All expectant parents hope that their babies will be healthy.
Yet sometimes problems arise that require a newborn to be
hospitalized. When this happens, the baby may be admitted to the
neonatal intensive care unit
(
NICU
) for treatment.
It's almost always stressful when a baby is unexpectedly
admitted to the NICU. But the doctors, nurses, and other caregivers
in the unit will do their best to provide emotional support for you
while caring for your infant's medical needs.
About the NICU
With equipment designed for infants and a hospital staff who
have special training in newborn care, the NICU is an intensive
care unit created for sick newborns who need specialized
treatment.
Sometimes the NICU is also called:
- a special care nursery
- an intensive care nursery
- newborn intensive care
Babies may be sent to the NICU if:
- they're born
prematurely
- difficulties occur during their deliveries
- 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 they'll remain in the unit depends
on the severity of their illness.
Although not all babies in the NICU have the same illness or
condition, some diagnoses are common to newborns who need intensive
care.
Here's a brief look at those conditions, what causes them,
how they're diagnosed, how they're treated, and how long
infants usually stay in the unit after they've been
diagnosed.
Anemia
What is it?
One of the more common blood disorders,
anemia
is a low number of red blood cells in the blood. Babies who are
anemic may:
- have apnea (stop breathing for 20 seconds or more)
- have low blood pressure
- have a high heart rate
- seem sleepy
What causes it?
Premature infants may develop anemia for a number of reasons. In
the first few weeks of life, infants don't make many new red
blood cells. Also, their red blood cells have a shorter life than
an adult's. And the frequent blood samples that must be taken
for laboratory testing make it difficult for red blood cells to
replenish.
In full-term or preterm infants,
hemolytic disease of the newborn
(incompatibility between the blood types of the mother and baby)
can lead to anemia.
How is it diagnosed?
A doctor can diagnose anemia with a
blood test
.
How is it treated?
Minor cases are monitored closely, whereas severe cases
(especially in those premature babies who weigh less than 2.2
pounds [1,000 grams]) may require red blood cell transfusions.
Doctors also try to treat the underlying cause of the anemia.
How long will my baby be in the NICU?
By the time the underlying problem has been treated, the number
of red blood cells in the infant's circulation stabilizes. As
long as the baby is doing well and no longer has symptoms, then the
doctors usually let the infant go home with close follow-up with
the child's doctor.
Apnea
What is it?
Although it's perfectly normal for everyone to experience
occasional pauses in breathing, newborns who don't take at
least one breath in 20 seconds or more have a condition called
apnea
. During an apnea spell:
- the baby stops breathing
- the heart rate may decrease
- the skin may turn pale, purplish, or blue from lack of
oxygen
What causes it?
Apnea is usually caused by immaturity in the area of the brain
that controls the drive to breathe (the brain doesn't
"remember" to take a breath), although illness can also
be responsible. Almost all babies born at 30 weeks or less will
experience apnea, but apnea spells become less frequent with
age.
How is it diagnosed?
To accurately diagnose apnea, doctors monitor a baby's
breathing rate in the NICU and may order a polysomnogram, which
involves attaching the baby to several monitors and observing the
infant for about 8 to 12 hours. The pneumogram provides information
about the baby's heart rate, breathing, and oxygen saturation
in the blood.
How is it treated?
In the NICU, all premature babies are monitored for apnea
spells. The first line of treatment for apnea is simply stimulating
the baby to help him or her remember to breathe. This can mean
rubbing the infant's back or tapping the feet. However, when
apnea occurs frequently, the infant may require medication (most
commonly caffeine or theophylline) and/or a special nasal device
that blows a steady stream of air into the airways to keep them
open.
How long will my baby be in the NICU?
Babies remain in the unit until they've been apnea-free for
24 to 48 hours. Some may go home with an apnea monitor and on
caffeine so parents can continue to watch for the condition. Many
babies outgrow apnea by the time they're 10 weeks past their
original due date.
Bradycardia
What is it?
This is an abnormal slowing of the heart rate.
What causes it?
Bradycardia often arises from other problems like low oxygen
levels in the blood or apnea.
