One of the major strengths of Children’s NICU is our family centered approach to care. Parents and caregivers are encouraged to partner with providers in decision-making and provide care along side the physician, nurses and therapists. Social workers, chaplains and child life specialists are available to assist with family needs as well.
The NICU Parent Advisory Council is a group of former NICU parents who have input in the program, policy and design of the NICU. Their expertise help shape NICU care. Children’s was chosen in 2005 as the region’s first hospital to have the March of Dimes NICU Family Support Program. The project provides information and emotional support to families throughout the hospitalization, during the transition to home and in the event of a newborn death.
Helpful Web Resources
Baby Steps to Home
March of Dimes: General infant information
National Institute of Health
Spenser’s Hope: Prematurity information and support
Association for Retinopathy of Prematurity and Related Diseases
National Organization for Rare Disorders
Procedures and Equipment in NICU
Children’s NICU has many complex machines and monitoring devices designed for the unique needs of tiny babies. There are mechanical ventilators (breathing machines), oxygen, medications, and supplies for medical care. Furthermore, there is technology to monitor nearly every system of a baby's body including body temperature, heart rate, breathing, oxygen and carbon dioxide levels, and blood pressure. The following list includes some of the monitoring equipment often used in the NICU:
- Heart or cardiorespiratory monitor — This monitor displays a baby's heart and breathing rates and patterns on a screen. Wires from the monitor are attached to adhesive patches on the skin of the baby's chest, abdomen and leg.
- Blood pressure monitor — Blood pressure is measured using a small cuff placed around the baby's upper arm or leg. Periodically, a blood pressure monitor pumps up the cuff and measures the level of blood pressure. Some babies need continuous blood pressure monitoring. This can be done using a catheter (small tube) in one of the baby's arteries.
- Temperature — A temperature probe is placed on the baby's skin with an adhesive patch. A wire connects the temperature probe to the overhead warmer (or isolette) to help regulate the heat needed to keep the baby warm.
- Pulse oximeter — This machine measures the amount of oxygen in the baby's blood through the skin. A tiny light is taped to the baby's finger or toe, or in very tiny babies, a foot or hand. A wire connects the light to the monitor where it displays the amount of oxygen in the baby's red blood cells.
- Ultrasound — In the NICU, ultrasound may be used to examine the heart, abdomen and internal structures of the baby's brain. Ultrasound is painless and provides much information about a baby's health.
- X-ray — Portable x-ray machines may be brought to the baby's bedside in the NICU. X-rays are taken for many reasons including checking the placement of catheters and other tubes, looking for signs of lung problems such as hyaline membrane disease and checking for signs of bowel problems.
- Computed tomography — CT scans are sometimes done to assess bleeding inside a baby's head. A CT scan is done in a special room and the baby will need a sedative medication so that he/she will be motionless for the exam.
- Magnetic Resonance Imaging (MRI)
- Endotracheal tube (ET)—This tube is placed through the baby's mouth or nose into the trachea (windpipe). The ET tube is held in place with special tape and connects to a mechanical ventilator (breathing machine) with flexible tubing. An x-ray is used to check the tube's placement. When a baby has an ET tube, he/she is unable to make sounds or cry.
- Respirator or mechanical ventilator—This machine helps babies who can not breathe on their own or who need help taking bigger breaths. High frequency ventilators give hundreds of tiny puffs of air to help keep a baby's airways open. Ventilators can also deliver extra oxygen to the baby.
- Continuous positive airway pressure (CPAP)—Through small tubes that fit into the baby's nostrils, called nasal CPAP, this machine pushes a continuous flow of air or oxygen to the airways to help keep tiny air passages in the lungs open. CPAP may also be given through an ET tube.
- Extracorporeal membrane oxygenation (ECMO)—This is a special technique for babies with respiratory disease that does not respond to maximum medical care. With ECMO, blood from the baby's vein is pumped through an artificial lung where oxygen is added and carbon dioxide is removed. The blood is then returned back to the baby.
Intravenous Line and Tubes
Because most babies in the NICU are too small or sick to take milk feedings, medications and fluids are often given through their veins or arteries. Babies may also need frequent lab tests and measurements of blood oxygen levels. There are several ways a baby may receive fluids and medications and have blood drawn without additional needle sticks, including the following:
- Intravenous line (IV) — Babies may have an IV placed in a hand, foot or scalp, where veins are easily accessed. Tubing connects the IV to a bag containing fluids that are carefully delivered with a pump.
