What to Expect in the NICU
Nothing can fully prepare you for your baby's stay in neonatal intensive care unit, but understanding the layout, equipment, and tests done in the NICU can help.
If you went on a tour of the hospital where you'll deliver, chances are you never thought to check out the neonatal intensive care unit (NICU). Yet if your baby is born premature or very sick, this bustling, high-tech nursery is where she'll call home until she's healthy and strong. With its tangle of tubes and symphony of alarms, the NICU can be a scary place for already worried parents, but knowing exactly what you may encounter there can help you to feel empowered in caring for your baby.
Depending on the hospital, some NICUs are set up like large nursery-style rooms, with isolette cribs grouped according to severity of the infant's needs. But more hospitals are offering private set-ups, with each infant in a separate room that may also have sleeping accommodations for caregivers.
Monitors and Alarms
Newcomers to the NICU are often surprised by how noisy it can be. That's because every baby is hooked up to monitors that sound an alarm whenever certain vital signs—like heart rate, oxygen levels, respiratory rates, blood pressure, and temperatures—or fluid levels from an IV or breast milk pump change.
Don't panic if you hear alarms going off—many are simply cautionary. "Most babies in the NICU, regardless of how severe their illness is, receive the same type of monitoring and basic equipment," explains Amy Hair, M.D., a neonatologist at Texas Children's Hospital in Houston. The alarms "are protective and help us respond quickly to the immediate needs of their baby," says Liz Drake, a clinical nurse specialist with CHOC Children's at Mission Hospital in California.
Isolettes and Warmers
Because preemies have a hard time regulating their body temperature, almost all babies in the NICU stay in isolettes, formerly called incubators, which help keep newborns warm. You may also see another type of crib, called a radiant warmer, which is usually for babies born closer to 40 weeks and features an open flat bed with a smaller warmer above, says Dr. Hair.
Jaundice, a condition caused by high levels of bilirubin that leads yellowing of the skin and eyes, is very common in premature babies. To treat it, babies are placed under bright blue lights, called bililights, for three to seven days of phototherapy. Your baby may look like he's receiving a tanning treatment, complete with special glasses to protect his eyes.
Speaking of light, expect the nursery to be dimmed and blankets to be draped over some incubators. Because premature babies' eyes aren't developed enough to adjust to light outside of the womb—their pupils can't constrict until after 32 to 34 weeks' gestation—the shade is a must, Drake says.
Their lungs are underdeveloped, so preemies often require respiratory support. Some common helpers include:
- Ventilators. If your baby has trouble breathing on her own, a ventilator will do the breathing for her by delivering air to the lungs through a tube in her mouth.
- Oxygen masks and hoods. These pieces, which attach to the baby's face or nose or fit loosely around the head, help deliver oxygen.
- CPAP. This machine provides continuous positive airway pressure to your baby's lungs, which helps them work more effectively.
Machines and Tubes
Of all the parts of the NICU, the snaking tubes and hissing machines may be the toughest for worried parents to see. When Jessica Watson first wheeled into the NICU to see her triplets—two daughters and one son—she felt helpless and overwhelmed. "I turned from isolette to isolette just watching my tiny preemies," she says. "It was incredibly emotional to see my babies hooked up to so many machines."
Although Watson says she's a "wimp" around hospitals, she felt empowered after learning what her babies were hooked up to. "You want to know exactly what is going on and take part in their care in any way possible, so you get used to all of the medical equipment quickly," she says. Some of the most common ones? IVs, monitor leads and wires on the baby's chest, and small tubes entering the baby's nose.
Even after learning how the equipment works, you may feel apprehensive about touching your baby, for fear of displacing the tubes and monitors. Don't be scared, says Dr. Hair. "Although their baby is attached to equipment, we still often feel comfortable having the parents hold and cuddle their babies," she says. In fact, except in very rare cases, parents are encouraged to touch and hold their babies as much as possible. Skin-to-skin contact, or kangaroo care, helps stabilize a preemie's breathing and temperatures, and hearing a parent's voice can be calming. "Babies recognize their mother's voice," says Susan Malfa, RNC, MSN, Regional NICU nurse manager for Maria Fareri Children's Hospital at Westchester Medical Center in Valhalla, New York.
Which tests are performed on your baby depends on her illness, but some common ones include:
- Blood tests. The information gleaned from blood tests helps the medical team know how to treat the infant soon after birth and is used to screen for a variety of long-term diseases.
- X-rays. Premature babies often have an X-ray of the lungs to make sure they're well expanded and to check for signs of premature lung disease, says Dr. Hair.
- Hearing screening. All babies have a hearing screen prior to discharge to ensure that they are hearing correctly.
Sometimes more specialized testing is needed, such as CTs or MRIs to look at the brain, echocardiograms to see how the heart is functioning, and radiographs to look for problems associated with the gastrointestinal tract, says Niceta Bradburn, M.D., neonatologist and medical director of Women's and Children's Services at St. Vincent Healthcare in Indiana.
Of course, as helpful as all the specialized equipment, testing, and staff are, nothing can replace you. "A parent is the most important person in their infant's life," says Drake. "Understanding [the baby's] medical care and being partners with the health-care team in caring for their infant is immeasurable. It's the best medicine."
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