The Neonatal Intensive Care Unit at Seattle Children’s Hospital has 48 Level IV beds and additional acute care beds for convalescing infants. The Seattle Children’s NICU admits critically ill neonates from a multi-state area including Washington, Wyoming, Alaska, Montana, and Idaho, requiring a higher level of subspecialty and multidisciplinary care. Common diagnoses include congenital diaphragmatic hernia, necrotizing enterocolitis, meconium aspiration syndrome, bronchopulmonary dysplasia, gastroschisis, perinatal infection, persistent pulmonary hypertension, myelomeningocele, life-threatening malformations, genetic diagnoses, and hypoxic-ischemic encephalopathy. Services provided include extracorporeal membrane oxygenation (ECMO), therapeutic hypothermia, continuous renal replacement therapy (CRRT), hemo- and peritoneal dialysis, pediatric medical and surgical subspecialty consultation. Fellows play a key role in accomplishing the clinical mission and rotate between teams for service. On call they aid in supporting all the patients and admissions. Dedicated occupational and physical therapists provide feeding and developmental care to NICU patients. NICU discharge coordinators collaborate with the NICU team and families to safely transition patients to their homes.