How is it diagnosed?
Taking the baby's pulse and monitoring in the NICU will
confirm a diagnosis of bradycardia.
How is it treated?
Bradycardia is treated by dealing with the underlying cause,
such as apnea. In some rare cases, a heart defect may be
responsible for the slower heart rate. For the appropriate care,
babies with a heart defect need to see a pediatric cardiologist (a
doctor who specializes in treating heart problems in children).
How long will my baby be in the NICU?
Usually, the length of the stay is determined by the condition
causing
the bradycardia,
not
the bradycardia itself.
Bronchopulmonary Dysplasia (BPD)
What is it?
Babies who still need oxygen at 4 weeks before their original
due date are considered to have
bronchopulmonary dysplasia
- one of the most common chronic lung diseases in infants in the
United States.
What causes it?
Bronchopulmonary dysplasia occurs in different infants for
different reasons. It can happen in full-term as well as premature
infants and doctors believe that it's due to an individual
infant's response to a number of possible factors.
The combination of the premature baby's immature lungs and
the treatments (including machines and oxygen) to help the little
one breathe is thought to cause damage (or scarring) to the lungs.
Infections and pneumonia can also lead to the condition. Milder
levels of damage are called
chronic lung disease of prematurity
(CLD)
. As the babies mature, they grow more lung tissue, which can
improve their breathing over time.
How is it diagnosed?
The diagnosis of bronchopulmonary dysplasia usually doesn't
occur until 2 to 4 weeks into the infant's life. At that point,
the doctors make a diagnosis based on whether there was lung damage
or an injury at birth and whether the infant has needed extra
oxygen for a prolonged period of time. Chest X-rays can also help
determine the extent of the lung damage.
How is it treated?
Bronchopulmonary dysplasia is sometimes treated with steroids to
decrease the amount of scarring. However, because steroids can
cause side effects, doctors usually wait as long as possible to
begin steroid treatment. Steroids are never used without a complete
discussion with the family as to potential benefits and risks.
Other, more commonly used medicines include diuretics (which
make the child urinate, or pee, and help eliminate excess fluid
that can build up in the damaged lungs) and bronchodilators (which
relax the muscles that surround the airways and allow them to open
up).
Babies with the disease also sometimes need ventilators
(breathing machines) at home to help them breathe. And although
it's uncommon, in severe cases, the surgical insertion of a
breathing tube in the neck (called a tracheostomy) may be required
so the baby can go home on a ventilator. Occasionally, babies need
home oxygen therapy for several months.
How long will my baby be in the NICU?
Bronchopulmonary dysplasia is a serious condition that calls for
longer stays in the NICU, sometimes up to several months. The
smallest infants are usually the ones who develop the disease, so
their stays are longer to make sure they're stable before
they're discharged.
Hydrocephalus
What is it?
Hydrocephalus means "water on the brain."
What causes it?
A buildup of cerebrospinal fluid that surrounds the brain and
the spinal cord causes hydrocephalus. It occurs when something -
often bleeding from an intraventricular hemorrhage (see below) or
an abnormality of the brain or skull - blocks the flow of the
fluid. The buildup can create pressure that can damage the
brain.
How is it diagnosed?
Doctors suspect hydrocephalus if a baby has a particularly large
head or if head size increases rapidly. A computed tomography (or
CT scan - a type of X-ray) can confirm this suspicion.
How is it treated?
Less serious cases are usually simply monitored, but more severe
ones require a surgeon to place a tube in the brain (called a
ventriculoperioneal shunt, or VP shunt) that drains the fluid from
the brain into the abdomen.
How long will my baby be in the NICU?
Again, this depends on the severity of the case. A serious
condition may require a stay of several weeks or months, with later
monitoring so as to recognize potential long-term side effects like
mental retardation and
seizures
.
Intraventricular Hemorrhage (IVH)
What is it?
Intraventricular hemorrhage is bleeding in the brain. Severe
cases may cause a drop in blood pressure or seizures. Other
symptoms could include:
- a weak suck
- high-pitched cry
- apnea
- bradycardia
- anemia
What causes it?
