maternal-Fetal Medicine Fellowship at the University of Utah in 2008. Her areas of interest are preeclampsia, immunologic/hematologic... Read More
M. Sean Esplin, MD is an Associate Professor of Obstetrics and Gynecology. He joined the University of Utah Maternal-Fetal Medicine Division in 2000, after completion of his Maternal-Fetal Medicine Fellowship at the University of Utah. He is board certified in both Obstetrics and Gynecology and the subspecialty of Maternal-Fetal Medicine. Dr. Espli... Read More
Keri Gibson, MD, is a board-certified physician specializing in obstetrics and gynecology. She received her medical degree from the University of Virginia School of Medicine in 2005. She is a member of the American College of Obstetrics and Gynecology, and served as a Peace Corps volunteer in Mali, West Africa. Dr. Gibson’s professional interests ... Read More
Sarah is board Certified Nurse Midwife who has been faculty at the University of Utah College of Nursing from 2008-2012. After a short leave, Sarah chose to return to Utah to work within the Birthcare Healthcare practice again. Sarah has an active full scope midwifery practice and sees clients at South Jordan Health Center as well as Madsen Health ... Read More
Cara C. Heuser, MD is an Assistant Professor of Obstetrics and Gynecology at the University of Utah Health Sciences Center. She is an attending physician at Intermountain Medical Center in Murray, UT, as well as the UUHSC. She completed her Maternal-Fetal Medicine Fellowship at the University of Utah in 2011. Dr. Heuser's primary area of clinical a... Read More
Calla M. Holmgren, M.D. is an Assistant Professor of Obstetrics and Gynecology at the University of Utah Health Sciences Center where she completed her fellowship in Maternal-Fetal Medicine in 2007. She is board certified in Obstetrics and Gynecology. Her special interests include diabetes, disorders of coagulation, and genetics.... Read More
Marc Jackson, MD is an Associate Professor in the Department of Obstetrics and Gynecology at the University of Utah. Dr. Jackson graduated from UT Southwestern Medical School in Dallas, completed residency in Obstetrics and Gynecology at the University of Texas in San Antonio, and completed his fellowship in Maternal-Fetal Medicine at the Universit... Read More
Felicia Katz, MD., is a Board Eligible physician specializing in Obstetrics and Gynecology. She was born and raised in Eugene, Oregon, then lived in Los Angeles, California for many years while completing her medical training. She received her Bachelor’s degree in Biology from the California Institute of Technology (Caltech), then received her medi... Read More
Toni V. LaMalfa, C.N.M., is a certified midwife. She obtained a bachelor of science degree in nursing, and a master’s degree in nurse midwifery from the University of Utah. She is a member of the Utah chapter of the American College of Nurse-Midwives. LaMalfa specializes in all aspects of women’s health and preventative care, such as abnormal pap s... Read More
Dr. Maclean’s clinical interests include women's health, obstetric care and general gynecology for women of all ages. She is accepting new obstetric patients into our group obstetrical practice and also provides services at the Greenwood University Hospital’s Community Clinic.... Read More
Heather Major, MD is an Assistant Professor in the Department of Obstetrics and Gynecology at the University of Utah, where she completed her fellowship in Maternal-Fetal Medicine in 2010. Dr. Major's research interests include genetic factors which predispose to preterm birth, platelet and immune response in preeclampsia, and perinatal infections.... Read More
Rita Paegle, DNP, MSN, CNM, is a Certified Nurse Midwife at the University of Utah. She received her degree from the University of Utah. Her areas of clinical interest and expertise include international health care, policy, high risk obstetrics, health prevention and promotion, and OB triage. She is also fluent in Spanish.... Read More
Dr. Park was born in Salt Lake City and grew up on a farm in Murray. He graduated from Granite High School. He went to college at the University of Utah and College of Medicine at the University of Utah. He specialized in Obstetrics and Gynecology, completing his residency at Fitzsimons Army Medical Center in Denver, CO. After completing twenty y... Read More
