NICU

NICU (pronounced "Nickyoo") stands for Neonatal Intensive Care Unit. The NICU is a specialized nursery for premature infants and very sick babies. Sometimes the NICU is also called:

•   a special care nursery
•   an intensive care nursery
•   newborn intensive care

Babies who need to go to the unit are often admitted within the first 24 hours after birth. Babies may be sent to the NICU if:

•   they're born prematurely
•   difficulties occur during their delivery
•   they show signs of a problem in the first few days of life Only very young babies (or babies with a condition linked to being born prematurely) are treated in the NICU - they're usually infants who haven't gone home from the hospital yet after being born. How long these infants remain in the unit depends on the severity of their illness.

Who Will Be Taking Care of My Baby?
Although there will be many people helping your child during the NICU stay, those who are the most responsible for your baby's day-to-day care will likely be nurses, whom you may come to know very well and may rely on to give your information and reassurances about your baby. The nurses you may interact with include a:

•   charge nurse (the nurse in charge of the shift)
•   primary nurse (the one assigned to your baby)
•   clinical nurse specialist (someone with additional training in neonatology care)

You'll also meet many other people who may help care for your baby:

•   a neonatologist (a doctor specializing in newborn intensive care who heads up the medical team)

•   neonatology fellows, medical residents, and medical students (all pursuing their training at different levels)

•   various specialists (such as a neurologist, a cardiologist, or a surgeon) to treat specific issues with the brain, the heart, etc.

•   a respiratory therapist (who administers treatments that help with breathing)

•   a nutritionist (who can determine what babies on IV nutrition need)

•   a physical therapist and/or occupational therapist (who work with feeding and movement issues with the infants and their parents)

•   a pharmacist (who helps manage your baby's medications)

•   lab technicians (who process the laboratory tests - i.e., urine, blood - taken for your baby)

•   a chaplain (who can counsel you and try to provide comfort; chaplains may be interfaith or of a particular religious affiliation but they're there to support anyone looking for a spiritual/religious connection)

•   a social worker (who helps you get the services you need and also lends emotional support by connecting you to other families and therapists, if needed) 

There are three different NICU levels. A level III NICU is the best for the worst cases.
To better help you help your baby during his or her time in intensive care, it's a good idea to get as much information as possible about what to expect. If you have questions throughout your baby's stay in the unit, talk to the neonatologist or the nurses.

The nurses see your baby every day, so they can give you frequent updates on your little one. Remember, though, that nurses do not make diagnoses. To discuss a diagnosis or your baby's overall plan of care, find the neonatologist or the resident. They have all the information about your baby and can talk to you about the big picture.

Some things you might want to ask the neonatologist and/or the nurses include:

•   How long will my baby be in the unit?
•   What, specifically, is the problem?
•   What will be involved in my baby's treatment and daily care?
•   What medicines will my baby have to take?
•   What types of tests will be done on my baby?
•   What can my baby eat and when?
•   Will I be able to nurse or bottle-feed my baby - if so, when and   how?
•   Will someone help me learn how to nurse my baby?
•   What can I do to help my baby?
•   Will I be able to hold or touch my baby?
•   How often and for how long can I stay in the unit? Can I sleep there?
•   What sort of care will my baby need when we get home?
•   Is there someone who can help us through the process?

You may also want to talk to the nurses in more detail to find out more about your baby's daily care and what to expect when you spend time with your little one. You should also learn the visiting schedule and any rules of the NICU so you'll know which family members can see the baby and when they can visit.

You may also want to ask the social worker some of the following questions:

•   Where can we get food when we're here?
•   Can we eat in the NICU?
•   Are there cots or recliners available if we're allowed to stay overnight? What about blankets and pillows?
•   Is there nearby temporary housing available (such as through the Ronald McDonald House)?
•   If so, how do we get a room?
•   Is the room free?
•   If not, is the cost low and/or covered by our health insurance?
•   Are there computers, with Internet access, available for doing work or emailing friends and loved ones about our baby's progress?
•   Are there phones available in or around the NICU?
•   Can we use our cell phones in the NICU? If not, can we be reached in the NICU?
•   Is there a support group or other parents of children in the NICU we can talk to?