IVH usually occurs in premature babies because the vessels in
their developing brains are especially fragile and can bleed
easily.
How is it diagnosed?
It's diagnosed with an ultrasound of the head so that
doctors can look for collections of blood in the brain.
How is it treated?
There's no specific treatment for intraventricular
hemorrhage, so NICUs try to prevent it by controlling babies'
blood pressure. Once diagnosed, the problem is closely monitored
with frequent ultrasounds. If serious, IVH leads to severe
hydrocephalus, which can be treated with a surgically placed
shunt.
How long will my baby be in the NICU?
This depends on the severity of the bleeding. Infants with
serious cases may spend several weeks to months in the NICU and be
at risk for conditions like
cerebral palsy
or seizures later in life.
Jaundice
What is it?
Jaundice
is a high level of bilirubin in the blood (bilirubin is a byproduct
of the natural breakdown of blood cells, and the liver usually
"recycles" it back into the body). Although mild jaundice
is fairly common in full-term babies, it's much more common in
premature babies.
What causes it?
Jaundice occurs when a baby has increased blood cell breakdown
and the liver can't handle the extra bilirubin, which builds
up, giving the skin and the whites of the eyes a yellowish color.
Babies with jaundice are sometimes more sleepy than usual and, in
severe cases, may be lethargic.
How is it diagnosed?
Although the yellow skin is a fairly good indicator, a diagnosis
is made with a blood test to measure the bilirubin level.
How is it treated?
Extremely high levels of bilirubin can cause brain damage, so
infants are monitored for jaundice and treated quickly, before
bilirubin reaches dangerous levels. Standard treatment includes
providing adequate fluids and light therapy, in which the baby
spends time under a special blue-colored light. Some cases may also
require a blood transfusion.
How long will my baby be in the NICU?
Babies with this condition stay in the NICU until their
bilirubin level drops, usually in about 2 to 3 days.
Necrotizing Enterocolitis (NEC)
What is it?
The most common intestinal condition in newborns,
necrotizing enterocolitis
occurs in about 1% to 5% of infants in the NICU and happens more
commonly in low birth weight and premature infants.
What causes it?
It's thought that a number of factors can contribute to the
development of NEC, which is the necrosis, or death, of parts
of the intestine.
Although a full-term infant can get the condition, the more
premature a baby is, the greater the risk for NEC - perhaps because
the intestines aren't developed enough to handle digestion.
Factors that are also believed to contribute include the
introduction of milk feeding, damage to the intestines from an
infection, and poor blood flow.
Babies with NEC may:
- have a tender or tense abdomen
- need more oxygen or higher ventilator settings
- have blood in their bowel movements
- exhibit signs of apnea
How is it diagnosed?
An X-ray of the abdomen confirms the diagnosis.
How is it treated?
If there's no sign of a rupture in the intestines, doctors
treat necrotizing enterocolitis by:
- giving antibiotics
- stopping all intestinal feeding (such as formula feeding,
breastfeeding, or using a feeding tube)
- switching to an IV
- draining the baby's stomach
- performing regular abdominal X-rays
In the case of an intestinal rupture, a surgeon may remove the
diseased section of the intestine or make an incision in the
abdomen to allow the infected fluid to drain.
How long will my baby be in the NICU?
Recovering from NEC can take a long time. Babies may spend many
weeks in the NICU readjusting to regular feeding.
Patent Ductus Arteriosus (PDA)
What is it?
The ductus arteriosus (DA) is a blood vessel in the heart that
connects the aorta (which provides blood to the rest of the body)
to the pulmonary artery (which sends blood to the lung). It allows
blood to bypass the lungs while a baby is still in the womb.
What causes it?
The ductus arteriosus usually closes shortly after birth, which
allows for normal blood circulation. But in some babies, most often
premature ones, it remains open, or patent. Then blood flows
through the ductus arteriosus and floods the vessels in the lungs,
causing respiratory problems.
How is it diagnosed?
Those breathing problems are one clue that a baby has PDA. A
heart murmur may also lead doctors to suspect the condition, which
is then confirmed with an ultrasound of the heart.
