Seven in the evening. Twelve hours. A unit full of babies, and you are the one they call.
What this is
A shift in a neonatal intensive care unit, simulated properly. Every baby has a real
body underneath: lungs that stiffen, a gut that tires, an infection that grows while you
are looking somewhere else. You never see that hidden state directly. You see monitors,
which sometimes lie, and a baby, who never does.
Nurses will bring you problems. Parents will ask you questions you cannot answer easily.
The pharmacist will query your dose, and they will be right to. Somewhere in the small
hours the delivery room will call.
Choose your level
Your preference; the level never changes this.
How to play
The unit view shows every bed at once: the baby, the monitor numbers, and what
support they are on. A bed glowing amber wants a look. A bed glowing red wants you now.
Click any bed to go to the bedside. Esc comes back,
1–6 jump between beds,
space pauses.
Time is the real resource. Every action costs minutes: examining a baby is five,
intubating is fifteen, an echo takes the best part of an hour to come back. While you are
doing one thing you are not doing another.
You do not set the clock — where you are does. Beside a baby it walks: one real
second is half a minute of the night, so there is room to look and think. Standing in a
quiet unit it builds and runs on, which is how you get through the hour an echo takes;
the top bar tells you when it is doing that. It stops building the moment a baby goes red
or somebody has asked you twice, and a decision on screen stops it dead. Pause whenever
you want — space, or the button — there is no penalty for thinking.
Look at the baby. The picture at the bedside is not decoration. Colour, effort,
posture and whether the eyes are open all come from the same hidden state the monitor is
sampling — and the monitor has artifacts. A probe that has slipped off a foot will read 74
percent on a baby who is pink and wriggling. Turning up the oxygen would be the wrong answer.
Most alarms are handled for you. The nurses are experienced. They will stimulate a
baby through a spell without being asked, and they titrate the oxygen themselves to hold each
baby in the target range — up quickly when a baby needs it, down slowly afterwards. Your
job is not to chase every beep, it is to notice the pattern: why is this baby having more
spells tonight than yesterday?
What you inherit is not always what a baby needs. Somebody will usually be on a
ventilator when you walk in, on settings that crept up over the last two days and that nobody
has been back to since. Peak pressure costs lungs, and a rate wound up too far blows the
carbon dioxide down and clamps the vessels in the brain. Weaning is the job.
So watch the oxygen as a symptom, not a setting. A number that has crept up over the
night is the earliest thing this unit will show you, and it means something has changed in the
lungs. Each nurse will go so far on her own and then come and find you, because past that point
what a baby needs is a decision, not another adjustment.
Asking for help is scored as a good move, because it is one.
At the end you get the truth. Every baby's hidden diagnosis is revealed, along with
what actually happened, what you did well, and what you would want to do differently. That
debrief is the real point of the game.
A note for grown-ups
The medicine here is simplified but not invented: the oxygen targets, the pressure limits,
the glucose infusion rate formula, the Apgar scoring, the sepsis and NEC and pneumothorax
stories all behave roughly the way they do in a real unit. The game takes mortality seriously
rather than hiding it — a baby can die, but only after a sustained crisis that was ignored,
and it is handled with a debrief rather than a game-over screen. If you would rather that not
happen at all, untick the box above.