Dr. Pittman is a women's health provider and obstetrician gynecologist in the general obstetrics and gynecology division. Dr. Pittman’s clinical interests include general gynecology for women of all ages, and is accepting new obstetrical patients. She is accepting new patients at the Madsen Health Center for her special clinical interest of pedia... Read More
T. Flint Porter, MD, MPH is an Associate Professor of Obstetrics and Gynecology at the University of Utah Health Sciences Center and Assistant Director of the Fellowship Training Program in Maternal-Fetal Medicine. He joined the Maternal-Fetal Medicine Division in 1997 after completing his fellowship at the University of Utah. He is serving as the ... Read More
|Madsen Health Center||(801) 581-4014|
|South Main Public Health Center||(801) 585-0640|
|South Main Public Health Center
Teen Mother & Child Program
Obstetrics & Gynecology, Clinic 4
|University Neighborhood Partners - Hartland Clinic||(801) 581-4014|
Brandon L. Reynolds, D.O., is a board-certified obstetrician and gynecologist. He received his doctorate degree from Midwestern University’s Arizona College of Osteopathic Medicine in 2000. He is a Fellow of the American College of Osteopathic Obstetricians and Gynecologists. Dr. Reynolds’s professional interests include high risk pregnancy, mini... Read More
Douglas Richards, MD is a Professor of Obstetrics and Gynecology at the University of Utah Health Sciences Center. He is Associate Residency Program Director of the Department of Obstetrics and Gynecology. He completed a fellowship in Maternal-Fetal Medicine at the University of North Carolina in 1987. He is board certified in Obstetrics and Gyneco... Read More
Nancy C. Rose, MD is a Professor of Obstetrics and Gynecology in the Division of Maternal Fetal Medicine at the University of Utah Health Sciences Center. She completed postdoctoral fellowships in Reproductive Genetics and Maternal Fetal Medicine at the University of Pennsylvania. She is a staff physician in the Department’s Diagnostic Imaging Cent... Read More
Howard T. Sharp, M.D. is an obstetrician and gynecologist at the University of Utah Health Sciences Center. Dr. Sharp provides women's health and has a special interest is in the treatment of chronic pelvic pain, and is the head of the Pelvic Pain Clinic located in the Women’s Pelvic Care Center at UUHSC. His other clinical interests include mini... Read More
Robert M. Silver, MD is a Professor of Obstetrics and Gynecology at the University of Utah Health Sciences Center who joined the University of Utah Maternal-Fetal Medicine Division after completing his fellowship there in 1994. He is serving as the Chief of the Division of Maternal-Fetal Medicine and as Co-Director of Labor and Delivery at the UUH... Read More
Marilee Simons, M.D., is a board eligible obstetrics and gynecology physician. She received her bachelor’s degree in biology and chemistry from Carroll College in Helena, Montana, and obtained her medical degree from Creighton University in Omaha, Nebraska. She then completed residency training in obstetrics and gynecology at the University of Utah... Read More
|Eccles Primary Children’s Outpatient Services Building||(801) 662-1000|
Dr. Andrea N. Smith is an experienced physician specializing in women's healthcare as an Obstetrician/Gynecologist. She earned an undergraduate degree in Business Finance at the University of Colorado. She then went on to complete her medical degree at the University of Colorado Health Sciences Center. After completing medical school, Dr. Smith com... Read More
Amy E. Sullivan, MD has been an Assistant Professor of Obstetrics and Gynecology at the UUHSC since completing her Maternal-Fetal Medicine Fellowship there in 2003. She is board certified in Obstetrics and Gynecology and in Maternal-Fetal Medicine. Her interests include multiple gestations and maternal cardiac disorders in pregnancy; however, Dr. S... Read More
Trece Swanson, DNP, CNM is a Certified Nurse Midwife at the University of Utah. She received both a Master of Science (MS) degree and a Doctorate of Nursing Practice (DNP) degree from the University of Utah. She is a board certified nurse-midwife, and a member of the Utah Chapter of the American College of Nurse-Midwives. She has 16+ years of ex... Read More
Dr. Thompson works as an obstetrician and gynecologist for the institution. Dr. Thompson's clinical interests include adolescent medicine, contraception, and menopausal care. Dr. Thompson is available for gynecologic consultations and new obstetrical patients. Dr. Thompson's research interests include: emergency contraception, novel contraceptive d... Read More
