New parents eagerly look forward to bringing their baby home, so
it can be frightening if your newborn needs to be admitted to the
neonatal intensive care unit (NICU). At first it may seem like a
foreign place, but understanding the NICU and what goes on there
can help reduce your fears and let you better help your baby.
About the NICU
If your baby is sent to the NICU, your first question probably
will be: What is this place? 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 who need to go to the unit are often admitted within the
first 24 hours after birth. Babies may be sent to the NICU if:
- they're born
prematurely
- difficulties occur during their delivery
- 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.
Who Will Be Taking Care of My Baby?
Although many people help care for babies in the NICU, those
most responsible for day-to-day care are nurses, whom you may come
to know very well and rely on to give you information and
reassurances about your baby.
The nurses you might interact with include a:
-
charge nurse
(the nurse in charge of the shift)
-
primary nurse
(the one assigned to your baby)
-
neonatal nurse practitioner
(someone with additional training in neonatology care)
Other people who may help care for your baby include:
-
a neonatologist
(a doctor specializing in newborn intensive care who heads up the
medical team)
-
neonatology fellows, medical residents, and medical
students
(all pursuing their training at different levels)
-
pediatric hospitalist
(a pediatrician who works solely in the hospital setting)
-
various specialists
(such as a neurologist, a cardiologist, or a surgeon) to treat
specific issues with the brain, heart, etc.
-
a respiratory therapist
(who helps administer treatments
that help with breathing)
-
a nutritionist
(who can determine what babies on IV nutrition need)
-
a physical therapist and/or occupational
therapist
(who work with feeding and movement issues with the infants and
their parents)
-
a pharmacist
(who helps manage a baby's medications)
-
lab technicians
(who process the laboratory tests - i.e., urine, blood -
taken)
-
a chaplain
(who can counsel you and try to provide comfort; chaplains may be
interfaith or of a particular religious affiliation but
they're there to support anyone looking for a
spiritual/religious connection)
-
a social worker
(who helps you get the services you need and also lends emotional
support by connecting you to other families and therapists, if
needed)
Questions to Ask the Neonatologist or the Nurses
To better help you help your baby during a stay in intensive
care, it's wise to get as much information as possible about
what to expect. If you have questions, talk to the neonatologist or
the nurses.
The nurses see your baby every day, so they can give you
frequent updates on your little one. Remember, though, that nurses
do
not
make diagnoses. To discuss a diagnosis or your baby's overall
plan of care, find the neonatologist, fellow, nurse practitioner,
hospitalist, or the resident. They have all the information about
your baby and can talk to you about the big picture.
Some things you might want to ask the neonatologist and/or the
nurses include:
- How long will my baby be in the unit?
- What, specifically, is the problem?
- What will be involved in my baby's treatment and daily
care?
- What medicines will my baby have to take?
- What types of tests will be done?
- What can my baby eat and when?
- Will I be able to nurse or bottle-feed my baby - if so, when
and how?
- Will someone help me learn how to nurse my baby?
- What can I do to help my baby?
- Will I be able to hold or touch my baby?
- How often and for how long can I stay in the unit? Can I
sleep there?
- What sort of care will my baby need when we get home?
- Is there someone who can help us through the process?
You may also want to talk to the nurses in more detail about
your baby's daily care and what to expect when you spend time
with your little one. You should also learn the visiting schedule
and any rules of the NICU so you'll know which family members
can see the baby and when they can visit.
Questions to Ask the Social Worker
You may also want to ask the social worker:
- Where can we get food when we're here?
- Can we eat in the NICU?
- Are cots or recliners available if we're allowed to stay
overnight? What about blankets and pillows?
- Is nearby temporary housing available (such as through the
Ronald McDonald House)?
- If so, how do we get a room?
- Is the room free? If not, is the cost low and/or covered by
our health insurance?
- Are computers with Internet access available for doing work
or emailing friends and loved ones about our baby's
progress?
- Are phones available in or around the NICU?
- Can we use our cell phones in the NICU? If not, can we be
reached in the NICU?
- Is there a support group or other parents of children in the
NICU we can talk to?
What to Expect in the NICU
Walking into the NICU can feel like stepping onto another planet
- the environment is probably unlike anything you've
experienced. The unit is often busy, with lots of activity, people
moving around, and beeping monitors.
Once settled in the unit, your baby will receive care tailored
to your little one's specific needs. Most NICU babies are on
special feeding schedules, depending on their level of development
or any problems they have. For instance, some infants are too
premature or too sick to eat on their own, so they have a feeding
tube that runs through the mouth and into the stomach. Others need
high-calorie diets to help them grow.
Medications are another crucial part of NICU care - your child
may take antibiotics, medicine to stimulate breathing, or something
to help his or her blood pressure or heart rate, for example.
