The Neonatal Intensive Care Unit (NICU)

The birth of a baby is a wonderful and very complex process. Many physical and emotional changes occur for both the birth parent and the baby.

A baby must make many physical adjustments to life outside the birth parent's body. Leaving the uterus means that a baby can no longer depend on the birth parent's blood supply and placenta for important body functions.

Before birth, the baby depends on functions from the birth parent. These include breathing, eating, elimination of waste, and immune protection. When a baby leaves the uterus, its body systems must change. For instance:

• 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 on their own.

Your baby's body systems must work together in a new way. In some cases, a baby has trouble making the transition outside the uterus. Preterm birth, a difficult birth, or birth defects can make these changes more challenging. But a lot of special care is available to help newborn babies.

What is 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 for the tiniest patients. NICUs may also care for babies who are not as sick but do need specialized nursing care. Some hospitals don’t have the staff for a NICU. In these cases, 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.

Some newborn babies will need care in a NICU. Giving birth to a sick or premature baby can be unexpected for any parent. The NICU can be overwhelming. This information is to help you understand why a baby may need to be in the NICU. 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 preterm (born before 37 weeks of pregnancy), have low birth weight (less than 5.5 pounds), or have a health condition that needs special care. In the U.S., about 1 in 10 babies are born preterm. Many of these babies also have low birth weights. Twins, triplets, and other multiples often are admitted to the NICU. This is because 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.

Below are some factors that can place a baby at high risk and increase the chances of being admitted to the NICU. But each baby must be assessed to see if they need the NICU. High-risk factors are detailed below.

Birth parent factors include:

• Being younger than age 16 or older than age 40

• Drug or alcohol use

• 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 include:

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

• Buttocks delivered first (breech birth) or other abnormal position

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

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

• Forceps, vacuum, or cesarean delivery

Baby factors include:

• 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?

Some of the specially trained healthcare providers who may care for your baby include:

• 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. They may do procedures and direct your child's care.

• Pediatric resident. This is a healthcare provider who is getting extra training in the care of children. They 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. They can do procedures and help direct your child's care.

• Registered nurse (RN). RNs care for your baby 24 hours a day. They carefully watch for any changes and give medicines. They can show you how to take part in your baby'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.

• Registered dietitian nutritionist (RDN). RDNs make sure 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 the healthcare providers in the NICU 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. This may be a priest, minister, lay pastor, or other religious advisor. The chaplain can give spiritual support and counseling to help families cope with the stress of the NICU.

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 help parents.