Mercy Health - Children's Hospital
Services - Newborn Intensive Care Unit (NICU)
What Can I Expect in the NICU?
We hope the first impression you have when you enter the NICU is one of warmth, quiet, and calm. The lighting is intentionally soft because premature babies are very sensitive to light and noise. Too much of either can be very stressful, even affecting their heart rate and breathing.
You will notice that many of the babies have quilts or blankets over their isolette (cribs). This does not mean that anything is wrong. This is just another way we provide a quiet, dark place for babies to recover and grow.
When you first see your baby, you may be surprised by the amount of life-saving medical equipment being used. Here are the most common devices:
- Isolette: Babies rest in sophisticated Isolettes, or incubators, which provide the controlled environment that these tiny babies need.
- Oxygen Therapy: The number one problem among babies born prematurely is breathing. Their lungs, which are not mature, are unable to provide the oxygen babies need to survive. If your baby has breathing difficulties, he may need extra oxygen. In this case, a clear plastic box or hood is placed over the head to deliver warm, moist oxygen.
- Sometimes, a ventilator (breathing machine) may be used to help your baby breathe. This machine is attached to an endotracheal tube (ET tube) inserted in the mouth to the windpipe. Other babies require extra pressure in their lungs to help keep the lungs inflated. CPAP (Continuous Positive Airway Pressure) provides this pressure via a soft facemask or nasal prongs.
- Babies may also get extra oxygen through a thin plastic tube with little prongs going into the nose (nasal cannula). Monitors: Cardiac monitors carefully track the heartbeat of each NICU patient, while oxygen monitors tell staff how well babies are breathing on their own and/or when ventilator settings should be adjusted. Intravenous lines (IVs): IVs provide NICU patients with the medications and nourishment they need. You may see these in your baby's hand, foot, arm, legs, or scalp. Placing the IV in the baby's scalp requires shaving some of his hair.
- If your baby cannot eat for a long time, sometimes a central line, a very tiny, flexible IV, is placed and threaded into the vein to give the baby more sugar. This central line is more stable and usually does not need to be changed until we disconnect it.
- Umbilical artery catheter (UAC) or Umbilical venous catheter (UVC): This is a small piece of tubing threaded into the baby's artery or vein in the umbilical stump. In addition to delivering fluids, medication, and nutrients, blood can be withdrawn painlessly for laboratory studies.
- Temperature Probe: A coated wire will be placed on the baby's skin and covered with an adhesive patch. The coated wire measures the baby's temperature. This information is used to help regulate the amount of heat from the overhead heater or isolette.
- Blood Samples are often drawn when your baby arrives in the unit and throughout the hospital stay. We obtain samples by taking a small amount of blood from the baby's heel, vein, umbilical vein or artery catheter.
- Blood Transfusions: Your baby may need a transfusion while in the NICU to replace blood removed for lab tests. Blood is provided by the blood bank. If you desire, you may select the donors for your baby through the Designated Donor Program. If you would like to use Designated Donor blood, ask your baby's nurse or doctor for information.
- Phototherapy lights are used to treat the jaundice so common in premature infants. These are special fluorescent lights used for babies with jaundice, a yellow skin coloring that commonly occurs in newborns, particularly premature infants. The lights help your baby get rid of excess bilirubin-a pigment that makes babies jaundiced. We protect your baby's eyes with eye pads when under the light. Sometimes, when bilirubin levels are high, an exchange transfusion may be necessary, which involves exchanging the baby's blood with fresh, whole blood containing normal bilirubin levels.
- Feeding tube: Babies who are gavage fed (tube feedings) are given breast milk or formula through a tube passed from the mouth to the stomach.
As a parent, how you can help:
These suggestions are offered to help you parent your son or daughter in the NICU. If your baby is very small or very sick there are ways you can be involved in his/her care:
- Your baby already knows your voice. Comfort your baby by talking to him/her in a soft and gentle voice. Your baby might enjoy hearing you read or sing very softly to him/her. We have a selection of books in our new parent library, or you can bring a favorite from home. If you are not able to be with him/her very often, you might consider a tape-recorded message to be used in your absence.
