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Around 10 to 15 percent of all babies born in the US need to spend time in a neonatal intensive care unit (NICU). Babies most often need extra care to assist them with breathing until their lungs have matured.

There are many reasons why your baby may need special care, the most common one being prematurity (being born before 37 weeks). Babies may need to spend days, weeks, or sometimes months in a NICU until they are big enough and well enough to go home.

Neonatal intensive care unit

If your baby is in a NICU, this is a particularly stressful time. It helps to understand a bit about who will be caring for your baby, what they will be doing, and how to make sure you’re fully informed at all times.

In the US, most hospitals have a unit to provide special nursing and medical care for babies; these are divided into three levels depending on the degree of care offered. Level one is the most basic level. These units don’t provide long-term ventilatory support, but they are expert at caring for babies who are slightly premature, need frequent nursing, or have previously been ventilated and are ready to be transferred to less intensive care. Level two units ventilate and give intensive care to babies from 26 weeks’ gestation. Level three units offer intensive care for babies born as early as 23 weeks, and can often do neonatal surgery.

All these units are staffed by special nurses and doctors who will be happy to show you around before the baby is born if there is time.

Ward rounds

Most units have rounds each morning, and the more intensive units will have another round later in the day. Some allow parents to be present and to ask questions during rounds, while others prefer parents to wait outside and then make time to talk to them afterward.

Communication and visiting

You may be able to spend some time with your baby before he is sent to a NICU. However, if your baby needs to be on a ventilator, or has another serious problem, he will be sent immediately to neonatal intensive care, and you may not have any time together after the birth. You’ll be encouraged to see your baby as soon as he has been transferred, and if you’re unable to go immediately, you may be given a photo of your baby.

You should be able to see your baby any time of the day or night and the nurses will be happy to update you regularly. The doctors will also give you an update on an ad hoc basis or arrange to meet you for a more formal chat. Other family members may be able to visit the unit with your permission.

You will both be encouraged to touch, stroke, and caress your small baby, and to spend as much time as possible talking and singing to him.

Your baby’s care

While your baby is in the NICU, he may be treated with medication and have various tests and checkups. In some cases, he will need to be on a ventilator.

Tests and X-rays

Your baby may have blood tests to check for infection and anemia, to check kidney function, oxygen, and carbon dioxide levels, sugar levels, and to identify his blood group. The frequency of these depends on how ill or premature your baby is. In neonatal intensive care babies need blood tests periodically. Some babies need an X-ray while they’re there, and very premature babies often need many chest X-rays and sometimes abdominal ones.

Assisting your baby

Some babies need a little extra oxygen, while others need constant oxygen through a nasal tube. For very premature babies, a tube may be placed into the trachea (windpipe) and connected to a ventilator that blows oxygen into the lungs. Babies are monitored to see when they can be weaned off the ventilator.

Most babies in intensive care need one or more IVs to give fluids, blood, and antibiotics. Very small babies may be fed through a long, fine feeding tube running through the mouth or nose to the stomach. They may also need at least one blood transfusion, for some cases of conditions like anemia and jaundice.

Antibiotics are often given to prevent infection. Some babies need medicine to keep their blood pressure up, and many who are ventilated need medicine to sedate them and to prevent or treat pain.

The role of parents

How you can help your baby

For most, the experience of having their baby in a NICU is extremely stressful. Parents may feel that they have no role in the care of their baby; however, this is not the case. The most important thing you can do for your baby is to start expressing breast milk. Breast milk will nearly always be the best milk for a premature baby and can be stored in a freezer until needed.

You may be able to touch and stroke your baby and can be helped to cuddle him while he is on a ventilator. Babies thrive on skin-to-skin contact, called kangaroo care. You’ll be encouraged to tuck your baby on your chest inside your shirt so that he can enjoy a close bond. Talking, reading, and singing to your baby helps him become familiar with you. You may be able to change his diaper and help with feedings, even if these are through a nasogastric tube.

Spend plenty of time with your baby, especially when breast-feeding since this may help the letdown reflex , but save some time for yourself too so that you conserve energy for when you return home with your baby.

Carrying your baby close to your body and enjoying skin-to-skin contact together will help your tiny baby thrive.

Babies who are nursed in a quiet, calm environment progress better

Research shows that babies who are cared for in quiet units with subdued lighting go home sooner that those who are nursed in a noisy unit with bright lights on throughout the day and night.

Your baby’s caregivers

Who’s who on the neonatal unit
Neonatal nurses

Most of the care in a neonatal intensive care unit is carried out by highly trained nurses. These include registered nurses and neonatal clinical nurse specialists who have advanced training. Some intensive care units also have neonatal nurse practitioners, who have advanced education and training and can perform many procedures.

Doctors

Neonatologists are the doctors who run the neonatal intensive care units. These are the doctors who will coordinate your baby’s daily care plan. They are pediatricians who have received advanced training to care for sick and premature newborns. The neonatologist in charge of the department is known as the attending doctor. In addition to neonatologists, there are often neonatology fellows and pediatric residents, as well. Neonatology fellows are pediatricians who are getting advanced training to care for sick newborns. Pediatric residents are doctors who are being trained in the specialty area of pediatrics.

Other members of staff

A neonatal intensive care unit depends on a number of other staff members. These include a registered dietitian, physical and occupational therapists, technicians (who can draw blood or take X-rays), pharmacists, and, in some neonatal intensive care units, a psychotherapist to offer much needed emotional support to parents.

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