We understand you will be anxious and worried about your baby and after admission to the NICU we will let you see him/her as soon as possible. Not all babies in the NICU are equally sick. Some require major treatments and others only require routine care and observation. During the first few hours of life, your baby may need many treatments and tests. These tests will vary, depending on your baby, and may include blood work, X-rays, intravenous starts, or procedures to help your baby breathe. The medical team will discuss specific issues with you and explain the risks and complications involved. We will ask for your consent before these treatments.
At first the NICU may feel very frightening and intimidating. The equipment that we use for patient care may have alarms that can make you anxious. This next section will explain some of the equipment and what it is used for.
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Isolettes / Open Care Beds - Isolettes or open care beds are used to keep your baby warm, in a quiet atmosphere. They also allow for close monitoring and easy access for the health care team if we need to perform any tests or procedures on your baby.
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Monitors - All babies that are admitted to the NICU are connected to monitors. These monitors provide the health care team with your baby’s heart rate, breathing rate, blood pressure and oxygen saturation. They have alarms that are set to ring if there is an increase or decrease from the normal ranges. They will also ring if your baby is active. The monitor allows for the health care team to know what your baby’s vital signs are at all times without disturbing your infant.
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Intravenous (IVs) - Many babies who come to NICU need to have an intravenous line put into a vein. The IV will provide fluid, sugar, antibiotics or nutrition (TPN) if this is what your baby requires. All intravenous infusions in the NICU are run on a continuous infusion pump.
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Ventilators / Respirators - Many babies in the NICU have problems breathing. For a premature infant, it is related to the immaturity of their lungs. Problems can range from needing a little bit of oxygen to needing a machine to help your baby breathe. The ventilator is a machine that is connected to your baby through a tube that goes into your baby’s lungs. There are a variety of ventilators used in the NICU and they provide a variety of support ranging from doing all of the breathing for your baby to just keeping your baby’s lungs slightly inflated to make his/her breathing easier. As your baby grows stronger and breathing improves the ventilator support is slowly removed. We will explain the process to you, and feel free to ask questions at anytime.
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CPAP (Continuous Positive Airway Pressure) - Nasal CPAP is given by small prongs or a mask that fits your baby’s nose. This provides small amounts of pressure to inflate your baby’s lungs and may also provide oxygen to your baby. When your baby is on CPAP they will be doing the breathing on their own, but the CPAP makes it a little easier.
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Nasal Prongs - Nasal prongs are tiny prongs that fit into your baby’s nose. These prongs are used to deliver oxygen if your baby needs it.
Developmental Care
Babies who are born prematurely require an environment which mimics that of their mother’s womb in order to continue developing in a healthy way. The NICU is such an environment. It is specially set up to support your baby’s growth and development. This includes keeping the noise level low, dimming the lights when possible, minimizing handling and covering isolettes to promote sleep.
Sleep time is very important to help infants in the development of their brains and to grow and recover from illness. Your baby’s health care team will do many things to promote sleep such as using rolls and blankets to keep the baby’s arms and legs close to their bodies for comfort, clustering the medical care that the baby needs around feedings and providing undisturbed sleep periods between feedings.
As members of your baby’s health care team, the family has a very important part to play in the growth and development of your baby. The nurses in the Neonatal Intensive Care Unit will provide you with information booklets that will help you understand some of the things that will promote growth and development of your infant, such as skin-to-skin cuddling (kangaroo care) and understanding your baby’s likes and dislikes. It is also important for you to think about how you can schedule your visits and cuddling times around your baby’s feeding schedule. This will maximize your baby’s sleep and development.
By working together we will provide the best care possible for the growth and brain development of your newborn baby.
Phototherapy
Approximately 80 per cent of premature infants and many full-term infants will develop jaundice in the first few days of life. Jaundice is caused from an increase of bilirubin in the blood and causes your baby’s skin and sometimes eyes to turn yellow. Jaundice is treated using a method called phototherapy. Lights are placed over, below, or around your baby to break down the bilirubin at the skin level. We will cover your baby’s eyes with eye patches to protect them from the light.
Routine tests in the NICU
Head ultrasounds are done on all babies that are less than 32 weeks gestation age or less than 1,500 grams at birth. They are done initially between 7 and 14 days of life, again at 6 weeks of life and at 40 weeks gestation age.
Eye exams are done on all babies that are less than 30 weeks gestation and less than 1,500 grams at birth. This exam is done at approximately 6 weeks of life.
Hearing tests are done on all babies admitted to the NICU prior to discharge.
Newborn blood screening is done on all babies admitted to the NICU within the first 72 hours of life. Babies less than 33 weeks gestation will require a repeat newborn screen at 3 weeks of life.
Feeding your baby
Nutrition is a very important part of your baby’s growth and development so the health care team will coordinate your baby’s specific needs. Sick babies and premature babies often have a hard time with feeding in the early days. At first your baby may be started on nutrition through an intravenous which is called Total Parenteral Nutrition (TPN). As your baby grows the TPN will be changed to breast milk or formula. Or your baby may be fed with a feeding tube . This is a tiny tube that is inserted into the nose and down into the stomach. Through this tube your baby may receive breast milk or formula.
The amount of feeding increases as your baby gains weight and his/her digestive system develops. Until your baby can coordinate sucking, swallowing and breathing, a pacifier may be given to encourage sucking.
At around 32 to 34 weeks gestation your baby will begin to be fed by breast or by bottle. The progression of feeding is slow and your baby will only be fed by mouth a few times a day at first. The rest of the feeds will be by tube. As your baby grows stronger the number of breast or bottle feeds will increase until your baby no longer needs the feeding tube at all. This progression of feeding will vary depending on your baby’s specific needs.
Coping with the NICU experience
As parents of an infant that has been admitted to the NICU you will experience many mixed emotions about your baby’s well being. You did not expect to deliver early or to leave the hospital without your baby. You may find it difficult to cope with the many ups and downs of your NICU experience without some stressful moments.
Feelings of frustration, anger, fear and anxiety are normal. Coping with an infant that is admitted to the NICU is very stressful and no one expects you to do it by yourself. Although all of these feelings are normal it will help if you talk about them. You may wish to talk with each other, with someone that is close to you, or with other parents who have infants in the NICU. The NICU staff are always available for you to share your feelings with, or you may wish to speak with our social worker.
