What to Expect in the NICU

Understanding Your Baby’s Experience

While in the NICU, your baby may experience some of the following:

• Your baby may be placed under a radiant warmer or in an incubator, also called an isolette, which is designed to keep your baby warm. When babies can regulate their body temperature and stay warm on their own, they are placed in an open crib.
• A sensor to monitor oxygen, a “pulse ox,” may be placed on your baby’s wrist or foot.
• Heart rate and breathing monitor wires (EKG leads) may be placed on the baby’s chest.
• Intravenous lines (IVs, also called catheters) may be placed in your baby’s hand, foot, arm or other place in his body to deliver fluids and medications into the bloodstream.
• A thin, flexible NG or OT tube may be placed into your baby’s nose or mouth and goes down into your baby’s stomach. The tube will be used to suction swallowed air out of the stomach and to feed your baby.
• Tiny prongs may be inserted into your baby’s nostrils to provide airway support (CPAP) and deliver humidified oxygen (high flow) for easier breathing.
• In some cases a breathing tube, also called an ET tube, may be placed to support your baby. This tube may also be used to provide medication.

NICU Screening Tests

The following are some of the screening tests that your baby may have before discharge from the NICU:

• CCHD/Oximetry screening: New Jersey-mandated cardiac evaluation to check for possible heart problems
• Hearing test: A New Jersey-mandated screening test to check for hearing loss in your baby. This test provides an opportunity for early intervention if needed for your baby.
• Chemstrip glucose test: A blood test to check the baby’s sugar level
• Hepatitis B immunization: As recommended by the Centers for Disease Control. It is recommended that your baby receive this within the first 24 hours of life. All babies receive a first dose prior to discharge.
• Car seat challenge: Prior to release from the hospital, all babies born at less than 37 weeks gestation are fitted in their car seat and spend 90 minutes in the car seat while on the respiratory monitor. This assessment determines whether babies will have any problems while sitting at the semi-reclined angle of their car seat.
• Metabolic screenings: New Jersey Department of Health-mandated metabolic screenings that test your baby for disorders, including phenylketoneuria (PKU), which is a rare disorder that prevents the body from processing the amino acid phenylalanine, and many other metabolic disorders. This is a blood test which is sent directly by our lab to the NJ Department of Health. Your doctor will receive the results of the test and will contact you if needed.

Parents will also receive CPR education.

Pain and Your Baby

Your baby will receive care and support in the NICU, but some procedures, such as “heel sticks” (taking some blood from the baby’s heel), inserting intravenous lines, injections, and removing tape from the baby’s skin may be uncomfortable for them. The NICU staff are very mindful that there is a little person on the receiving end of all those needles, tubes and tape. They try their best to minimize any pain associated with the various procedures and provide soothing and pain management techniques.

Understanding Signs of Pain

Your baby may cry for different reasons, like needing to be changed, fed or held. It can sometimes be difficult to tell if he or she is in pain. Your NICU team can help you learn how to tell if your baby is uncomfortable or in pain. Signs of pain may include:

• Changes in heart rate and breathing patterns
• Waving arms and legs
• Facial expressions
• Crying
• Changes in coloring and body stiffness
• Restlessness
• Feeding difficulties

Making Your Baby More Comfortable

If your baby seems to be in pain, your NICU team may try the following to help:

• Kangaroo care (or skin-to-skin care). This is a technique practiced on newborns, usually preterm, in which the infant is held, skin-to-skin, with an adult
• Cuddling your baby
• Swaddling or gently rocking your baby
• Placing a drop of sucrose (a sugar solution) or a few drops of your breast milk onto your baby’s tongue
• Giving a pacifier, either plain or dipped in sucrose or breast milk for sucking
• Gently touching your baby
• Decreasing environmental stimuli, for example turning down the lights and noise around your baby
• Giving pain medication, if ordered
• Providing the baby with cluster care, which is simply doing all the hands-on care (diaper, feeding, bathing, suctioning, repositioning, holding, etc.) at one time which allows for newborns and parents to have extended amount of rest in between

Bonding with Your Baby in the NICU

Loving Touch

The NICU team will teach you ways to hold your baby and help you know when and how long your baby can be touched. Once your baby is stable enough, you can start with holding hands and letting your baby hold your finger. Instead of stroking, rubbing or patting your baby (as stroking may be overstimulating to your baby) use a gentle yet steady touch in the same place. You can also cup the crown of your baby’s head with your hand.

Kangaroo Care (Skin-to-Skin Care)

This is a technique practiced on newborns, usually preterm, in which the infant is held, skin-to-skin, with an adult. Your baby knows your scent and voice, so will feel comforted. Kangaroo care helps your breast milk production, will maintain your baby’s temperature, keep heart and breathing rates steady, and provide a calm environment allowing him or her to preserve energy and grow stronger. Skin-to-skin care also helps you bond with your baby.