How is it treated?
Sometimes doctors can close the ductus arteriosus by
administering medicine. But if that doesn't work, or if the
baby is too sick to take the medicine, the infant will need surgery
to close it.
How long will my baby be in the NICU?
Although recovery time varies from child to child, many babies
bounce back from PDA treatment in several days.
Periventricular Leukomalacia (PVL)
What is it?
A type of brain injury, periventricular leukomalacia occurs in
the brain tissue that surrounds the fluid-filled cavities of the
brain, called ventricles. This area of the brain is called white
matter, in contrast to the grey matter that makes up the rest of
the brain. So, the injury occurs to the white matter that provides
connections between the brain and the muscles of the body.
What causes it?
PVL is thought to be caused by severe intraventricular
hemorrhaging (bleeding in the brain).
How is it diagnosed?
Often no signs of PVL will be apparent in the nursery.
Premature infants are at greater risk of having it, so doctors will
frequently get studies like a head ultrasound or an MRI (magnetic
resonance imaging) to look for periventricular leukomalacia. As the
infant gets a little older, he or she may show signs of
developmental delays.
How is it treated?
There's no specific treatment, only close monitoring and
support with therapists if a child does develop significant delays,
usually after discharge from the hospital
How long will my baby be in the NICU?
Babies with this condition may be in the NICU for several weeks
or months.
Respiratory Distress Syndrome (RDS)
What is it?
One of the most common and immediate problems facing premature
infants is difficulty breathing. Although there are many causes of
breathing difficulties in premature babies, the most common is
called respiratory distress syndrome (RDS).
What causes it?
In RDS, the infant's immature lungs don't produce enough
of an important substance called surfactant. Surfactant allows the
inner surface of the lungs to expand properly when the infant makes
the change from the womb to breathing air after birth.
How is it diagnosed?
Doctors suspect respiratory distress syndrome in any premature
baby or in full-term infants who are breathing particularly hard
and fast or require extra oxygen. A chest X-ray can confirm this
diagnosis.
How is it treated?
RDS is treatable and many infants do quite well. When premature
delivery can't be stopped, most pregnant women can be given
medication just before delivery to help prevent RDS. Then,
immediately after birth and several times later, artificial
surfactant can be given to the infant through a breathing tube.
Although most premature babies who lack surfactant will require
a breathing machine, or ventilator, for a while, the use of
artificial surfactant has greatly decreased the amount of time they
spend on the ventilator.
How long will my baby be in the NICU?
Babies with serious cases usually require many days or weeks in
the unit.
Retinopathy of Prematurity (ROP)
What is it?
The eyes of premature infants are especially vulnerable to
injury after birth. A serious complication is called retinopathy of
prematurity (ROP), which is an abnormal growth of the blood vessels
in an infant's eye (within the retina).
About 7% of babies weighing 2.8 pounds (1,250 grams) or less at
birth develop the condition, and the resulting damage may range
from mild (the need for glasses) to severe (blindness).
What causes it?
The cause of ROP in premature infants is unknown. Although it
was previously thought that too much oxygen was the primary
problem, further research has shown that oxygen levels (either too
low or too high) play only a contributing factor in the development
of the condition.
How is it diagnosed?
Because many very premature babies have some level of ROP, an
eye exam by a pediatric eye doctor is standard at 8 to 10 weeks
before the premature baby's original due date.
How is it treated?
For slight damage, the eye doctor may just follow the baby with
frequent exams. But if the damage is greater, laser surgery will be
needed to prevent it from progressing.
How long will my baby be in the NICU?
ROP alone doesn't usually determine the length of a
newborn's stay in the unit. It often occurs in conjunction with
other problems, and those will be a greater influence on when a
baby can leave. But babies generally recover from the laser surgery
in 24 to 48 hours.
Sepsis
What is it?
A very serious condition,
sepsis
is the body's response to infection that has spread throughout
the blood and tissues. The body mounts a widespread inflammatory
response to the infection that can quickly spiral out of control
and cause even more harm.