Walter Townson, MD, is a board-certified physician specializing in obstetrics and gynecology. He received his undergraduate degree from Brigham Young University, and his medical degree from the University of Texas Southwestern. Dr. Townson is a fellow of the American College of Obstetrics and Gynecology and currently serves as clinical associate pr... Read More
Dr. Trauscht- Van Horn is a women's health provider in the University of Utah Department of Obstetrics and Gynecology and is the Clinical Director of the Obstetrics and Gynecology Women’s Health and Breast Care Clinic. She also serves as the Medical Director for Planned Parenthood of Utah and is the Clinical Supervisor for the Salt Lake Sexual Assa... Read More
David Turok, M.D., is an Associate Professor in the University of Utah Department of Obstetrics and Gynecology, and is board certified in Obstetrics and Gynecology and Family Practice. His areas of clinical interest and expertise include all aspects of women's healthcare, particularly family planning.... Read More
Michael W. Varner, MD joined the Department of Obstetrics and Gynecology in 1987 and currently serves as Professor and Vice-Chair for Research. He developed the Obstetrics and Gynecology Research Network, a consortium of over 50 research personnel who conduct and administer the many clinical trial networks - both obstetric and gynecologic - in whic... Read More
A Team of Doctors Helps a Young Family Defy Odds
It was the day they had waited for—an ultrasound was going to reveal whether their baby would come home in a pink or blue blanket. But after learning they would be the parents of baby boy, Frank and Julia Wentz were told he had multiple heart tumors. “It was our worst fear becoming a reality,” says Julia.
A follow-up fetal echocardiogram confirmed he had rhabdomyomas, or non-cancerous tumors that consumed nearly the entire left ventricle on his heart. “The doctor said the tumors were the largest he had seen in more than 20 years.”
Some doctors suggested a heart transplant was the best option, others said a transplant was too risky. But after further review in a care conference that included a cardiologist, heart transplant team, a genetics counselor, and Dr. Janice Byrne—a University Hospital high-risk pregnancy specialist who cared for Julia during her pregnancy—they determined the baby had a rare genetic disease that would not require surgery. The U physicians diagnosed the unborn child with Tuberous Sclerosis Complex (TSC).
TSC is a devastating genetic disorder affecting more than 1 million people worldwide, including 50,000 in the United States. Generally diagnosed during childhood, TSC causes benign tumors to form throughout the body, including in the brain, eyes, skin, heart, kidneys and other vital organs. Although relatively unknown, it is the primary genetic cause of epilepsy and autism spectrum disorder.
Once their son, whom they named Gabriel, was born, he was immediately admitted into the newborn intensive care unit (NICU) at University Hospital. Additional MRI’s revealed Gabriel also had tumors in his brain, which would cause infantile seizures.
Immediately, the little boy with the full-head of black hair won the hearts of the doctors and nurses at the hospital. “It was amazing to see how much they genuinely cared about Gabriel,” Frank says, “like he was their own.” Doctors became familiar with Julia and Frank, too. Nurses would stop to chat with the couple in the hallways, concerned about their welfare as much as Gabriel’s. “It was simple questions like ‘how are you doing?’ that made the difference,” says Julia.
Gabriel’s doctors worked together to prescribe the most effective medicines to treat his tumors and seizures. “We didn’t want our baby to spend another night away from home,” says Julia. “So his doctors and nurses made sure he was out of the NICU and home in time for Christmas.”
Doctors initially gave their baby four months to live, but with exceptional care and attention, Gabriel is defying odds. “Doctors call him their miracle baby,” she says.
Now, just a few months shy of celebrating his second birthday, Gabriel has been seizure free for more than a year and doctors at University Hospital expect him to thrive as he continues to live with TSC. The Wentz family maintains an active relationship with University doctors, engaging in new treatment options that fit Gabriel’s prognosis.