To ensure that your baby's care stays on track, the doctors
also will order various tests, possibly including periodic blood
and urine tests, X-rays, and ultrasounds. For infants whose care is
complicated and involved, the doctors or nurses will place a line
into an artery or vein so they can draw blood without having to
repeatedly stick the baby. NICU staff try to make the infants'
stay in the nursery as comforting as possible for the infant as
well as the families.
The nurses can explain what all of the monitors, tubes, tests,
and machines do, which will go a long way toward demystifying the
NICU.
NICU Equipment
In the meantime, here's a brief look at what some of the
unfamiliar equipment does and how it may help your baby, depending
on your little one's condition and diagnosis:
-
Feeding tubes:
Frequently, NICU babies are unable to get as many calories as
they need through regular feeding from a bottle, so the nurses
will use a small feeding tube to deliver formula or breast milk
(that the mother pumps). The tube is either placed into the
baby's the stomach through the mouth or by the nose.
If an infant is able to take some milk from the bottle, the nurse
will just give the rest through the feeding tube. Sometimes, the
babies get all their nutrition through the feeding tube so that
they don't use excess energy trying to feed from the bottle.
The feeding tubes shouldn't be painful - they're taped in
place so they won't move around and cause friction. However,
if they're in place for a long time they can cause erosions
in the stomach or nose where they rub, so are changed routinely
to avoid this.
-
Infant warmers:
These are beds with radiant heaters over them. Parents can touch
their babies in the warmers, but it's always a good idea to
talk to the NICU staff about it at first, just in case.
-
Isolettes:
These are small beds enclosed by clear, hard plastic. The
temperature of the isolette is controlled and closely monitored
because premature infants frequently have difficulty maintaining
their body temperature. Holes in the isolettes allow access to
the infants so the nurses and doctors can examine the infants and
parents can touch their babies.
-
IVs and lines:
An intravenous catheter (or IV) is a thin, flexible tube inserted
into the vein with a small needle. Once in the vein, the needle
is removed, leaving just the soft plastic tubing.
Almost all babies in the NICU have an IV for fluids and
medications - usually in the hands or arms, but sometimes in the
feet, legs, or even scalp. At first, the IV may be inserted in
the baby's umbilical cord. In the first hours after delivery,
the umbilical cord provides a way for the doctors to insert
arterial or venous lines into the infant without having to use a
needle through the skin.
Instead of giving your baby injections every few hours, IVs allow
certain medications to be given continuously, several drops at a
time. These are known as drips or infusions. Doctors may use
these medications to help with heart function, blood pressure, or
pain relief.
Some situations require larger IVs to deliver larger volumes of
fluids and medications. These special IVs are known as central
lines because they're inserted into the larger, more central
veins of the chest, neck, or groin, as opposed to the hands and
feet. They're inserted by a specially trained pediatric
surgeon.
Arterial lines
are very similar to IVs, but they're placed in arteries, not
veins, and are used to monitor blood pressure and oxygen levels
in the blood (although some babies may simply have blood pressure
cuffs instead).
-
Monitors:
Infants in the NICU are attached to monitors so the NICU staff
are constantly aware of their vital signs. The nurses will often
place the infants in positions that seem the most soothing, like
on their tummies or on their sides.
The single monitor (which picks up and displays all the necessary
information in one place) is secured to your baby's body with
chest leads, which are small painless stickers connected to
wires. The chest leads can count your child's heart rate and
breathing rate. A pulse oximetry machine (or pulse ox) may also
display your baby's blood oxygen levels on the monitor. Also
painless, the pulse ox machine is taped to your baby's
fingers or toes like a small bandage and emits a soft red light.
A temperature probe, a coated wire adhered to your baby's
skin with a patch, can track your little one's temperature
and display it on the monitor. And unless blood pressure is being
directly monitored through an arterial line, your baby will
usually have a blood pressure cuff in place.
-
Phototherapy:
Often, premature infants or those who have infections have
jaundice
(a common newborn condition in which the skin and whites of the
eyes turn yellow). Phototherapy is used to help get rid of the
bilirubin that causes jaundice. The infants might lie on a
special light therapy blanket and have lights attached to their
beds or isolettes. Usually, they only need phototherapy for a few
days.
-
Ventilators:
Babies in the NICU sometimes need extra help to breathe. The
infant is connected to the ventilator (or breathing machine) via
an endotracheal tube (a plastic tube placed into the windpipe
through the mouth or nose). Babies who've been in the NICU
for a prolonged stay - months at a time - may have a tracheostomy
(a plastic tube inserted directly into the trachea) that's
connected to the ventilator on the other end. There are many
different kinds of ventilators - different situations call for
different machines - but they all accomplish the same basic
purpose: to help a baby breathe.