Reading to Your Baby

Reading to your baby is a one-on-one activity that is a great opportunity for cuddling and bonding. Hearing your voice is soothing to your baby and promotes feelings of intimacy while your baby is in the NICU. Researchers agree that reading aloud is the single most important activity parents, grandparents, and caregivers can do to promote early brain development and lifelong learning success.

Glossary

To help you become more at ease with the NICU environment and equipment, we have provided a glossary of terms for your reference.

• Anemia: A common blood condition that occurs when the level of healthy red blood cells (RBCs) in the body becomes too low.
• Apgar: The first test given to a newborn. The Apgar quickly evaluates the newborn’s condition to see if there is an immediate need for extra medical care. The test is given twice in the delivery room, at one minute after birth and again at 5 minutes after birth. The baby is evaluated in 5 areas, and is given a score for each area. The total of these 5 produces the Apgar score.
• Apnea: A pause in your baby’s breathing that lasts longer than 15-20 seconds. Apnea of prematurity occurs in babies born before 34 weeks gestation. A baby may not be able to regulate breathing if his brain or respiratory system is immature or underdeveloped. An Apnea monitor detects interruptions in breathing.
• Aspiration: Breathing of material into the windpipe or lungs, or the removal of that material by suction.
• Back to Sleep: A safe sleep campaign instructs parents and caregivers to place all babies on their back for sleeping.
• Bilirubin: A normal physiologic substance produced from the breakdown of hemoglobin (Hb), the substance in red blood cells that carry oxygen. Bilirubin normally passes through the liver and is excreted as bile through the intestine. A build-up of bilirubin can cause jaundice. Bililights are fluorescent lights used to treat jaundice (phototherapy).
• Blood gas test: A test that determines the amount of oxygen and carbon dioxide in the blood.
• Blood pressure cuff: A small cuff placed around the baby’s arm or leg that is used to monitor his blood pressure.
• Bradycardia: A heart rate less than 100 beats/minute—slower than normal for an infant
• Breast pump: A machine that collects breast milk. A hospital-grade pump is often more powerful than those for home use and may be available to rent. Check with your health insurance company to see if they will provide one.
• Bronchopulmonary dysplasia (BPD): A chronic lung disorder that is most common among children who were born prematurely, with low birth weight, and who received prolonged mechanical ventilation.
• Cardiac monitor (CR monitor or heart monitor): A device that measures baby’s heart rate, breathing and blood pressure. Three Gel Patches (leads) are placed on the infant’s chest and abdomen and are connected by thin wires to the monitor.
• Complete blood count (CBC): A blood test that checks the number and type of white blood cells, the concentration of hemoglobin, the percentage of blood volume consisting of red blood cells (hematocrit), and the number of platelets.
• Continuous positive airway pressure (C-PAP): A way of delivering air to your baby’s lungs to keep her airway continuously open, either through small tubes in the nose or through a tube inserted into the windpipe. The tubes are attached to a ventilator, which helps the baby breathe.
• Electrocardiogram (EKG/ECG): A test that measures electrical activity of the heart through adhesive patches placed on the chest, arms and legs.
• Electrode (also called a probe or sensor): A plastic strip or wire taped to your baby’s arm or leg, or a disk taped to her chest or stomach, electrodes relay vital signs to a monitor.
• Endotracheal (ET) tube: This slender tube is passed through the baby’s nose or mouth and down into the infant’s lungs/ trachea (windpipe). The tube is attached to a ventilator. Certain medications may be given through the ET tube.
• Extremely low birth weight: A birth weight of less than 1000 grams, or 2lb 3oz.
• Fontanelle or fontanel: The “soft spot” between the bones on top of a baby’s head and a smaller spot on the back of the head that will later grow together.
• Gastroesophagael reflux: A condition that occurs when gastric juice from the stomach backs up into the esophagus. Adults refer to this as “heartburn,” although it has nothing to do with the heart.
• Gastrointestinal tract (GI tract): The pathway that goes from the mouth to the anus where food is ingested, digested, absorbed, and eliminated from the body as a bowel movement.
• Gavage feeding: A way to feed a baby with breast milk or formula before he has learned how to swallow. A small, flexible tube is placed into the mouth or nose and goes into the stomach.
• Gram: A unit of weight. One gram weighs the same as 1 plain M&M or 1 small paper clip. There are about 30 grams in an ounce.
• Heel stick: A small prick in the heel of the foot for obtaining a blood sample.
• Hyperglycemia: High blood sugar levels
• Hypoglycemia: Low blood sugar levels
• Intrauterine growth restriction (IUGR): Inadequate growth of the fetus producing a smaller than expected size for the gestational age. IUGR can happen at any time during pregnancy.
• Intravenous (IV) catheter: A small tube inserted into a vein in the hand, foot, arm, leg, or scalp used to deliver medicine and fluids to the body.
