The Neonatal Intensive Care Unit (NICU)

Newborn babies who need intensive medical care are often put in a special area of the hospital called the neonatal intensive care unit (NICU). The NICU has advanced technology and trained healthcare professionals to give special care to the tiniest patients. NICUs may also care areas for babies who are not as sick but do need specialized nursing care. Some hospitals don’t have the staff for a NICU and babies must be moved to another hospital. Babies who need intensive care do better if they are born in a hospital with a NICU than if they are moved after birth.

Care for your baby in the NICU by-


heartbeat

  • Neonatologist. This is a pediatrician with extra training in the care of sick and premature babies. The neonatologist (often called the attending physician) supervises pediatric fellows and residents, nurse practitioners, and nurses who care for babies in the NICU.

  • Neonatal fellow. This is a pediatrician getting extra training in the care of sick and premature babies. He or she may do procedures and direct your child's care.

  • Pediatric resident. This is a doctor who is getting extra training in the care of children. He or she may do or assist in procedures and help direct your child's care.

  • Neonatal nurse practitioner. This is a registered nurse with extra training in the care of newborn babies. He or she can do procedures and help direct your child's care.

  • Respiratory therapist. This is a person with special training in giving respiratory support. This includes managing breathing machines and oxygen.

  • Physical, occupational, and speech therapists. These types of therapists make sure a baby is developing well. They also help with care including positioning and soothing methods. Speech therapists help babies learn to eat by mouth.

  • Dietitians. Dietitians ensure the babies are growing well and getting good nutrition. They watch your baby's intake of calories, protein, vitamins, and minerals.

  • Lactation consultants. These are healthcare providers with extra training and certification in helping women and babies breastfeed. They can help with pumping, maintaining milk supply, and starting and continuing breastfeeding.

  • Pharmacists. Pharmacists help in the NICU by assisting the care providers choose the best medicines. They check medicine doses and levels. They keep the team aware of possible side effects and monitoring that may be needed.

  • Social workers. Social workers help families cope with many things when a child is ill. They give emotional support. They help families get information from healthcare providers. They support the family with other more basic care needs, too. These can include money problems, transportation, or arranging home healthcare.

  • Hospital chaplain. The hospital chaplain may be a priest, minister, lay pastor, or another religious advisor. The chaplain can give spiritual support and counseling to help families cope with the stress of the NICU.


    Equipment That Is Used in the NICU 

    Neonatal Intensive Care Units (NICUs) have complex machines and devices for the unique needs of tiny babies. The NICU can be overwhelming to a new parent. Learning about what to expect in the NICU can help ease your concerns.

    Some of the equipment often used in the NICU includes:

    • 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, and abdomen. 

    • 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 1 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 incubator) 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 foot or hand. A wire connects the light to the monitor where it displays the oxygen saturation or "sat." This refers to the amount of hemoglobin in the baby's red blood cells that is saturated with oxygen.

    • X-ray. Portable X-ray machines may be brought to the baby's bedside in the NICU. X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays are taken for many reasons including checking the placement of catheters and other tubes, looking for signs of lung problems, such as respiratory distress syndrome or pneumothorax, and checking for signs of bowel problems.

    • CT scan. A CT scan is a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. 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 may need a sedative medication so that he or she will be motionless for the exam.

    • MRI. MRI is a procedure that uses a large magnet, radio waves, and a computer to make detailed images of organs and other tissues in the body. Like a CT scan, MRI is done in a special area of the hospital. It is often done to examine a baby's brain stem, spinal cord, and soft tissues. The baby will need a sedative medicine so that he or she will lie still for the exam.

    • 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 or she is unable to make sounds or cry.

    • Respirator or mechanical ventilator. This machine helps babies who can't breathe on their own or who need help taking bigger breaths. High frequency ventilators give hundreds of very fast puffs of air to help keep a baby's airways open. Ventilators can also give 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 to the airways to help keep tiny air passages in the lungs open. CPAP can give extra oxygen as well. It may also be given through an ET tube.

    • Extracorporeal membrane oxygenation (ECMO). This is a special treatment 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. ECMO is only used in specialized NICUs.

Watching your baby's electrolyte and blood levels

    • Hypernatremia. This is high amounts of sodium (salt) in the blood.

      • Hyperkalemia. This is high amounts of potassium in the blood. It can be diagnosed by blood test. Or it can be diagnosed by changes in the baby's heart rate pattern.

        • Hyperglycemia. This is high amounts of glucose (sugar) in the blood. It is diagnosed by blood tests, often done by heel stick. Some babies may need insulin to control high glucose levels.

          • Hypoglycemia. This is low blood sugar. It is usually treated with IV fluids that have dextrose. This is a type of sugar.

            • Hypocalcemia. This is low calcium levels in the blood. It is usually treated with calcium in IV fluids.

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