Neonatal Intensive Care
For Extra Special Deliveries
If you're like most parents-to-be, you're taking the Boy Scouts motto "be prepared" to new levels. You've been seeing your obstetrician regularly and having all the necessary tests. You may have read books on pregnancy and parenting and taken classes.
But there's one thing many prospective parents don't prepare for, because it's not easy to think about: What if everything doesn't go as planned?
Tests during pregnancy can show potential concerns ahead of time, but some women have no complications up until delivery. And while the chances of your baby needing extra care at birth are low – less than 10 percent of newborns require intensive care – it's important to know neonatal intensive care is available if your baby needs it.
What is neonatal intensive care?
Neonatal intensive care is, simply, specialized medical care for newborns experiencing complications. Care is provided in a neonatal intensive care unit (NICU), which can also be called a "special care nursery" or by other names.
Most babies are cared for in NICUs because they're born prematurely -- before the normal 40-week gestation period. The two most common reasons these babies need intensive care are breathing problems – often due to immature lungs – and infections that may have prompted the premature birth. Other factors that can lead to prematurity include maternal diabetes, vascular or other diseases. The age of the mother can also be a big factor.
While most newborns needing intensive care are admitted to the NICU within 24 hours after birth, babies may also be admitted because of problems that arise during their first few days. Depending on his or her condition, a baby may be in the intensive care unit for a few hours to several weeks or longer.
A NICU is staffed by neonatologists, physicians specializing in newborn intensive care, and nurses specially trained and certified in neonatology. Depending on the baby's condition, other physician specialists will also provide care. Physician assistants, nurse practitioners, pharmacists, respiratory therapists, nutritionists, social workers and other professionals provide and support care for the baby and family as needed.
Hospitals offer different levels of neonatal care, ranging from Level I facilities for full-term or near-term infants at low risk of complications to Level IV intensive care units, which treat the most critically ill or premature babies.
Inside the neonatal intensive care unit
Some of the more common pieces of equipment and treatments you'll find in a NICU include:
Radiant warmer – An open table which heats the baby by radiant heat and allows easy access to a critically-ill infant.
Isolette – A heated bed enclosed in transparent plastic to keep the baby warm. A sensor attached to the baby's skin automatically triggers a change in air temperature when needed.
Feeding tube – Breast milk, formula and medicines can be given through a tiny tube inserted into the baby's nose or mouth that goes into the stomach. Babies use the tube until they are ready for breast- or bottle-feeding.
IV – The intravenous line, or IV, delivers fluids, nutrients and medication to your baby. To alleviate pain, babies may receive local anesthesia before the IV is inserted.
Bubble CPAP – Small nasal prongs which deliver oxygen and baseline pressure, helping infants with respiratory difficulties.
Ventilator (respirator) – Babies who have trouble breathing on their own may be put on a ventilator for a period of time. The ventilator delivers oxygen through an endotracheal (ET) tube doctors place in the baby's trachea (airway).
Monitoring devices including:
Cardiac-respiratory monitor – Small devices called leads are taped to your baby's chest and connected by wires to the monitor, which shows heart rate, rhythm and respiration
Oxygen saturation monitor (oximeter) – Small, non-invasive device that consists of a cuff wrapped around the baby's foot, hand, toe, or finger. The cuff is placed over a pulse point and measures, via light waves, the amount of oxygen in the baby's blood.
Even with all the technology, constant monitoring and specialized care, neonatal intensive care units can be designed as restful places and should include quiet equipment; an acoustically optimized nursing station to keep noise down; a cycling of light to enhance proper day/night rhythm in babies; and a light level for each baby that is appropriate for that infant's level of maturity.
Bonding with your baby in the NICU
With the special equipment NICU babies need, holding, feeding and playing with them in the traditional ways can be challenging. But that doesn't mean parents can't bond with their little ones in intensive care.
Depending on the baby's condition and treatments, most units allow parents to visit any time and spend as much time as they like with their newborn. Some babies can be held, even with ventilators and IVs. Parents may be able to stroke their baby while he or she is in an isolette. Softly talking or singing to your baby can be soothing to both parent and newborn.
Staff can teach parents bonding techniques like "kangaroo care" – placing the baby on the parent's bare chest for skin to skin contact. A lactation consultant can also offer special training and tips to mothers of intensive care newborns, who may be unable to nurse for a time.
When a baby has spent a period of time in the special care nursery and is ready to go home, many NICUs have transition rooms where parents can spend a night or two with their newborn, receiving instruction and getting familiar with their child's needs.
One of the most difficult experiences for parents of NICU babies is watching other parents go home with their infants while their own little ones remain hospitalized. While having a baby in the NICU can be physically and emotionally stressful for parents, it's important to remember that you are a vital partner in helping your baby receive the best and most advanced care possible.
