AI Scribe for Neonatologists
Daily NICU progress notes, admission H&Ps, discharge planning, family meetings, and delivery-room resuscitation — documented in seconds. PatientNotes captures corrected gestational age, ventilator settings, feed advancement, and growth trajectory, then maps them to the right CPT and ICD-10 codes.
Documentation for Every NICU Encounter
From a 5-minute stable-feeder progress note to a 45-minute family meeting, PatientNotes uses the right structure for the encounter.
NICU Daily Progress
Captures CGA, BW + current weight/length/HC, vent settings (mode, FiO2, PEEP, PIP, RR, Vt), feeds (TPN+lipids vs trophic vs full enteral), labs (CBC, BMP, blood gas, bilirubin), and the active problem list.
Discharge Planning
Goes-home checklist: car seat tolerance trial, hearing screen, CCHD pulse oximetry, immunizations, hep B vaccine, RSV (palivizumab/nirsevimab) eligibility, follow-up clinic appointments, and parental teaching.
Family Meeting
Goals-of-care discussion, prognosis sharing, redirection-of-care decisions, palliative-care consult notes, and structured documentation of who was present, language interpreter, and decisions reached.
Resuscitation Documentation
Delivery room note with NRP steps performed (warm/dry/stimulate, PPV, intubation, chest compressions, epinephrine), Apgar 1/5/10, time to first breath, cord gases, and admission temperature.
F/U Clinic Visit
High-risk infant follow-up after NICU graduation: corrected-age developmental milestones, weight catch-up, feeding tolerance, ophthalmology (ROP), audiology, and EI referral status.
Multidisciplinary Round
Structured rounds note that captures input from the bedside RN, RT, dietitian, pharmacy, and lactation consultant — and assigns the next 24-hour plan by problem.
Neonatology-Specific Features
Built around the language a working neonatologist actually uses — not generic medical English.
Corrected Gestational Age
Calculates and tracks CGA across the NICU stay (GA at birth + days/weeks of life), reconciles with sonographic dating when LMP is uncertain, and flags milestones — 32w CGA for caffeine wean consideration, 34w for oral feeding readiness, 36-37w for discharge planning.
Ventilator Language Fluency
Understands the modes used in the NICU (HFOV, HFJV, NIPPV, BiPAP, CPAP, low-flow NC, room air) and the parameters that go with each — FiO2, PEEP, PIP, MAP, amplitude, frequency, RR, Vt, and Ti — plus weaning strategy and reason for any uptitration.
Feeding & Growth Tracking
Captures feeding strategy (TPN with lipids, trophic feeds, advancing feeds, full enteral with fortifier), volume in mL/kg/day, fortification recipe (HMF or formula concentration), and weight/length/HC trajectory plotted against Fenton or Olsen growth curves.
NICU Med Reconciliation
Knows the NICU medication landscape: caffeine citrate 5 mg/kg/day maintenance after 20 mg/kg load, ampicillin 50 mg/kg q12h plus gentamicin 4 mg/kg q24-48h for early-onset sepsis, surfactant (Curosurf 200 mg/kg or Survanta 4 mL/kg) by ETT, and prostaglandin E1 starting dose for ductal-dependent lesions.
Family Meeting Structure
Documents who was present (parents, grandparents, social work, palliative care, interpreter), the language used, what was conveyed about prognosis, what decisions were made (continued aggressive care, redirection, comfort care), and the agreed next steps.
CPT 99221-99233 / 99291
Suggests initial hospital care (99221-99223), subsequent hospital care (99231-99233 by MDM and time), critical care time (99291 first 30-74 minutes, 99292 each additional 30), discharge management (99238-99239), and the right ICD-10 (P07.30 prematurity, P22.0 RDS, P59.9 jaundice, P22.1 transient tachypnea).
