NICU

The birth of a baby is a wonderful yet very complex process. Many physical and emotional changes occur for mother and baby.

A baby must make many physical adjustments to life outside the mother’s body. Leaving the uterus means that a baby can no longer depend on the mother’s circulation and placenta for important physiologic functions.

Before birth, breathing, eating, elimination of waste, and immunologic protection all came from the mother. When a baby enters the world, many body systems change dramatically from the way they functioned during fetal life:

   The lungs must breathe air.

   The cardiac and pulmonary circulation changes.

   The digestive system must begin to process food and excrete waste.

   The kidneys must begin working to balance fluids and chemicals in the body and excrete waste.

   The liver and immunologic systems must begin functioning independently.

Your baby’s body systems must work together in a new way. Sometimes, a baby has difficulty making the transition to the world. Being born prematurely, having a difficult delivery, or birth defects can make these changes more challenging. Fortunately for these babies, special newborn care is available.

What is the neonatal intensive care unit?

Newborn babies who need intensive medical attention are often admitted into a special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced technology and trained health care professionals to provide specialized care for the tiniest patients. NICUs may also have intermediate or continuing care areas for babies who are not as sick but do need specialized nursing care. Some hospitals do not have the personnel or a NICU and babies must be transferred to another hospital.

Some newborn babies will require care in a NICU, and giving birth to a sick or premature baby can be quite unexpected for any parent. Unfamiliar sights, sounds, and equipment in the NICU can be overwhelming. This information is provided to help you understand some of the problems of sick and premature babies. You will also find out about some of the procedures that may be needed for the care of your baby.

Which babies need special care?

Most babies admitted to the NICU are premature (born before 37 weeks of pregnancy), have low birth weight (less than 5.5 pounds), or have a medical condition that requires special care. In the U.S., nearly half a million babies are born preterm, and many of these babies also have low birth weights. Twins, triplets, and other multiples often are admitted to the NICU, as they tend to be born earlier and smaller than single birth babies. Babies with medical conditions such as heart problems, infections, or birth defects are also cared for in the NICU.

The following are some factors that can place a baby at high risk and increase the chances of being admitted to the NICU. However, each baby must be evaluated individually to determine the need for admission. High-risk factors include the following:

Maternal factors:

   Age younger than 16 or older than 40 years

   Drug or alcohol exposure

   Diabetes

   Hypertension (high blood pressure)

   Bleeding

   Sexually transmitted diseases

   Multiple pregnancy (twins, triplets, or more)

   Too little or too much amniotic fluid

   Premature rupture of membranes (also called the amniotic sac or bag of waters)

Delivery factors:

   Fetal distress/birth asphyxia (changes in organ systems due to lack of oxygen)

   Breech delivery presentation (buttocks delivered first) or other abnormal presentation

   Meconium (the baby’s first stool passed during pregnancy into the amniotic fluid)

   Nuchal cord (cord around the baby’s neck)

   Forceps or cesarean delivery

Baby factors:

   Birth at gestational age less than 37 weeks or more than 42 weeks

   Birth weight less than 2,500 grams (5 pounds, 8 ounces) or over 4,000 grams (8 pounds, 13 ounces)

   Small for gestational age

   Medication or resuscitation in the delivery room

   Birth defects

   Respiratory distress including rapid breathing, grunting, or apnea (stopping breathing)

   Infection such as herpes, group B streptococcus, chlamydia

   Seizures

   Hypoglycemia (low blood sugar)

   Need for extra oxygen or monitoring, intravenous (IV) therapy, or medications

   Need for special treatment or procedures such as a blood transfusion

Who will care for your baby in the NICU?

The following are some of the specially trained health care professionals who will be involved in the care of your baby:

   A pediatrician with additional training in the care of sick and premature babies. The neonatologist supervises pediatric fellows and residents, nurse practitioners, and nurses who care for babies in the NICU.

   Respiratory therapists

   Occupational therapists

   Dietitians

   Lactation consultants

   Pharmacists

   Social workers

   Hospital chaplains

The members of the NICU team work together with parents to develop a plan of care for high-risk newborns. Ask about the NICUs parent support groups and other programs designed to encourage parental involvement.


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