What Can I Expect in the NICU?

Walking into the NICU can feel like stepping onto another planet - the environment is probably unlike anything you've experienced. The unit is often busy, with lots of activity, people moving around, and beeping monitors. Sometimes the lighting is intense, although the staff usually tries to control the level of brightness in the room.

Once your baby is settled in the unit, he or she will receive care tailored to your little one's specific needs. Most NICU babies are on special feeding schedules, depending on their level of development or any problems they have. For instance, some infants are too premature or too sick to eat on their own, so they have a feeding tube that runs through the mouth and into the stomach. Others need high-calorie diets to help them grow.

Medications are another crucial part of NICU care - your child may take antibiotics, medicine to stimulate breathing, or something to help his or her blood pressure or heart rate, to mention just a few.

To ensure that your baby's care stays on track, the doctors will also order various tests, possibly including periodic blood and urine tests, X-rays, and ultrasounds. For infants whose care is complicated and involved, the doctors or nurses will place a line into an artery or vein so they can draw blood without having to repeatedly stick the baby. NICU staff tries to make the infants' stay in the nursery as comforting as possible to the infant as well as to the families.

At the beginning or as your baby's stay in the NICU goes on, the nurses can explain what all of the monitors, tubes, tests, and machines do, which will go a long way toward demystifying the NICU.

In the meantime, here's a brief look at what some of the unfamiliar equipment does and how it may help your baby, depending on your little one's condition and diagnosis:

* Feeding tubes: Frequently, NICU babies are unable to get as many calories as they need through regular feeding from a bottle, so the nurses will use a small feeding tube to deliver formula or breast milk (that the mother pumps). The tube is either placed into the baby's the stomach through the mouth or by the nose.

If an infant is able to take some milk from the bottle, the nurse will just give the rest through the feeding tube. Sometimes, the babies get all their nutrition through the feeding tube so that they don't use excess energy trying to feed from the bottle.

The feeding tubes shouldn't be painful - they're typically taped in place so they don't move around and cause friction problems. However, if they're there for a long time they can cause erosions in the stomach or nose where they rub.

* Infant warmers: These are beds with radiant heaters over them. Parents can touch their babies in the warmers, but it's always a good idea to talk to the NICU staff about it at first, just in case.
* Isolettes: These are small beds enclosed by clear, hard plastic. The temperature of the isolette is controlled and closely monitored because premature infants frequently have difficulty maintaining their body temperature. Holes in the isolettes allow access to the infants so the nurses and doctors can examine the infants and parents can touch their babies.
* IVs and lines: An intravenous catheter (or IV, for short) is a thin, flexible tube inserted into the vein with a small needle. Once in the vein, the needle is removed, leaving just the soft plastic tubing.

Almost all babies in the NICU have an IV for fluids and medications - usually in the hands or arms, but sometimes in the feet, legs, or even scalp. At first, the IV may be inserted in the baby's umbilical cord. In the first hours after delivery, the umbilical cord provides a way for the doctors to insert arterial or venous lines into the infant without having to use a needle through the skin.

Instead of giving your baby injections every few hours, IVs allow certain IV medications to be given continuously, several drops at a time. These are known as drips. Doctors may use these medications to help with heart function, blood pressure, or pain relief.

Some situations require larger IVs that can be used to deliver larger volumes of fluids and medications. These special IVs are known as central lines because they're inserted into the larger, more central veins of the chest, neck, or groin, as opposed to the hands and feet.

Arterial lines are very similar to IVs, but they're placed in arteries, not veins, and are used to monitor blood pressure and oxygen levels in the blood (although some babies may simply have blood pressure cuffs instead).

* Monitors: Infants in the NICU are attached to monitors so the NICU staff is consistently aware of their vital signs. Because they're monitored, the nurses will often place the infants in positions that seem the most soothing, like on their tummies or on their sides.