- Umbilical catheter — After the umbilical cord is cut at birth, newborn babies have the short stumps of the cord remaining. Because the umbilical cord stump is still connected to their blood and circulatory system, a catheter (small flexible tube) can be inserted into one of the two arteries or the vein of the umbilical cord. Medications, fluids and blood can be given through this catheter. After placement of the umbilical catheter, x-rays are taken to check the location in the baby's body.
- Percutaneous line— A catheter is placed in a deep vein or artery in the baby's arm and is used for meeting a baby's longer-term needs than an IV in the hand or scalp.
A baby may need IV lines or catheters for just a short time or for many days. Once a baby is well enough to take milk feedings and is gaining weight, IV lines can often be removed. Sometimes, an IV may be needed for giving a baby antibiotics or other medication even when the baby can be fed normally.
Warmth and Temperature Regulation
Babies are not as adaptable as adults to temperature change. A baby's body surface is about three times greater than an adult's, compared to the weight of his/her body. Babies can lose heat rapidly, as much as four times more quickly than adults. Premature and low birthweight babies usually have little body fat and may be too immature to regulate their own temperature, even in a warm environment. Even full-term and healthy newborns may not be able to maintain their body temperature if the environment is too cold.
When babies are cold-stressed, they use energy and oxygen to generate warmth. If skin temperatures drop just one degree from the ideal 97.7° F (36.5°C), a baby's oxygen use can increase by 10 percent. By keeping babies at optimal temperatures, neither too hot or cold, they can conserve energy and build up reserves. This is especially important when babies are sick or premature.
Ways to keep babies warm
There are several ways to keep babies warm, including the following:
- Immediate drying and warming after delivery — A baby's wet skin loses heat quickly by evaporation and can lose 2 to 3°F (Immediate drying and warming can be done with warm blankets and skin-to-skin contact with the mother, or another source of warmth such as a heat lamp or over-bed warmer.)
- Open bed with radiant warmer — An open bed with radiant warmer is open to the room air and has a radiant warmer above. A temperature probe on the baby connects to the warmer to regulate the amount of warming. When the baby is cool, the heat increases. Open beds are often used in the delivery room for rapid warming. They are also used in the NICU for initial treatment and for sick babies who need constant attention and care. Babies on radiant warmer beds are usually dressed only in a diaper.
- Incubator/isolette — Incubators are walled plastic boxes with a heating system to circulate warmth. Babies are often dressed in a T-shirt and diaper.
Once a baby is stable and can maintain his/her own body temperature without added heat, open cribs or bassinets are used. Babies are usually dressed in a gown or T-shirt, a diaper and a hat. A baby can lose large amounts of heat through his/her head. Often, a blanket is wrapped snugly around the baby, called swaddling.
Parenting in the NICU
You can be with your baby in the NICU at any time. The staff of the NICU will give you instructions on special handwashing techniques before entering the area. Sometimes, masks are needed. Although the NICU permits visitation of babies by other family members, limiting visitors is a good idea. Many sick and premature babies are very susceptible to infection. Siblings should be carefully checked for signs of colds or other illness and helped with handwashing before visiting their baby brother or sister.
Most parents find that becoming involved with their baby's care gives them a sense of control and helps them become closer to their baby. This also is important for the baby, helping the baby feel secure and loved. Once a baby's condition is stable, parents are encouraged to hold and rock him/her. Staff in the NICU can show you how to care for your baby in many ways. Learning these aspects of care is helpful in preparing you to take your baby home.
Emotions and responses
Having a baby in the NICU can be a shock for many parents. Few parents expect complications of pregnancy or their baby to be sick or premature. It is quite natural to have many different emotions as you try to cope with the difficulties of a sick baby.
Some common responses to the experience of having a baby in the NICU are:
- Shock over the unexpected birth
- Mother's physical weakness after birth
- Disappointment over not having a healthy baby
- Feelings of helplessness
- Fear about procedures and tests
- Separation from baby
- Anger at self and others
- Feelings of guilt over things done or not done
- Crying, sadness, emotional, upset
- Fears of the future, worries about long-term outcome
Parents respond to these feelings in different ways. Some openly express their concerns, while others keep their feelings inside. Some parents may be hesitant to develop a close relationship with their baby, or delay naming the baby. Coping with all of these feelings and emotions is often easier with the help of support from others who have been through the experience. Be sure to ask about parent support groups and hospital staff members who can help.