A real day in the NICU, before and after
A typical Level III NICU attending rounds on 12-22 patients in a 12-hour shift. The cognitive load is high — every patient has a corrected gestational age that has to drive the plan, vent settings that change every few hours, feeds advancing or holding, and a family who is in the unit and asking questions. The work that bleeds past the end of the shift is almost never the medicine. It is the daily progress notes (15 to 22 of them), the family-meeting documentation, and the admission H&P for the latest 28-week transfer.
With PatientNotes running on the rounding cart, the bedside discussion looks the same to the team. You talk through the overnight events with the bedside RN and the RT, look at the morning blood gas, decide whether to advance feeds, and update the parents on the apnea-of-prematurity plan. The conversation is the documentation. By the time you move to the next isolette, the daily progress note for the patient you just saw is drafted with the corrected GA, the weight delta, the vent settings, and a clean assessment-and-plan-by-problem.
The model is tuned for neonatology. It knows that a 30-week infant on DOL 18 is at 32w4d corrected GA, that 130 mL/kg/day of fortified breast milk at 24 cal/oz is reasonable for that infant, and that a capillary blood gas of pH 7.36 / pCO2 48 / HCO3 27 is a compensated picture and not an indication for re-intubation. Notes are typically ready 30-90 seconds after rounds on each patient — fast enough to review and sign before you finish the cohort.
Sample AI-Generated NICU Note
An actual DOL 18, CGA 32w4d daily progress note the model would produce. Real meds, real labs, real CPT/ICD mapping.
NICU DAILY PROGRESS NOTE — DOL 18, CGA 32w4d
Date: 04/22/2026 | CPT: 99232 (subsequent hospital care, moderate MDM)
Bed: NICU Pod B-7 | Attending: PatientNotes Clinical Team
PATIENT IDENTIFIERS:
- BG (Baby Girl) Singleton, born 04/04/2026 at 30w0d.
- Birth weight: 1,310 g (50th %ile, Fenton). Length 39 cm. HC 27.5 cm.
- Today: weight 1,485 g (+18 g overnight, +175 g from BW),
length 41 cm, HC 28.5 cm. Following 25-50th %ile growth curve.
- DOL 18, CGA 32w4d.
OVERNIGHT EVENTS (12-hour window):
- One brief desaturation to 84%, self-resolved in <30 sec, no
bradycardia, no apnea requiring stimulation.
- Tolerated 5 mL feed advance to 130 mL/kg/day without vomiting,
abdominal distension, or guaiac-positive stool.
- No new infectious concerns. Temp stable in air-mode isolette.
VENTILATION / RESPIRATORY:
- Currently on low-flow nasal cannula at 0.5 L/min, 25% FiO2.
- SpO2 92-97% throughout the shift, target 90-95% per unit protocol.
- Apnea/bradycardia events: 2 in past 24h, both isolated apnea
events <20 sec, no stimulation needed.
- On caffeine citrate 8.5 mg PO q24h (5.7 mg/kg/day) — therapeutic.
- RR 48-62, mild intercostal retractions when feeding.
- Last blood gas (capillary, 04/21 06:00): pH 7.36, pCO2 48,
HCO3 27, BE +1.2 — compensated, acceptable.
CARDIOVASCULAR:
- HR 138-162, no murmur on today's exam.
- BP 62/38 (mean 46), no inotropic support.
- Echo on DOL 5: small PFO, no PDA, structurally normal.
FEEDS / NUTRITION:
- Mother's expressed breast milk fortified with HMF (24 cal/oz)
at 130 mL/kg/day, advancing 20 mL/kg/day as tolerated.
- Goal feeds 150 mL/kg/day by DOL 21.
- Last residual: 1.5 mL clear, returned. Abdomen soft, non-distended.
- Stool: yellow seedy x3 in 24h, guaiac negative.
- Growth: +12.5 g/kg/day average over past week (target 15 g/kg/day).
- TPN/lipids: stopped on DOL 14 when reached 100 mL/kg/day enteral.
- Multivitamin liquid 1 mL PO daily, ferrous sulfate 2 mg/kg/day
PO daily started DOL 14.