Babies with sepsis may:
- be lethargic
- have a low or high temperature
- not eat well
- have apnea or difficulty breathing
- appear jaundiced
- just not look right
What causes it?
Sepsis is an infection caused by bacteria growing in the blood.
The bacteria can get into the blood:
- during labor and delivery from the mother
- from IV lines
- after close contact with an individual who's infected
with, or is a carrier of, bacteria
How is it diagnosed?
A blood culture - sometimes along with a
urine test
or
spinal tap
- is used to diagnose the illness.
How is it treated?
When doctors suspect sepsis, they'll treat the baby with
antibiotics until the lab results come back - usually for 48 hours.
If those results are positive for sepsis, the baby receives
antibiotics for 7 to 14 more days while being closely
monitored.
How long will my baby be in the NICU?
Cases of sepsis are often severe (the infection can lead to
meningitis
, organ damage, and occasionally, death) and require a fairly long
NICU stay, sometimes several weeks.
Transient Tachypnea of the Newborn (TTN)
What is it?
Rapid breathing in a full-term newborn (more than 60 breaths a
minute) is called
transient tachypnea
. Until about 4 hours after the delivery, this can actually be
normal.
What causes it?
After 4 hours after delivery, doctors start to look for a cause
of the rapid breathing, such as
pneumonia
, a blood infection, or problems with the lungs, including
underdevelopment.
How is it diagnosed?
Blood tests and X-rays can help diagnose the underlying
condition.
How is it treated?
The lung condition usually subsides within a few days with
treatment. Babies are helped to breathe or receive oxygen, if
needed, and the NICU staff closely watch their oxygen levels.
How long will my baby be in the NICU?
A stay of 24 to 72 hours is normal while NICU staff monitor the
baby's condition.
Other Complications
In addition to specific diagnoses, infants in the NICU can
experience general problems. For instance, newborns lose heat
easily, and preemies in particular have trouble regulating their
body temperature, as they lack the energy or fat reserves to
generate heat and the body mass to maintain it. So NICU babies must
be kept warm in warmers or isolettes.
High or low blood pressure can also be a risk for premature
babies because their developing blood vessels can't handle
changes in blood pressure and may tear more easily.
Some preemies have trouble feeding because they aren't
physically coordinated enough yet to do it. Eating is the most
energy-consuming process for a newborn, and babies in the NICU
often don't have the strength or energy to feed on their own.
Instead, they have to be fed through an IV line or a tube. And if
the digestive tract isn't sufficiently developed to handle
food, that can cause problems too, as seen with necrotizing
enterocolitis.
A related condition is
reflux
. Although all infants have some reflux in the early months (hence
all the spitting up), preemies have a particular problem with it
because they have poor muscle tone. Sphincters are muscles, and
when the one between the esophagus and the stomach is weak, it
allows the acidic stomach contents to bubble back up into the
esophagus. (A preemie's immature nervous system has trouble
controlling the sphincter as well.) The acid irritates the
esophagus, which can lead to feeding problems. Inhaling and choking
on the reflux is a more serious risk.
Newborns who need intensive care are also vulnerable to
infections
. Their skin and mucous membranes - the body's primary lines of
defense against bacteria and viruses - aren't well developed
enough to provide adequate protection. With several
immune-compromised babies in one space, infections that are
introduced into the NICU can spread easily, and with nurses caring
for multiple babies, the possibility of communicating infectious
agents increases. That's why NICU staff are vigilant about
keeping that environment as clean as possible.
Talking to the Doctor
If your baby is admitted to the NICU, you'll want to find
out as much about his or her care as possible. Some questions to
ask the doctor are:
- How long will my baby be in the unit?
- What, specifically, is the problem?
- What will be involved in my baby's treatment?
- What medicines will my baby have to take?
- What can I do to help my baby?
You may also want to talk to the nurses to find out more about
your baby's daily care and what to expect when you spend time
with your little one.
Once you have the answers to these questions, you'll be on
your way to helping your baby during his or her time in intensive
care.
Reviewed by:
Michael L. Spear, MD
Date reviewed: June 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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