Bonding With Your Baby in the NICU
All the machines may seem overwhelming, but don't let them
keep you from interacting with your baby. Bonding with a baby in
the NICU is as important as bonding with any newborn, sometimes
even more so. You simply have to learn the best way to do it.
Parents can always visit and spend time with their NICU babies.
The number of people who can visit a baby in the NICU may be
limited, but parents are usually allowed to stay almost 24 hours a
day (except when the medical team performs its daily examination
and evaluation). Ask the NICU's social worker about what
accommodations are available for parents - cots, recliners, or
nearby housing such as through the Ronald McDonald House
Charities.
Other family members can visit only during specified hours and
only a few at a time. And siblings may not be allowed in the NICU
because children have a greater risk of introducing an infection.
Check with the hospital staff to determine which family members can
see your baby.
Depending on how sick your child is, you may be able to hold
your little one even if he or she is on a ventilator or has an IV.
If the doctors feel that would be too much for your baby, you can
still hold his or her hand, stroke his or her head, and talk and
sing to him or her. A gentle, consistent touch will be the most
reassuring.
But for some very premature infants, touching is extremely
stressful (if they were still in the womb, they would have little
tactile stimulation). In these cases, doctors may suggest that you
minimize physical contact but still spend as much time as possible
with your baby. Check with the doctor or nurses to figure out how
much and what type of contact is best.
If you can hold your baby, you may be able to
breastfeed
or pump your milk and bottle-feed. Most NICUs have screens to allow
mothers to breastfeed their babies at the bedside.
Kangaroo care (or skin-to-skin contact) is another option to
help you forge a bond with your new baby. Here's how it
works:
- Place your baby (who's usually dressed in just a diaper
and a hat) on your chest underneath your shirt, so your little
one is resting directly on your skin.
- Loosely close your shirt over your baby to help keep him or
her warm.
Doctors and researchers have suggested that skin-to-skin contact
can improve babies' recovery time and help them leave the NICU
sooner.
But the best way for parents to help their babies in the NICU is
to be there for them and learn to read their behaviors. This will
help you to figure out:
- when your baby is stressed and needs to rest
- when your baby is ready to bond with you
- what type of interaction your baby likes (stroking, singing,
etc.)
- what time of day your baby is the most alert
- how long your baby can respond to you before getting
tired
Although you want to make time for interacting with your infant,
you also want to allow periods of undisturbed sleep. Let your baby
set the pace for your time together and you'll both get more
out of it.
Other NICU Basics
Here are some basics to help make the NICU a little less
mysterious:
Everyone who comes into the NICU must
wash their hands
when they enter. (There will be a sink and antibacterial soap in
the room and near the entrance of the NICU.) This is a crucial part
of keeping the NICU environment as clean as possible so the babies
won't be exposed to
infections
. Some units require visitors to wear hospital gowns, particularly
if a child is in isolation. You may also need to wear gloves and a
mask.
Ask the nurses what you're allowed to bring into the
unit
- the risk of infection limits what you can leave with your baby.
Some parents tape pictures to the isolette or decorate the
incubator. If you want to give your child a stuffed toy, the staff
may wrap it in plastic first.
When you're in the NICU, keep noise and bright lights
to a minimum.
Try not to bang things on the isolette or infant warmer, talk in a
loud voice, or slam doors. If you're concerned about light, ask
a nurse if you can drape a blanket partially over the isolette.
Most important, let your baby sleep when he or she needs to.
Making the NICU Stay More Manageable
The time when your baby is in the NICU can be stressful - you
may be away from your friends and family, including any other
children you may have. Your life may seem like it's been turned
upside down as you wait for the day when your baby may be able to
leave with you. You may feel like you eat, sleep, and breathe the
NICU 24 hours a day, 7 days a week. And you may feel especially
confused and overwhelmed if your baby was unexpectedly born
prematurely and/or if the NICU is located far away from your home
and your usual support system.
As hard as it may be sometimes, it's important to pay
attention to your
own
needs and those of the rest of the family, particularly other kids.
Make plans for a weekly family activity, and sit down together and
talk about how this experience makes you feel. Doing something for
yourself can be as simple as taking a relaxing bath, going for a
walk, or reading a favorite book for an hour.
You can also turn to other parents in the NICU for comfort.
They'll likely know better than anyone what you may be feeling.
Also be sure to talk to the NICU's social worker about
parents' support groups, where you can share your feelings,
worries, and triumphs together. The hospital's chaplain may
also be able to provide you with support and even a shoulder to cry
on.
When you take care of yourself, you'll be more rested and
better prepared to take care of your baby. But that care
doesn't have to center on your infant's illness. Enjoy your
new baby, spend time together, and get to know your little one.
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.
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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