LABS (today, 04/22):
- CBC: WBC 9.2, Hgb 12.4, Hct 37%, Plt 245k. Stable.
- BMP: Na 138, K 4.6, Cl 104, HCO3 26, BUN 8, Cr 0.4, Ca 9.8.
- Bilirubin: total 4.8, direct 0.3 — off phototherapy since DOL 9.
- Last CRP (04/19): 0.4, negative.
ACTIVE PROBLEM LIST:
1. Prematurity, born at 30w0d, now 32w4d CGA. Resolving.
2. Resolving RDS, off invasive ventilation since DOL 8.
3. Apnea of prematurity — on caffeine, 2 events in past 24h.
4. Anemia of prematurity — Hgb 12.4, asymptomatic, on iron.
5. Resolved hyperbilirubinemia (peak total bili 13.8 on DOL 4).
6. Feeds advancing on schedule.
ASSESSMENT AND PLAN BY PROBLEM:
1. Prematurity / Resp: Continue NC 0.5 L 25% FiO2. If sustained
FiO2 21% on room-air challenge over 24h, trial off NC tomorrow.
Continue caffeine — wean criteria not met (still 32w4d, recent
apnea events).
2. Feeds: Advance to 150 mL/kg/day by DOL 21. Fortifier 24 cal/oz
maintained. Reassess fortification at full feeds.
3. Growth: +12.5 g/kg/day. Discuss fortification escalation with
dietitian if growth velocity drops below 12 g/kg/day x 2 days.
4. Anemia: Continue iron. No transfusion criteria met (Hgb 12.4,
no respiratory support beyond NC). Recheck CBC in 5 days.
5. Family: Mother room-in tonight, plans first kangaroo care
session today. Lactation consult to follow-up later.
6. Discharge planning: target 36-37w CGA, ~3 weeks from today.
Hearing screen, CCHD, ROP exam scheduled at 31w CGA done.
Car-seat tolerance trial when stable on room air.
Critical care time today: 0 minutes. E&M time at bedside: 28 minutes
(rounding, exam, family update, order entry).
Suggested CPT: 99232 (subsequent hospital care, moderate MDM,
25-min typical time, met).
Suggested ICD-10: P07.30 (preterm <37w), P22.0 (RDS resolving),
P28.4 (apnea of prematurity), P61.2 (anemia
of prematurity), Z38.00 (liveborn infant).Intelligent ICD-10 Suggestions
The codes most NICUs bill on a daily basis — surfaced from the documentation, not guessed.
P07.30Preterm newborn, unspecified weeks of gestationP07.21Extreme immaturity of newborn, gestational age less than 23 completed weeksP22.0Respiratory distress syndrome of newbornP22.1Transient tachypnea of newbornP59.9Neonatal jaundice, unspecifiedP36.9Bacterial sepsis of newborn, unspecifiedZ38.00Single liveborn infant, delivered vaginallyP77.9Necrotizing enterocolitis in newborn, unspecifiedThe AI suggests relevant codes based on what you actually documented. You review and confirm — there is no auto-billing.
Neonatologists using PatientNotes today
Three composite stories drawn from real onboarding interviews. Names changed, details preserved.
Dr. Naveen Kapoor
Solo neonatologist coverage, Level III community NICU, Bend OR
Naveen covers a 22-bed Level III on a 7-on/7-off schedule with one NNP. Before PatientNotes he was finishing daily progress notes between 8 and 11 PM at home, with notes for the day still open in Epic. He runs PatientNotes on the workstation cart at the isolette, and the corrected-GA, weight delta, and ventilator settings are pulled into the daily note. He pastes into Epic, signs, and is done before he leaves the unit. The $50/month price meant the hospital did not need to approve it through procurement.
