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 ease 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 medical staff specially trained 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
- problems happen during their delivery
- they show signs of a health issue 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 stay in the unit depends on the severity of their condition.
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: Often, NICU babies cannot 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 placed into the baby’s stomach through the mouth or through 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 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 greater 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 (or pulse ox) machine also may display your baby’s blood oxygen levels on the monitor. Also painless, the pulse ox 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 with infections also 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. An 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.