The Neonatal Intensive Care Unit (NICU)

The Neonatal Intensive Care Unit (NICU)

The birth of a baby is a wonderful and
very complex process. Many physical and emotional changes occur for both mother and
baby.

A baby must make many physical
adjustments to life outside the mother’s body. Leaving the uterus means that a baby can no
longer depend on the mother’s blood supply and placenta for important body functions.

Baby in a neonatal intensive care unit

Before birth, the baby depends on functions from the mother. These
include breathing, eating, elimination of waste, and immune protection. When a baby leaves
the womb, its body systems must change. For example:

  • The lungs must breathe air.

  • The cardiac and pulmonary
    circulation changes.

  • The digestive system must begin
    to process food and excrete waste.

  • The kidneys must begin working
    to balance fluids and chemicals in the body and excrete waste.

  • The liver and immune systems
    must begin working on their own.

Your baby’s body systems must work
together in a new way. In some cases, a baby has trouble making the transition outside the
womb. Preterm birth, a difficult birth, or birth defects can make these changes more
challenging. But a lot of special care is available to help newborn babies.

What is the neonatal intensive care unit
(NICU)?

Newborn babies who need intensive
medical care are often put in a special area of the hospital called the neonatal
intensive care unit (NICU). The NICU has advanced technology and trained healthcare
professionals to give special care for the tiniest patients. NICUs may also care areas
for babies who are not as sick but do need specialized nursing care. Some hospitals
don’t have the staff for a NICU and babies must be moved to another hospital. Babies who
need intensive care do better if they are born in a hospital with a NICU than if they
are moved after birth.

Some newborn babies will require
care in a NICU. Giving birth to a sick or premature baby can be unexpected for any
parent. The NICU can be overwhelming. This information is to help you understand why a
baby may need to be in the NICU. You will also find out about some of the procedures
that may be needed for the care of your baby.

Which babies need special care?

Most babies admitted to the NICU
are preterm (born before 37 weeks of pregnancy), have low birth weight (less than 5.5
pounds), or have a health condition that needs special care. In the U.S., nearly half a
million babies are born preterm. Many of these babies also have low birth weights.
Twins, triplets, and other multiples often are admitted to the NICU. This is because
they tend to be born earlier and smaller than single birth babies. Babies with health
conditions such as breathing trouble, heart problems, infections, or birth defects are
also cared for in the NICU.

Below are some factors that can
place a baby at high risk and increase the chances of being admitted to the NICU. But
each baby must be assessed to see if he or she needs the NICU. High-risk factors
include the below.

Maternal factors include:

  • Being younger than age 16 or older than age 40
  • Drug or alcohol use
  • Diabetes
  • High blood pressure (hypertension)
  • Bleeding
  • Sexually transmitted diseases
  • Multiple pregnancy (twins, triplets, or more)
  • Too little or too much amniotic fluid
  • Premature rupture of membranes (also called the amniotic sac or
    bag of waters)

Delivery factors include:

  • Changes in a baby’s organ systems due to lack of oxygen (fetal
    distress or birth asphyxia)
  • Buttocks delivered first (breech birth) or other abnormal
    position
  • The baby’s first stool (meconium) passed during pregnancy into
    the amniotic fluid
  • Umbilical cord wrapped around the baby’s neck (nuchal cord)
  • Forceps or cesarean delivery

Baby factors include:

  • Baby born at gestational age of less than 37 weeks or more than
    42 weeks
  • Birth weight less than 5 pounds, 8 ounces (2,500 grams) or over
    8 pounds, 13 ounces (4,000 grams)
  • Small for gestational age
  • Medicine or resuscitation in the delivery room
  • Birth defects
  • Respiratory distress including rapid breathing, grunting, or
    stopping breathing (apnea)
  • Infection such as herpes, group B streptococcus, chlamydia
  • Seizures
  • Low blood sugar (hypoglycemia)
  • Need for extra oxygen or monitoring, IV (intravenous) therapy,
    or medicines
  • Need for special treatment or procedures such as a blood
    transfusion

Who will care for your baby in the NICU?

Some of the specially-trained
healthcare providers who may care for your baby include:

  • Neonatologist. This is
    a pediatrician with extra training in the care of sick and premature babies. The
    neonatologist (often called the attending physician) supervises pediatric fellows
    and residents, nurse practitioners, and nurses who care for babies in the
    NICU.

  • Neonatal fellow. This is a
    pediatrician getting extra training in the care of sick and premature babies. He
    or she may do procedures and direct your child’s care.

  • Pediatric resident. This is a
    doctor who is getting extra training in the care of children. He or she may do or
    assist in procedures and help direct your child’s care.

  • Neonatal nurse practitioner.
    This is a registered nurse with extra training in the care of newborn babies. He
    or she can do procedures and help direct your child’s care.

  • Respiratory therapist. This
    is a person with special training in giving respiratory support. This includes
    managing breathing machines and oxygen.

  • Physical, occupational, and
    speech therapists.
    These types of therapists make sure a baby is developing
    well. They also help with care including positioning and soothing methods. Speech
    therapists help babies learn to eat by mouth.

  • Dietitians. Dietitians ensure
    the babies are growing well and getting good nutrition. They watch your baby’s
    intake of calories, protein, vitamins, and minerals.

  • Lactation consultants. These
    are healthcare providers with extra training and certification in helping women
    and babies breastfeed. They can help with pumping, maintaining milk supply, and
    starting and continuing breastfeeding.

  • Pharmacists. Pharmacists help
    in the NICU by assisting the care providers choose the best medicines. They check
    medicine doses and levels. They keep the team aware of possible side effects and
    monitoring that may be needed.

  • Social workers. Social
    workers help families cope with many things when a child is ill. They give
    emotional support. They help families get information from healthcare providers.
    They support the family with other more basic care needs, too. These can include
    money problems, transportation, or arranging home healthcare.

  • Hospital chaplain. The
    hospital chaplain may be a priest, minister, lay pastor, or other religious
    advisor. The chaplain can give spiritual support and counseling to help families
    cope with the stress of the NICU.

NICU team members work together
with parents to create a plan of care for high-risk newborns. Ask about the NICU’s
parent support groups and other programs designed to help parents.