Dr. Aisha Brennan
NICU group, 6 attendings + 4 NNPs, Level IV regional center, Cleveland OH
Aisha's group was quoted around $6,200 per clinician per year by Nuance for DAX. The group piloted PatientNotes for 30 days and the NNPs in particular pushed to keep it. They built a shared template for the daily note that orders problems by system the way their unit prefers. The group also uses the family-meeting template — every meeting is now documented with who was present, the interpreter, and the decision reached, which has reduced compliance findings on chart audits.
Dr. Reyna Otieno
Hospital-employed academic neonatologist, large university system, Atlanta GA
Reyna's system has Nuance DAX rolled out for primary care but had not extended it to the NICU when she joined faculty. She uses PatientNotes for her continuity NICU follow-up clinic, where each visit is short and the documentation is repetitive (corrected-age developmental milestones, weight catch-up, ophthalmology follow-up). She pastes the structured note into Epic and saves about 90 minutes a day. Her division now lets fellows trial PatientNotes during their NICU follow-up rotation.
Coming from Microsoft Dragon Medical One?
Dragon Medical One has been the dictation standard in hospital medicine for two decades, and many neonatologists are extremely fast with it. The newer Microsoft Dragon Copilot adds ambient capture on top. Both are real products — but the workflow is different from PatientNotes.
Dragon Medical One
- •Dictation: you talk to the microphone, the words appear in the EHR.
- •Mature voice profile — 99% accuracy after a few weeks of training.
- •$99-$200/month per clinician for Dragon Medical One; Dragon Copilot adds ambient at higher tiers.
- •Strong Epic / Cerner / Meditech integration via the Dragon plug-in.
- •You still write the note structure; Dragon just types it for you.
PatientNotes
- •Ambient: you talk to the bedside team and the parent, the note writes itself.
- •No voice training. Works on day one.
- •$50/month flat — no per-encounter fees, no enterprise minimums.
- •No EHR integration required — copy/paste workflow, ready in hours.
- •Generates the daily progress, family-meeting, and discharge structures for you.
How to switch in three steps
Sign up and run a parallel shift
For one full rounding shift, record bedside discussions in PatientNotes while still using Dragon as your primary. Compare the two notes side by side at the end of the shift — most neonatologists pick a Tuesday rounding day with a mix of stable and complex patients.
Customize one NICU template
Pick your highest-volume note type (most NICU teams pick the daily progress note) and customize it so the assessment-and-plan-by-problem section matches your unit's convention.
Cancel Dragon when you are ready
Most neonatologists are off Dragon within 5-7 days. Keep it as a backup for the first month if you want — they do not conflict.
PatientNotes vs Nuance DAX
Nuance DAX (now part of Microsoft Dragon Copilot) is the enterprise AI scribe most often pitched to NICU groups inside large academic systems. We have lost deals to DAX and we have won deals against DAX. Here is the honest read.
| Feature | PatientNotes | Nuance DAX |
|---|---|---|
| Monthly price (per clinician) | $50 | $250-$400 |
| Setup time | Same day | 4-12 weeks |
| Contract | Month-to-month | Typically 12-month minimum |
| NICU templates | Daily progress, admission H&P, discharge, family meeting, delivery room, F/U clinic | Available, often custom-built per practice |
| Corrected-GA tracking | Yes | Yes |
| Ventilator language fluency | Yes | Yes |
| Epic write-back integration | Copy/paste | Direct (App Orchard) |
| Best fit | Solo, community NICU, mid-size group, 1-25 clinicians | Large academic system already in Epic ecosystem |
If your hospital has already paid for DAX and integrated it into Epic, use that — the marginal benefit of switching is small. If you are a community-hospital neonatologist or a mid-size group buying directly, PatientNotes is almost always the right answer. The price difference alone funds an additional shift of NNP coverage in many groups.
Frequently Asked Questions
Real questions from neonatology onboarding calls.
Does PatientNotes work for neonatology?
