10 Things to Expect in the NICU


For someone so tiny, a preemie can be surprisingly resilient.
For someone so tiny, a preemie can be surprisingly resilient.
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Although you expect some ups and downs when it comes to pregnancy, labor and delivery, few moms imagine their babies spending time in the neonatal intensive care unit, or NICU. But the most routine pregnancy or delivery can change course, and even if you know ahead of time that your little one might need extra care, it can still be a rough time for new parents.

While your NICU experience will probably make you feel anxious, knowing what's going on can help you feel more in control and let you stay focused on your little one. We have 10 things you can expect during your baby's stay.

10
Lots of People
Part of your NICU team
Part of your NICU team
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A baby in the NICU doesn't just have one doctor or nurse standing guard -- there's a whole team. It might be overwhelming to see that many people surrounding an infant, but keep in mind that they're all there with your baby in mind. Your NICU team will depend on the hospital, but here are a few people who are likely to be on it.

The neonatologist, a pediatrician who's had training in taking care of babies that are ill or born prematurely, is the head of the team. There will also be other doctors and nurses who have neonatal training as well as support staff, such as a respiratory therapist (who provides breathing support) and a speech-language pathologist (who works with swallowing or feeding problems). Your NICU team will also include a social worker, who can assist you with everything from handling your insurance benefits to dealing with your emotions. Get to know your baby's NICU team, because you're a part of it, too.

9
Lots of Machines
Those machines all signify the best medical attention money can buy.
Those machines all signify the best medical attention money can buy.
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It might be a little scary to see your baby covered in tubes and wires, but each of these machines has a specific purpose, and knowing what it is will help you feel less intimidated. Your baby will be in either an isolette (also called an incubator) or a radiant warmer. An isolette is a plastic box with holes that allow hands to reach through. Radiant warmers are open cribs with overhead heaters. Both keep your baby's temperature stable, but the isolette adds a layer of protection against noise and germs.

On to the tubes and wires. Babies in the NICU usually have an IV to deliver fluids and medication. If you see tubes in your baby's nostrils or windpipe, he or she is connected to a ventilator to help with breathing. Little adhesive pads on the chest mean that a cardiopulmonary monitor is tracking the baby's breathing and heart rates, while a pulse oximeter measures how much oxygen is in his or her blood. There may also be a probe to monitor temperature and a cuff to check blood pressure.

8
Lots of Tests
A jaundiced baby under phototherapy lights to break down the bilirubin
A jaundiced baby under phototherapy lights to break down the bilirubin
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To make sure the baby's doing well, the neonatologist will order various tests. The most common are blood tests that check blood oxygen, sugar, bilirubin and electrolyte levels and make sure there are no signs of anemia or infection. If your baby needs to have blood drawn often, the NICU team might place a central line in an artery so he or she doesn't have to be stuck each time. Nurses will also check the baby's urine (to make sure the kidneys are doing their job) and weigh him or her at least once a day.

A portable X-ray machine may make an appearance in the NICU to get a better idea of the baby's lung development. Ultrasounds, MRIs and CT scans check organ function, while heart problems require an echocardiogram.

7
Other Babies

At first, all you can do is focus on your own baby. But if he or she needs an extended stay in the NICU, you might become curious about the other babies.

There are a lot of reasons why infants might need the extra care. It could be something relatively simple -- maybe the baby went through a difficult delivery and just needs some monitoring. It could also be something serious. Premature babies often spend time in the NICU because they have a hard time breathing on their own. You might also see babies with jaundice or heart problems. Some NICU patients only stay for a few hours, but others might need extra care for months. Every baby in the NICU has his or her own story.

6
Bonding Opportunities
Skin-to-skin contact works for twins, too.
Skin-to-skin contact works for twins, too.
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Having your baby in the NICU might make you feel distant, but in reality, there are plenty of opportunities to bond with the baby and take a part in his or her care. Even if your baby is in an isolette and too fragile for you to hold, you can always touch and talk to him or her.

