The Neonatal Intensive Care Unit (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 body functions.

Before birth, a baby’s breathing, eating, elimination of waste, and immune protection all come from the mother. When a baby enters the world, many body systems change dramatically from the way they worked 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 immune systems must begin working independently.

Your baby's body systems must work together in a new way. Sometimes, a baby has trouble making the transition to the world. Prematurity, 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 healthcare 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 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 transferred after birth.

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 health condition that requires special care. In the U.S., nearly half a million babies are born preterm. 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 health conditions such as breathing trouble, 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:

  • Younger than age 16 or older than age 40

  • Drug or alcohol exposure

  • Diabetes

  • High blood pressure (hypertension)

  • 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:

  • Changes in a baby’s organ systems due to lack of oxygen (fetal distress or birth asphyxia)

  • Buttocks delivered first (breech delivery) or other abnormal presentation

  • The baby's first stool (meconium) passed during pregnancy into the amniotic fluid

  • Umbilical cord wrapped around the baby's neck (nuchal cord)

  • Forceps or cesarean delivery

• Baby factors:

  • Baby born at gestational age of less than 37 weeks or more than 42 weeks

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

  • Small for gestational age

  • Medicine or resuscitation in the delivery room

  • Birth defects

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

  • Infection such as herpes, group B streptococcus, chlamydia

  • Seizures

  • Low blood sugar (hypoglycemia)

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

  • 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 healthcare professionals who may be involved in caring for your baby:

• Neonatologist. A pediatrician with additional 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. A pediatrician currently receiving additional training in the care of sick and premature babies. He or she may perform procedures and direct your child's care.

• Pediatric resident. A physician currently receiving additional training in the care of children. He or she may perform or assist in procedures and help direct your child's care.

• Neonatal nurse practitioner. A registered nurse with additional training in the care of newborn babies. He or she can perform procedures and help direct your child's care.

• Respiratory therapist. A person with specialized training in providing respiratory support including managing breathing machines and oxygen.

• Physical, occupational, and speech therapists. Physical and occupational therapists make sure a baby is developing appropriately. They also help with developmental care including positioning and soothing techniques. Speech therapists assist with helping babies learn to eat by mouth.

• Dietitians. Dietitians ensure the babies are growing appropriately and receiving appropriate nutrition including calories, protein, vitamins, and minerals.

• Lactation consultants. Lactation consultants are healthcare providers with additional 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 in choosing the best medicines, monitoring drug dosing and levels, and keeping the team aware of possible side effects and necessary monitoring.

• Social workers. Social workers assist families in dealing with a wide range of emotions they face when a child is ill. They help families get needed information from doctors, and support the family with other more basic care needs such as money problems, transportation, or arranging home healthcare.

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

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