- Placing your hand gently on your baby and holding him/her in a flexed position helps your baby feel protected and secure. Too much stimulation can be stressful for a very small baby. Your baby’s nurse can help you know when your baby is ready for gentle stroking or massage.
- Help protect your baby from bright light and noise. You may bring in a special blanket or quilt to place over your baby’s bed to make his/her space darker and quieter. If your baby is awake and peeking about, then shield his/her eyes from bright light with your hand. You may bring a few small items to decorate his space.
- Check with your baby’s nurse to see when he/she is ready to be held. Once he/she is stable enough to be moved from the bed into your arms you may consider the very close comfort of skin to skin holding.
- Bring your own breastmilk or direct donate blood.
As your baby feels better and is growing there are more ways you can parent your baby:
- Breastfeeding or bottle-feeding your baby as soon as he/she is ready. The staff can offer you tips on how to help your baby learn to eat so he/she can keep growing well and not get too tired.
- Changing your baby’s diaper and washing his/her face and mouth can help him/her feel more comfortable.
- Changing your baby’s position every few hours can help him/her be more comfortable as well. Providing the bedding in a sort of “nested” manner can help you baby feel more secure. Whether your baby is on her/his back, tummy, or either side, having soft blankets tucked around him/her feels comfortable.
- Request to be involved in giving your baby his/her bath whether it is a sponge bath or he/she is ready for a small tub. The nurses will help you feel more comfortable as you begin to do this.
- When preparing to take your baby home, talk with the staff about staying overnight to practice at the hospital so that you will feel more confident taking your baby home.
Take Care of yourself, your partner and your family
For many babies, the NICU stay is like a roller coaster ride, with ups and downs, trumphs and setbacks. Of course, the parents are also along for the ride. The following tips can help you deal with the ups and downs.
- Give yourself permission to cry and feel overwhelmed. You may be concerned that if you let your feelings flow, you'll never be able to pull yourself back together. But you will. Allow yourself to feel this release of emotion.
- Establish a routine. Find a way to balance work, home life and visiting the hospital. Allow yourself to leave your baby's side when you feel comfortable doing so. Your baby needs you, but it's also important to have time to yourself, with your partner and with your other children. Also take time to do things you enjoy, such as exercise. These restful breaks will help you find the strength to keep going.
- Connect with other NICU parents. These parents share many of your feelings and struggles. Share your experiences, informally or in a support group. It's helpful to be surrounded by others who understand what you're going through. Ask NICU staff if there are graduate NICU parents with whom you can connect for support.
- Explore your spiritual side. It might be helpful for you to reflect and lean on your personal spiritual perspective. You may find comfort speaking with a pastor, priest, rabbi, minister or imam. It is normal for this experience to challenge your religious and spiritual beliefs. In any case, remember that prayer, meditation or quiet reflection can help you find emotional strength and hope, and can guide you through this challenging time.
- Keep a journal. Expressing your feelings on paper can help you cope with and move through them. A journal may also help strenthen your hope and patience by reminding you how far you and your baby have come.
- Vent your frustrations. If your baby has a setback, you may be plunged into fear and anxiety. Voice your fears, and hope for the best.
- Celebrate when you can. When your baby makes progress, let yourself experience the joy.
- Accept the support of others. Let people know how they can best help you. Go to family and friends for support.
- Accept that you and your partner will react differently. Share your experiences and listen with empathy so that you each can feel supported.
Preparing for Discharge
Your baby may be getting ready to go home when:
- He/she no longer needs an incubator to keep warm - he/she is sleeping in a crib.
- He/she can breast or bottle feed.
- He/she is gaining weight steadily (1/2 to 1 ounce a day).
- He/she is breathing on his/her own.
- He/she weights about 4 pounds.
No matter how much you wanted the day to come, leaving the support of the neonatal intensive care unit (NICU) staff and equipment can feel overwhelming. Rest assured that any doubts or fears about your ability to care for your baby at home recede as time passes. As your baby grows stronger, you feel more calm and confident.