The single monitor (which picks up and displays all the necessary information in one place) is secured to your baby's body with chest leads, which are small painless stickers connected to wires. The chest leads can count your child's heart rate and breathing rate. A pulse oximetry machine (or pulse ox) may also display your baby's blood oxygen levels on the monitor. Also painless, the pulse ox machine is taped to your baby's fingers or toes like a small bandage and emits a soft red light.

A temperature probe, which is also a coated wire, adhered to your baby's skin with a patch, can track your little one's temperature and display it on the monitor. And unless your baby's blood pressure is being directly monitored through an arterial line, your baby will usually have a blood pressure cuff in place as well with the monitor showing the blood pressure readings.

* Phototherapy: Often, premature infants or those who have infections have jaundice (a common newborn condition in which the skin and whites of the eyes turn yellow). Phototherapy is used to help get rid of the bilirubin that causes the jaundice. The infants can have a special light therapy blanket that they lie on top of and lights that are attached to their beds or isolettes. Usually, they only need phototherapy for a few days, depending on the reason for the jaundice.
* Ventilators: Babies in the NICU sometimes need extra help to breathe. The infant is connected to the ventilator (or breathing machine) via an endotracheal tube (a plastic tube that's placed into the windpipe through the mouth or nose). Babies who've been in the NICU for a prolonged stay - months at a time- may have a tracheostomy (a plastic tube inserted directly into the trachea) that's connected to the ventilator on the other end. There are many different kinds of ventilators - different situations call for different machines - but they all accomplish the same basic purpose: to help your child breathe.
Although you want to make time for interacting with your infant, you also want to allow him or her to have periods of undisturbed sleep. Let your baby set the pace for your time together and you'll both get more out of it.

What Else Do I Need to Know?
Here are some basics to help make the NICU a little less mysterious:

Everyone who comes into the NICU must wash their hands when they enter. (There will be a sink and antibacterial soap in the room.) This is a crucial part of keeping the NICU environment as clean as possible so the babies won't be exposed to infections. Some units require visitors to wear hospital gowns, particularly if your child is in isolation. You may also need to wear gloves and a mask.

Ask the nurses what you're allowed to bring into the unit - the risk of infection limits what you can leave with your baby. Some parents tape pictures to the isolette or decorate the incubator. If you want to give your child a stuffed toy, the staff may wrap it in plastic first.

When you're in the NICU, keep noise and bright lights to a minimum. Try not to bang things on the isolette or infant warmer, talk in a loud voice, or slam doors. If you're concerned about light, ask a nurse if you can drape a blanket partially over the isolette. Most importantly, let your baby sleep when he or she needs to. 

Marissa had received 2 doses of SURFACTANT, a substance formed in the lungs that is needed to keep the air sacs in the lungs open. Marissa required mechanical ventilation for over one week to assist her breathing, as well as oxygen during the first month of life. Marissa had two head ultrasounds. The first ultrasound showed abnormal increased echogenicity in the periventricular white matter, on the second ultrasound it was within normal limit. She had two cardiac echos, the first one revealed a moderate patent ductus arteriousus, and in the second there was no evidence of that problem. Her hearing and eye exams were both normal. One day before Marissa was released she had an inguanal hernia repair, the surgery was fast and everything turned out ok.
Marissa was diagnosed with the following:

Hyaline Membrane Disease- A lung disorder that results in breathing difficulties and an insufficient level of oxygen in the blood.

Apnea- A pause in breathing that lasts 20 seconds or longer.

Bradycardia- A steady, but slower than normal, heartbeat rate in a newborn. Bradycardia is a heartbeat rate below 100 beats per minute.

Umbilical Hernia- A soft protrusion of bowel or peritooneum at the umbilicus caused by a weakness in the abdominal wall.

Bilateral Single Palmar Creases- A single crease across the palm of the hand. This is a common feature of Down Syndrome and other syndromes.