Patient education: What to expect in the NICU (The Basics)

What is the NICU? — 

"NICU" is short for "neonatal intensive care unit." It is a part of the hospital where doctors and nurses take care of babies who are sick or who were born too early. ("Neonatal" means newborn.)

The NICU is sometimes called the special care nursery, intensive care nursery, or newborn intensive care unit.

Why might my baby need to go to the NICU? — 

Your baby might need to go if they:

●Are born sick or premature (3 or more weeks before the due date)

●Have problems during birth, such as trouble breathing

●Have health problems within a few days of being born, such as:

•Jaundice (when the skin or white part of the eyes turn yellow)

•Problems with the heart, lungs, or intestines

•Symptoms of an infection

Who takes care of my baby in the NICU? — 

The doctors and nurses in the NICU are specially trained to take care of sick and premature newborns. The NICU staff might include:

●Neonatologist – This is the doctor in charge. They are trained in caring for newborn babies.

●Nurses – There will be 1 or more nurses assigned to take care of your baby.

●Respiratory therapist – This person helps with newborns' oxygen needs. They give treatments to help babies breathe.

●Nutritionist – This person is specially trained to make sure newborns get the calories and nutrients they need to grow.

●Specialists – These are doctors or other health professionals who are trained to:

•Treat problems with certain parts of the body, like the brain or heart

•Help your baby learn how to feed and move their arms and legs

What happens in the NICU? — 

In the NICU, you will probably notice:

●An incubator or "isolette" – This is a special bed that is surrounded by clear plastic to help keep your baby safe and warm. Sometimes, a "warmer" might also be used. This is an open bed with an overhead heater.

●Dim lights – This helps keep your baby calm.

●Tubes, wires, or machines connected to your baby – These help your baby get bigger and stronger so they can go home. Some of these things help the staff know when your baby needs help.

●Beeping or flashing alarms – These help the staff know when something needs their attention. The alarms can go off for many reasons. Often, they do not mean your baby is in distress. They can mean a medicine has run out or a monitor fell off. Sometimes, an alarm might be for something more urgent. The NICU staff can help you understand what the different alarms mean.

Some things that usually happen in the NICU include:

●Monitoring – The doctors and nurses carefully monitor (watch) each baby. You might see wires connecting your baby to a monitor (similar to a TV screen). These wires are attached to their skin with stickers and do not hurt the baby. The monitor keeps track of the baby's vital signs. Vital signs include temperature, heart rate, breathing rate, and blood pressure.

●Tests – The NICU doctors and nurses will probably do tests. These are to make sure they are giving your baby the best care. These might include blood tests, urine tests, ultrasounds, or X-rays.

●An "IV" (a thin tube placed in a vein) – This makes it easier for the doctors and nurses to give medicine and fluids to your baby. Sometimes, they might place an IV into a blood vessel in the umbilical cord. They can also use this type of IV to do blood tests.

●Medicines – Most babies in the NICU need 1 or more medicines. These can include:

•Antibiotics to fight infection

•Medicines to help their heart or lungs work

●Oxygen – Many babies in the NICU need extra oxygen for a little while. If they are having trouble breathing, they might be attached to a ventilator. This is a machine that helps them breathe.

●Other treatments – Depending on why your baby is in the NICU, they might need other treatments, too. For example, babies with jaundice are put under a special light.

The NICU staff might feed your baby, check their vital signs, and change their diaper in 1 session. This helps:

●Your baby rest or sleep for longer periods of time between care

●Reduce your baby's stress

How does my baby eat in the NICU? — 

It depends on how sick or how premature they are. Your baby might be able to breastfeed, or drink breast milk or formula from a bottle.

The baby might need a feeding tube. This is a small tube that goes into their mouth or nose, down their throat, and into their stomach. The tube can deliver breast milk or formula right into their stomach. For babies who are too sick to be fed even through a feeding tube, nutrition is given through an IV. The nurse might try to have your baby suck on a pacifier while they are being fed.

If you want to breastfeed your baby, talk to the NICU doctors and nurses. There are also breastfeeding experts called "lactation consultants" who can help. If your baby cannot suck from the breast, you can try using a breast pump. This is a device that pumps milk from the breasts. The milk can then be fed to the baby from a bottle or through a feeding tube. If your baby can't have milk yet, your breast milk can be frozen and stored to feed to your baby later.

Can I visit my baby in the NICU? — 

Yes. You can and should spend time with your baby in the NICU.

During your visits, the NICU staff can help you learn about:

●Holding your baby – You might be able to hold your baby. This can help you bond with them and comfort them. The doctor or nurse might suggest you try "skin-to-skin" care (figure 1). This is when you hold your baby on your bare chest while they are wearing only a diaper (and sometimes a hat). The baby should be covered with your shirt or a blanket to keep them warm.

You might not be able to hold your baby if they are very sick or were born very early. But you might still be able to hold your baby's hand or rest your hand on their head. Even if you cannot touch your baby at all, you can still talk or sing to them. The NICU doctors and nurses can teach you what kind of touch is safe for your baby.

●Preventing the spread of germs – Before going into the NICU, all visitors should wash their hands with hand sanitizer or soap and water. The staff might ask you and other visitors to clean your hands again before touching your baby.

●Your baby's cues – Even very young babies give signals or "cues" based on how they feel. The NICU staff can help you learn your baby's cues and what they mean. For example, if your baby is arching their back, scowling, or looking away from you, they might feel stressed. These can be signs they need rest and quiet. If they have their eyes open, are breathing comfortably, or turn toward your voice, these might be signs they are relaxed.

●Other visitors – Other family members can usually visit your baby in the NICU, too. But there might be rules about when they can visit and what they need to do. For example, they might need to wear special hospital gowns or masks. Children might not be allowed to visit, since they are more likely to carry germs that could hurt a very small or sick newborn.

When can I bring my baby home? — 

It depends on your baby's condition. For some health problems, a baby only needs to stay in the NICU for a few days. Babies who are very sick or premature might need to stay for weeks or even months.

Your baby's doctors and nurses will help you understand how your baby is doing and when they might be able to go home. You will also get instructions on how to take care of your baby at home, and what kinds of follow-up appointments your baby will need.

How can I get support while my baby is in the NICU? — 

Having your baby in the NICU can be hard and stressful. Social workers and hospital chaplains (spiritual counselors) can provide support during this difficult time.

There are also support groups for parents of sick or premature babies. It can help to talk to other people who are going through the same things. Try to get help from relatives and friends. That way, you will have support both in the hospital and at home.

More on this topic

Patient education: When a baby is born premature (The Basics)
Patient education: When your baby is measuring small during pregnancy (The Basics)
Patient education: Newborn screening (The Basics)
Patient education: Jaundice in babies (The Basics)
Patient education: Having twins (The Basics)
Patient education: Deciding to breastfeed (The Basics)
Patient education: Pumping and storing breast milk (The Basics)
Patient education: Enteral (tube) feeding (The Basics)
Patient education: How to care for a G tube or G button (The Basics)
Patient education: Benefits of breast milk for premature babies (The Basics)
Patient education: Skin-to-skin care with your newborn (The Basics)

Patient education: Jaundice in newborn infants (Beyond the Basics)
Patient education: Deciding to breastfeed (Beyond the Basics)
Patient education: Pumping breast milk (Beyond the Basics)