The neonatal intensive care unit (NICU) is a highly specialized unit which focuses on the care of sick and premature babies. Most people are not even aware that such a unit exists. To a new parent, the NICU can be a very intimidating and scary place.
Delivering a sick or premature baby can be strenuous enough; combine that with the separation of mother and baby and the busy sounds of the NICU, it’s no wonder why many parents find the NICU an overwhelming experience. Learning the generalities of this unit can help ease the transition in the event that your baby visits the NICU.
First, let’s take a look at the type of babies that may visit the NICU. Typically, this includes premature babies less than 37 weeks. Any baby born at 35 weeks or younger is an automatic NICU admission since these babies will need closer monitoring. However, babies born after 37 weeks may also visit the NICU. Some typical reasons for this include:
- To rule out infection
- For respiratory distress
- For low blood sugar (also known as hypoglycemia)
- For birth defects (e.g. spina bifida, heart abnormalities, gastrochisis, etc.)
- For narcotic withdrawal (e.g. heroin, cocaine, methadone, etc)
NICUs are usually classified as either Level II (also called the Special Care Nursery) or Level III (Intensive Care Nursery)
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and are staffed with specially trained doctors (neonatologists), nurses and respiratory therapists. Some units also have neonatal nurse practitioners (NNPs) on staff. These master degree nurses assist the neonatologist with procedures and the plan of care for the babies in the NICU.
The sounds of alarms and high tech equipment can be very unnerving to new parents. Here’s a brief overview of the most common equipment that you will see in this unit:
- Heart monitors: This piece of equipment is standard in every NICU and is used to monitor a baby’s heart rate, respiratory rate and oxygen saturation (which shows how well a baby is oxygenating). There are three heart monitor leads that connect the baby to the monitor: 2 leads are placed on either side of the chest and 1 lead is usually placed on the left upper quadrant of the abdomen. The oxygen saturation is monitored via a pulse oximeter (a.k.a. pulse ox) which will be placed on an extremity (usually a foot) and has a red illuminating light.
- Warmer: An open bed with an overhead heater which a baby is placed on initially and until they are stable enough to move to an isolette.
- Isolette: An insulated bed which helps maintain an optimal temperature for the baby and decreases stimulation from light and noise. The baby will remain in the isolette until he/she is able to move to an open crib.
- Ventilator: A respiratory equipment used to assist in ventilation. Babies who require the use of a ventilator will have a tube in either their mouth or one nostril that will extend down into their windpipe and inflate the lungs with air. Supplemental oxygen can also be delivered if need be.
- Nasal CPAP (NCPAP): An apparatus which is placed into both nostrils and provides a specified pressure into the lungs to help facilitate expansion and oxygenation. This machine is used to provide pressure to help keep the lungs open and can provide supplemental oxygen if needed.
- IV: Most babies in the NICU will require some form of intravenous access to provide fluid and nutrition until they are stable enough and are able to get this nutrition via breastmilk or formula. IVs are also used to administer antibiotics. An IV is usually inserted into an extremity and in some cases in the scalp. Scalp veins are usually reserved until there is no other possibility since they illicit panic in most parents. Just a word of advice, scalp IVs are very superficial and do not in any way protrude into a child’s brain.
Central IV lines: These IVs last longer than regular IVs and are reserved for those infants who will be on IV therapy for some time. Central lines can be inserted into the umbilical cord, through the chest or through an extremity. Central lines inserted through an extremity are called PICC (peripherally inserted central catheters) lines. PICC lines are very common in the NICU.
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- IV pumps: These pumps monitor the amount of IV fluids that are administered to a baby.
- Medication pumps: These pumps are used to infuse medications over a specified time. They can also be used to administer feedings.
- Feeding tubes: Premature babies, babies in respiratory distress and babies who have difficulties eating by breast or bottle will be fed via a feeding tube. Feeding tubes will be inserted into either a nostril (nasogastic tube) or the mouth (orogastric tube) and extend into the stomach.
- Emergency equipment: Every baby in the neonatal intensive care unit will have an ambu bag with a removable mask and suction available at the bedside. This is not to say that every baby will require the use of these devices, but they are available at the bedside in the event of an emergency.
The NICU experience can feel like a rollercoaster ride. Learning about the sights and sounds can help make the experience a bit less intimidating. Remember, the staff is available to you 24/7 to answer any questions that you may have so do not hesitate to ask.
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Author : Diba Tillery RN, BSN, IBCLC, CPST