If you can hold your baby, the neonatologist may encourage skin-to-skin contact. This technique, also called kangaroo care, means that you open your shirt and hold your diaper-clad baby directly against your chest. Some doctors believe this type of contact can shorten a baby's stay in the NICU.

For other opportunities to get close, learn your baby's routine and find out where you can help, whether it's changing diapers or giving baths.

5
Feeding Opportunities
A baby born at 28 weeks in the NICU during a media tour for the March of Dimes' Prematurity Awareness Month at New York University Medical Center
A baby born at 28 weeks in the NICU during a media tour for the March of Dimes' Prematurity Awareness Month at New York University Medical Center
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You might think that since your baby's care is being overseen by medical professionals, you can't have anything to do with feeding him or her, but that's not true.

If you'd planned to breast-feed, you can feed your baby breast milk -- it's great for preemies and sick babies. He or she might not be strong enough to drink from your breast, but you can still pump and feed it to him or her with a bottle. The hospital will have lactation consultants on staff to assist you with breast-feeding and pumping.

If you're not breast-feeding, you can give your baby a bottle of formula at feeding time. For babies who can't drink from a bottle, breast milk or formula will be fed to him or her through a feeding tube that runs from the nose or mouth directly to the stomach, also known as gavage feeding. Nurses can show you how to take part in this, too.

4
War on Infection

It's very important to keep down the risk of infections in the NICU because preemies and sick babies are so susceptible to them. That's why there will be a sink with antibacterial soap near the entrance to the NICU and probably hand sanitizer dispensers placed around the area. Each time you enter, you'll need to wash your hands. You'll see the members of your baby's NICU team washing their hands constantly before touching him or her.

Depending on what's going on with the baby health-wise, you might also need to wear a sterile gown, a mask or gloves. It might feel strange that you're required to do this -- after all, you're not a stranger -- but remember that it's for the baby's protection. Even if you wash your hands, you could still bring in germs.

3
Strict Visiting Policies
A sterile gown may not be stylish, but it's safe.
A sterile gown may not be stylish, but it's safe.
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NICUs have different visiting policies, so find out yours before you or some of your relatives end up feeling very disappointed. Generally, you'll be able to visit whenever you want, and there are often cots or recliners for when you need to rest. If your baby will be in the NICU for a long time, ask your social worker if there's temporary housing available, such as a Ronald McDonald House.

For other visitors, however, there are posted visiting hours. Your parents may be able to come by themselves, but often any visitors have to be accompanied by you (and provide ID once they're there). Typically, NICUs don't allow children under the age of 14 to visit unless they're a sibling, and there are special guidelines even for siblings, like providing immunization records and getting their temperature taken.

2
An Emotional Roller Coaster
A baby in the Premature Unit at La Paz Hospital in Madrid
A baby in the Premature Unit at La Paz Hospital in Madrid
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Some parents with babies in the NICU have described the experience as riding a roller coaster. A baby might have a triumph one day and then a setback the next, which means you can go from happy to scared, angry or upset in a very short time.

Family members and friends will want to support you, so tell them what you need. Hospitals have chaplains who are there to listen, or you may feel more comfortable talking with your own minister, pastor, priest or rabbi. You might also consider joining a NICU support group if there's one available, or just get to know other parents of NICU babies who know what you're going through. Remember to take care of yourself, so you can be there for your baby when you're needed.

1
Requirements for Going Home
This baby's ready for the backseat -- and home.
This baby's ready for the backseat -- and home.
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Taking your baby home isn't always as simple as strapping him or her into his car seat and heading out. Before you go, you'll meet with your baby's medical team to make a plan for his or her care and schedule follow-up visits.

Many hospitals require you to take parenting classes or demonstrate basic skills, such as feeding and bathing your baby, to the NICU nurses before you can take him or her home. Some require you to learn CPR. If your baby needs to remain on machines, such as an apnea monitor, nurses will teach you how to use them. Some NICUs also offer rooming-in, a sort of trial run, in which you stay in a hospital room with your baby overnight and handle all of his or her needs with medical staff nearby to help.

Having a baby in the NICU is a scary time in any parent's life, but with the right information and enough support, you'll keep your calm and make it through.