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Special Babies, Special Care

When most of us think of giving birth, we picture hard labor followed by the sweet reward of taking home a healthy, thriving baby. For some parents, that process takes longer than it does for others. If your child is premature or has a health problem at birth, such as an infection, he may have to spend some time in the neonatal intensive care unit (NICU), an area of the hospital reserved for newborns who come into the world needing specialized medical care. Some babies spend only several hours there; others, many months. But regardless of how long your baby is there, rest assured that he's closely monitored by NICU nurses, who undergo special training to care for the most fragile of babies. We talked to Michelle Fumagalli, RN, a NICU nurse manager at St. Luke's-Roosevelt Hospital Center in New York City, about what to expect if your baby winds up in the NICU.

What does the NICU look like, and how does it differ from a regular hospital nursery?

Unlike a hospital nursery, which is usually a collection of small plastic bassinets filled with snugly sleeping babies, a NICU is filled with rows of babies in incubators or isolettes, which look like large clear plastic containers. "The thing that surprises parents most is the amount of medical equipment in the area -- respirators, warming tables, IVs, blood-pressure monitors," says Fumagalli. "It can be overwhelming." Some or all of the equipment will be used for your baby, depending upon his needs. Regardless of how much equipment surrounds him, "you can still play a very active role in being a parent, which is important for parent-infant bonding," says Fumagalli.

Can parents hold and touch their babies who are in incubators?

Sick and premature babies have a lot of trouble regulating their body temperature, so they need to be kept warm in an incubator. "But that doesn't mean parents can't touch them. They can reach in and touch their baby with special gloves that are threaded through the incubator," says Fumagalli. "Depending upon the baby's health status, they may also be able to take her out for periods of time to feed her and care for her." Many experts recommend that premature babies get daily kangaroo care -- time spent pressed against their mother's bare skin -- because it promotes the parent-child bond and, in some cases, helps babies gain weight and thrive.

What are some signs that a hospital has a good NICU, and should parents consider this when choosing a place to give birth?

"If you know that you're at risk for complications, whether or not a hospital has a NICU is an important consideration," Fumagalli says. Hospitals are ranked by levels; a level 2 hospital may have a neonatologist (a doctor who specializes in caring for newborns) on staff and some NICU equipment, while a level 3 hospital has a full NICU and staff, including NICU nurses, neonatologists, respiratory therapists, and social workers trained to meet the needs of families with sick newborns. Large teaching and big-city hospitals are often level 3, Fumagalli notes. Another important factor is the NICU's newborn fatality rate. The lower it is, the better the facility.

How does a baby end up in the NICU?

Most of us think the NICU is for preemies only, "but newborn babies with all kinds of health problems are cared for there," says Fumagalli. "Fullterm newborns who've had surgery, suffer from an infection from their mother, had low APGAR scores, or went through a rough delivery are also NICU babies." If your doctor knows you're a candidate for a high-risk birth, he may have a team from the NICU present at your delivery to administer emergency care and take your baby there immediately.

What happens to a baby when she first enters the NICU?

There's a pretty standard protocol. First, the baby is placed on a warmer, an open flat bed with a heating element above it, to make sure her body temperature doesn't drop. Then she is hooked up to a heart monitor and the NICU doctors and nurses assess her respiratory status. She may need oxygen through her nose or a tube inserted into her throat to help her breathe. "After that, we take blood and set her up with some form of intravenous food, fluid, or medicine through a vein or through the umbilical cord," Fumagalli says. When all of the baby's vital signs and blood test results are back from the hospital lab, the team creates a health plan for the baby.

How is a NICU nurse different from a regular maternity-ward nurse?

"NICU nurses receive several months of intensive classroom and hands-on training," explains Fumagalli. They learn specialized cardiac and respiratory care; how to work the various machines, such as respirators; how to evaluate monitor readings; and how to administer emergency care. "The only nurses who can work in the NICU are those who have this special training."

The other job requirements -- calmness, compassion, good communication skills, and a love for helping children in crisis -- can't be learned in a classroom. "For nurses who choose to work in the NICU, it's all about loving the babies, giving them the best care possible, and doing everything you can to make sure they have a good outcome," she says.

How do nurses help the parents of a NICU baby?

NICU nurses spend lots of time with families and usually get to know them well. In essence, they're a one-stop information and service resource. "We provide the family with 24-hours-a-day updates on their baby's health status. We also work with parents to help them provide as much care for their baby as they can," Fumagalli says. For example, a NICU nurse can teach a new mom how to feed a baby who has difficulty sucking, help parents read monitors and adjust medical equipment, and simplify complicated health issues. "By the time their baby leaves the NICU, the parents are often practically nurses themselves," she says.

NICU nurses also work with a social worker to help parents handle this difficult time. "Many hospitals offer NICU parent support groups. I think talking to people who are going through the same challenges really makes families feel better," Fumagalli says.

Can moms breast- or bottlefeed their NICU babies?

One of the most challenging parts of caring for babies in the NICU is that many of them may have trouble feeding, at least at first. In the beginning, many can't nurse or bottlefeed and receive nutrients through an IV. "Some don't know how to suck, and others suck very weakly," Fumagalli says. "Plus, they tire very easily, so it may be hard for them to get a lot of food down. In addition, lots of premature babies have digestive problems too." As a result, they need to be fed small amounts at a time, which are carefully monitored, and they need to use special preemie-friendly bottles and nipples. The nurses assist mothers in breast- and bottlefeeding their babies. Often, new mothers will need to pump their milk to use in bottles at first, so the nurses can see exactly how much a baby is taking in while in the NICU.

What does a NICU baby usually look like?

Because many NICU babies are preemies, they may appear tiny and fragile, and their head may be proportionally bigger than their body. "They usually have a lot less body fat than fullterm kids, so they may look skinny, too," Fumagalli says.

How much time can parents spend with their baby in the NICU?

"Unless there's a serious emergency in the NICU or the baby needs to have some sort of procedure, a parent can spend the entire day there, reading to, talking to, and caring for her baby," Fumagalli says. "We also have services that allow parents to stay at the hospital or close by so they can be with their child as much as possible."

What's the average stay in the NICU?

There is no set amount of time, as each baby faces his own medical challenges. "Some fullterm kids have trouble breathing at birth and are out in 24 hours. Very young preemies may stay for months," says Fumagalli. A long stay in the NICU doesn't necessarily mean a poor health outcome for your child. Still, waiting to take your baby home is difficult. "It's especially tough for parents who have a preemie who needs to be in the NICU for a long time, because it seems like nothing is happening," she says. "It's important to realize that your baby is growing like she would in the womb, and that takes time."

What happens when the baby is ready to go home?

Babies leaving the NICU often go home with medicine and equipment such as oxygen tanks, and they may still have trouble feeding, so the nurses carefully train parents to make sure they know how to do everything to take care of their baby. "We also help them learn to distinguish between signs of distress and ordinary responses from their baby," says Fumagalli. "For example, a premature baby's heart rate may go up noticeably while she feeds, which is nothing to worry about. And parents can always call us with questions when they need to." Some families visit the NICU when their babies reach milestones months after they've been discharged. "We love to see the kids thriving and healthy," Fumagalli says. "It's a great reminder that the NICU isn't a horrible place. Most babies leave here and grow into happy, healthy kids. You'd never know that they ever had a health problem."

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.