Through it all, Julia and Frank say they’ve felt the support of the caregivers at University Hospital. “They made sure we were well informed and that we never felt alone,” Julia says. “It’s a blessing to know we have a family of doctors we can trust.”
- SPTB Microbiome
Keywords: Preterm Labor, Preterm Birth, Early Delivery
- Predictors of Pregnancy Outcome: Biomarkers in Anti-Phospholipid Antibody Syndrome (APS) and Systemic Lupus Erythematosus (SLE) (PROMISSE)
Keywords: Pregnant, Lupus in Pregnancy, SLE, APL
- Physical Activity During Pregnancy
Keywords: Physical Activity during Pregnancy, Pregnancy , Physical Activity, Exercise during pregnancy
- Vaginal Dryness Ring - VR101 Pilot Study
Keywords: Vaginal dryness, Vaginal moisturization, Post-menopausal symptoms, Peri-menopausal symptoms
- The Healthy Start for My Baby Study
Keywords: Women's Health, Gestational Diabetes
Keywords: Copper IUD, Non Hormonal IUD
Keywords: Hypertension and pregnancy, High blood presssure and pregnancy
Status: Not yet recruiting
- A Phase 3, Multi-Center, Open-Label Study of a Levonorgestrel-Releasing Intrauterine System for Long-Term, Reversible Contraception
Keywords: Long Term Birth Control, Birth Control, IUD
- In-hospital Post Partum Implant and IUD Tracking
Keywords: Contraception, IUD, Family Planning, Nexplanon, Inplanon
- A Randomized Trial of Fetal ECG ST Segment and T Wave Analysis as an Adjunct to Electronic Fetal Heart Rate Monitoring (STAN)
Keywords: Pregnant, Labor and Delivery, Full Term Pregnancy
- Pregnancy Loss Microarray
Keywords: Pregnancy Loss, Microarray, Genetic abnormalities
Status: Active, not recruiting
- BLIS Study
Keywords: breastfeeding, Mirena , IUD, Postpartum
- Optimizing Postpartum Contraception
Keywords: Postpartum, Contraception, Premature, Preterm births
Status: Active, not recruiting
- GAS - Maternal Morbidity
Keywords: G.A.S. maternal morbidity
Status: Active, not recruiting
Keywords: Pregnant, Preterm Birth
- Understanding Placenta Accreta
Keywords: Placenta Accreta, Accreta
- BPA - Female Fertility
Keywords: environmental toxins and female fertility
Keywords: Fertility, reproductive medicine, pregnancy outcomes, folic acid and zinc supplementation trial, semen quality, infertility
- Co-Collection Study
Status: Enrolling by invitation
Keywords: Prenatal Care, Pregnancy, Telemedicine, Low-risk, Obstetrics, Ob/Gyn
- A Randomized Trial of 17 Alpha-Hydroxyprogesterone Caproate for Prevention of Preterm Birth in Nulliparous Women with a Short Cervix (SCAN)
Keywords: Preterm Birth
Status: Active, not recruiting
- Pregnancy Loss Database and Tissue Bank
Keywords: recurrent pregnancy loss, miscarriage
Status: Enrolling by invitation
- Salt Lake Refugee Reproductive Health Project
Keywords: Refugee Reproductive Health
Status: Not yet recruiting
- GAS - Registry
Keywords: Puerperal Group A Streptococcal Sepsis
- Long-term Follow Up of Daughters of Kidney Transplant Patients
Keywords: Confirm safety of immunosuppressive agents during pregnancy or to identify any unrecognized health or reproductive problems in daughters of kidney transplant patients.
Keywords: Maternal Fetal Medicine, High Risk Pregnancy, NST, Non Stress Tests
- (TRIBE) IUD Bleeding Assessment
Keywords: IUD, Contraception, Family Planning
- Vaginal Cuff Closure
Keywords: Laparoscopic hysterecetomy
Status: Enrolling by invitation
Keywords: Pregnant, Cytomegalovirus, CMV, Infection in pregnancy
- NICHD Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be (NuMoM2b)
Keywords: Pregnant, First Pregnancy, First Time Moms
Status: Active, not recruiting