Yes. PatientNotes is used by neonatologists, neonatal nurse practitioners, and NICU fellows. The model is tuned for neonatal language, so it correctly captures corrected gestational age (CGA = GA at birth + chronologic age in weeks), birth weight in grams along with current weight and length and head circumference, ventilator settings (mode, FiO2, PEEP, PIP, RR, Vt), feeding strategy (TPN with lipids vs trophic feeds vs full enteral, plus fortifier), and standard NICU medications including caffeine citrate at 5 mg/kg/day maintenance and ampicillin/gentamicin sepsis dosing.
How much does an AI scribe cost for neonatology?
PatientNotes is $50 per clinician per month, billed monthly with no per-encounter fees. Nuance DAX (now part of Microsoft Dragon Copilot) and similar enterprise scribes typically run $250-$400 per clinician per month for hospital-based specialties like neonatology, often with a 12-month enterprise contract and an implementation fee. For a NICU group of 8 attendings and 6 NNPs, the difference is roughly $25,000-$45,000 per year.
Is Nuance DAX better than PatientNotes for neonatology?
DAX is a mature enterprise product with deep Epic integration, which matters when your hospital has already standardized the entire system on it. PatientNotes is materially cheaper, deploys in hours instead of weeks, and produces equivalent-quality NICU progress notes including the correct corrected-GA calculation, ventilator settings, and growth tracking. If your hospital has already paid for DAX, use what your system pays for. If your group is buying directly or piloting on its own, PatientNotes is usually the better fit.
Can NICU-specific notes be auto-generated?
Yes. PatientNotes ships with NICU templates for daily progress notes, admission H&P, discharge planning, family meetings, resuscitation/delivery room documentation, and follow-up clinic visits. You can also build custom templates that mirror your NICU style — for example, a structured daily note that always lists CGA, weight trend, vent settings, feeds, fluids, and the active problem list in the same order so the bedside RN and the daytime team can scan it quickly.
Does it integrate with Epic for NICU documentation?
PatientNotes works alongside Epic (including Epic Stork for L&D-NICU handoff), Cerner, Meditech, and CPSI. The note is generated in PatientNotes and pasted or copied into your EHR using a one-click copy. We do not require a write-back integration, which is what lets us deploy in a day instead of the 6-12 weeks an Epic App Orchard integration takes for hospital documentation. Most NICUs paste the daily note into the Epic NICU navigator and the growth-chart fields update from your structured weight/length/HC entries.
Will it help me bill NICU CPT correctly?
PatientNotes suggests inpatient hospital codes including 99221-99223 (initial hospital care), 99231-99233 (subsequent hospital care, choose level by MDM and time), 99238-99239 (discharge day management), 99291-99292 (critical care, time-based for unstable infants), and 99466-99467 (interfacility transport). It surfaces the right E&M level based on the documented complexity and the cumulative time you reported. It does not auto-bill — you review and confirm each code, which is the safe and audit-defensible pattern, especially for time-based critical-care billing.
How do I switch from Dragon Medical One to PatientNotes?
Three steps. First, sign up at patientnotes.ai and complete the 5-minute clinician onboarding. Second, run PatientNotes in parallel with Dragon for one rounding shift — record the bedside discussion in PatientNotes, then dictate with Dragon as you normally would. Compare the two notes and decide which feels closer to your style. Third, when ready, retire Dragon. Most neonatologists make the switch in under a week. Dragon is dictation; PatientNotes is ambient — you stop talking to a microphone and just talk to the bedside team and the parent at the isolette.
Is it HIPAA compliant for neonatology?
Yes. PatientNotes is HIPAA compliant, signs a Business Associate Agreement (BAA) with every hospital on request, and encrypts audio and notes at rest and in transit. Audio is processed and discarded — we do not retain recordings beyond the time needed to generate the note. Patient identifiers are minimized in the prompt sent to the language model. We do not train models on your data. This matters in NICU where charts include sensitive perinatal history and parental factors.
Round on more isolettes. Finish notes before the end of shift.
Neonatologists on PatientNotes save 90 minutes to two hours of charting per shift, which is the difference between leaving on time and signing 22 progress notes from home at 10 PM.
No credit card required. $50/month after trial. Cancel anytime.