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.

Before birth, the baby depends on functions from its mother. These include receiving oxygen, nutrition, eliminating waste, and immune protection. When a baby leaves the womb, its body systems must adapt. 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 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 a newborn.

What is the neonatal intensive care unit (NICU)?

Newborn babies who need advanced care are transferred to a specialized 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. Some hospitals do not have the staff for a NICU, and babies must be moved to another hospital. Babies who need intensive care have better outcomes if they are born in a hospital with a NICU than if they are moved after birth.

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 cared for 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, have low birth weight or have a health condition that needs special care. 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 higher risk and increase the possibility of needing care in the NICU. High-risk factors may be related to mom, baby or delivery.

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)

Baby factors include:

• Baby born at gestational age of less than 37 weeks or more than 42 weeks
• Birth weight less than 4 pounds, 4 ounces (2,000 grams)
• Small or large for gestational age
• Medicine or resuscitation in the delivery room
• Birth defects
• Respiratory distress including rapid breathing, grunting, or stopping breathing (apnea)
• Infection
• 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

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

Who will care for your baby in the NICU?

A multi-disciplinary team approach is utilized to provide family friendly care. A variety of medical professionals with special skills care for your infant. The following is brief description of the medical staff involved in caring for your baby.

• Neonatologist. This is a pediatrician with special training in the care of premature and special needs newborns. The neonatologist (often called the attending physician) directs your infant’s overall care but may ask other physicians and specialists to assist with treatment.
• Neonatal nurse practitioner (NNP). This is a registered nurse with advanced training in the care and management of special needs newborns. An NNP is in the NICU 24/7 and works closely with the neonatologist and nursing staff. He or she can perform procedures and help direct your baby's care.
• Neonatal Nurse. This is a registered nurse with special training in the care of premature and special needs newborns. He or she will coordinate the care your infant receives. Before each shift change, an outgoing nurse will give a full report on your baby's care and condition to the incoming nurse.
• Respiratory therapist. This is a person with special training in care for infants with breathing problems. This includes managing breathing machines and oxygen.
• Physical, occupational, and speech therapists. These types of therapists help to provide the staff and caregivers with age-appropriate developmental, feeding, and environmental techniques. Their role focuses on adapting to the environment, promoting calming skills, positioning and handling techniques, oral motor development, stimulation, family involvement, and therapeutic techniques.
• 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. You may ask your personal Chaplain to visit with you and your baby or you can ask a nurse to contact the hospital Chaplain for spiritual support.
• Other Personnel. Unit Assistants such as nurse's aides, housekeepers, and other personnel help the NICU operate smoothly by completing paperwork, ordering tests and supplies, maintaining equipment, and keeping areas clean. Various technicians also perform tests that assist the physicians with important clinical information.