Navigating the NICU

One in 10 pregnancies in the United States results in a preterm birth (a pregnancy that ends before 37 weeks), according to the Centers for Disease Control and Prevention(CDC). Prematurity and low birth weight is the second leading cause of death in infants during the first year of life, and is the leading cause of infant death for African-American babies.

The American Academy of Pediatrics (AAP) warns that premature infants have a higher risk for health problems, including: 

  • breathing problems 
  • feeding difficulties
  • learning and behavioral problems 
  • cerebral palsy 
  • hearing loss 
  • vision problems

As a result, many premature babies are sent to a neonatal intensive care unit (NICU). The NICU, also known as an intensive care nursery (ICN), specializes in the care of premature and critically ill newborns. Due to advances in medical care, babies are born premature are more likely to survive today than ever before. 

Who will I encounter in a NICU?

The NICU is equipped with the technology and the specially trained medical staff needed to effectively manage the multiple challenges premature infants may face. Although many people may help treat babies in the NICU, those most involved in their daily care, include:

  • Neonatologists. These are physicians specially trained in newborn intensive care. 
  • Neonatal nurses. These nurses have advanced training in newborn intensive care. They work under the supervision of neonatologists and will likely be the people working most closely with your baby on a daily basis. 
  • Neonatal nurse practitioner. This is a registered nurse (RN) who has also received advanced education and specialized training in neonatal intensive care. 
  • NICU Respiratory therapists. These are members of the NICU team responsible for the therapeutic equipment and processes that help the babies breathe, such as ventilators. 
  • NICU Physical therapists (PT) and occupational therapist (OT). These health professionals are trained to work with premature infants on feeding and movement issues.
  • Speech therapists. These are professionals trained in speech and language problems. They often work with newborns in NICUs to help them with feeding, sucking, and swallowing problems.
  • Other specialists. NICU babies often require treatment from neurologists, cardiologists, pediatric ophthalmologists, or surgeons. These specially trained physicians are consulted to treat specific issues with a newborn’s brain, heart, or eyes, etc. 
  •  NICU social workers. These professionals are trained to help families cope with the emotional, financial, and logistical aspects of a premature baby’s NICU stay. Social workers can help with insurance difficulties and assist in making any special arrangements necessary for a baby’s discharge or follow-up care.

What are common types of equipment used for NICU babies?

The NICU staff can help parents make sense of the monitors, tubes, and lights that can be overwhelming to emotionally distraught parents. Among the types of equipment parents can expect to see: 

  • Feeding tubes. NICU babies often require help feeding because they are not yet able to suck and swallow from a breast or bottle effectively. In these cases, a feeding tube is placed into the baby’s the stomach through the mouth or the nose in order to deliver breast milk that a mother has expressed with a pump. Once a baby is able to coordinate sucking, swallowing, and breathing, they can attempt to breastfeed. 
  • Incubators or Isolettes. These are the small beds enclosed by clear, hard plastic in which the babies are placed. The temperature in these beds is controlled and closely monitored since premature infants often have difficulty maintaining their body temperature. They also have windows on hinges or port holes, that allow nurses, doctors, and parents access to the babies. 
  • Radiant warmers. These are open beds that warm babies with radiant heat overhead, allowing easy access for doctors and nurses. 
  • Intravenous catheters (IVs). An IV is a thin tube inserted into a vein with a small needle. Almost all babies in the NICU have an IV for administering fluids and medications. In premature babies, IVs may be placed in the baby’s umbilical cord, hands, arms, feet, legs, or scalp. 
  • Monitors. Infants in the NICU are attached to cardiovascular monitors, which measure their heart rate, blood pressure, breathing rate, and oxygen saturation in their blood. 
  • PhototherapyAlmost all preterm infants are affected by hyperbilirubinemia, which is a high bilirubin level. This condition results in jaundice, or the yellowish discoloration of the skin and whites of the eyes. Phototherapy or special lights may be attached to a baby’s isolette to help to lower the bilirubin level in the baby’s blood.
  • Ventilators. NICU babies may need extra help to breathe. There are many different kinds of ventilators, but they all work to help deliver oxygen.
Visit the March of Dimes website for a full list of common equipment used in the NICU. 

When are NICU babies ready to go home?

There is no hard and fast rule about when a NICU baby is ready to be discharged. However as a general guideline, a premature baby that is otherwise healthy may be ready to go home around the time of her original due date. Your health care providers will want to make sure your baby is:
  • breathing on her own
  • feeding well
  • gaining weight
  • sleeping well
  • not dependent on an IV drip
  • able to maintain body temperature in an open crib 

What are some strategies to ease parents’ anxieties?

Parents can alleviate some of their isolation and frustration by finding ways to bond with their baby. Since each baby is different, parents should consult with their neonatologist or NICU nurse to figure out how much and what type of contact with their baby is best. The NICU staff may recommend certain bonding techniques such as skin-to-skin care, also called kangaroo care, where a diapered baby is placed on a parent’s bare chest. Studies show that babies held skin-to-skin gain weight faster, move into an open crib sooner, and go home earlier. 

  • Manage your expectations. A stay in the NICU is often not quick or simple. Quite the opposite, progress is often made slowly and incrementally. Parents should expect a long haul. 
  • Advocate. Write down important information about your infant’s treatment, including procedures and medications. Keep this information in one organized place so that the health care professionals you visit in the future are fully informed about your baby’s medical history.
  • Ask questions. It’s not always easy to absorb exactly what doctors are saying, especially if you’re an anxious and sleep-deprived parent. Don’t be afraid to ask your health care providers questions or to simply repeat what they’ve already told you.
  • Trust. When it’s finally time to go home, parents may be scared about taking on the responsibility of caring for their premature infant. In some extreme cases, parents must be trained to administer tube feeds and medications at home. Trust that your baby would not be discharged unless your neonatologist was confident she is ready for life outside the NICU. 

Learn more about how skin-to-skin care can help your preterm baby here

Last updated October 26, 2017

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