• Intubation: Inserting a tube through the mouth or nose, down the throat, and into the windpipe (trachea). This may be done if a baby has difficulty breathing or is at risk of stopping breathing because of illness, surgery, or other medical problems.
• Isolette or Incubator: A small bed enclosed in clear plastic, and allows for appropriate control of body and environment temperature. These units also allow for easy visualization of your infant by the medical staff.
• Jaundice: Also known as hyperbilirubinemia, jaundice is a temporary yellowing of the skin and eyes caused by too much bilirubin in the body. This condition may require use of special lights (phototherapy) until the baby is more mature.
• Kangaroo care: Creating skin-to-skin contact by holding a baby against a naked chest.
• Lactation consultant: A healthcare professional with special training and experience in helping breastfeeding mothers and babies.
• Lanugo: Fine, downy hair that covers a young fetus until shortly before or after birth.
• Late preterm baby: A baby born between at least 34 weeks but less than 37 weeks of gestation.
• Low birth weight: A birth weight of less than 2500 grams, or 5lb 8 oz.
• Magnetic resonance imaging (MRI): An imaging technique that uses magnets and computers to produce a detailed picture of tissue.
• Meconium: Very dark, tarry fecal materially usually passed in the first several bowel movements after birth. Meconium is sometimes passed before birth and is in the amniotic fluid. Treatment may be required when it is inhaled by the fetus while still in the uterus.
• Meconium aspiration: The inhalation of meconium by the baby’s lungs during birth that can cause breathing problems.
• Medicaid: A government program that provides healthcare and health-related services to both low-income individuals and others who qualify. A child may qualify regardless of parental income, based on other circumstances, even if the child has other health insurance.
• Monitor: A machine that records information such as heartbeat, breathing rate, and blood pressure.
• Nasal cannula: The oxygen tube placed under a baby’s nose with 2 prongs that go into the nostrils. It blows air with extra oxygen directly into the nose. This is also known as nasal prongs.
• Necrotizing enterocolitis (NEC): An infection that inflames or infects part of the baby’s intestines that may require drugs and/or surgery.
• Open crib or bassinet: An open bed that provides a safe environment for your newborn.
• Oral (OGT) or nasal (NGT) gastric tube: A small flexible tube which is placed either in the nose or mouth and passes to the baby’s stomach that may be placed either on admission for evaluation of the baby’s esophagus or stomach and/or to remove air and mucus from your baby’s stomach. It is held in place by a small piece of tape. This small flexible tube may also be used to feed your baby when necessary.
• Patent ductus arteriosus: Aa heart condition caused by failure of an embryonic blood vessel—the ductus arteriosus—to close at birth as it should. This condition may require medicine or surgical closure.
• PICC (percutaneous insertion central catheter): A long catheter placed into a vein with the tip extending into a large blood vessel near the heart. It is used to administer medications and for IV nutrition.
• Pulse oximetry (pulse ox) test: A measurement of the baby’s blood oxygen level (% of saturation). There is a lighted probe that is held in place by a Band-Aid like wrap which may be placed on the baby’s wrist, hand, foot, finger or toe. The information will be displayed on the CRM or a separate monitor.
• Radiant warmer: A bed that provides heat to the infant via an overhead heat source. A temperature probe regulates the heat provided by the warmer in accordance with your baby’s temperature, while providing a safe area and easy access to your baby.
• Respiratory distress syndrome (RDS): Also known as hyaline membrane disease, in this condition premature babies with immature lungs do not develop surfactant, a protective film that helps air sacs in the lungs stay open. Babies who are not premature may also develop respiratory distress from other reasons, such as infections or meconium aspiration.
• Retinopathy of prematurity (ROP): A condition in which blood vessels in the baby’s eyes do not develop normally.
• Surfactant/pulmonary surfactant: A protective substance that keeps small air sacs in the lungs from collapsing between each breath so that the baby can breathe more easily.
• Swaddling: Wrapping an infant snugly in a blanket to limit movement and provide comfort. Leave your baby’s hands out when swaddling. Swaddling is not advised at bedtime, use a blanket sleeper and put your baby on her back to sleep.
• Tachycardia: Rapid heart beat
• Tachypnea: Rapid breathing
• Transient tachypnea of the newborn (TTN): Rapid breathing of the newborn baby noted after birth and caused by too much fluid in the baby’s lungs.
• Total parenteral nutrition (TPN): A way to give nutrients through an intravenous infusion
• Ultrasound (sonogram): A radiologic test to see an image of an internal body structure. If the baby is preterm, she may have an ultrasound of her head.
• Umbilical artery catheter (UAC): A line placed into the artery in the baby’s umbilical cord to draw blood or give your baby fluids.
• Umbilical venous catheter (UVC): A line placed into the umbilical vein to draw blood or give fluids to a baby.
• Ventilator (respirator): An appliance that will support a baby’s breathing or may be used to breathe for a baby, depending on his/her needs.
• Very low birth weight: A birth weight of less than 1500 grams, or 3lb 5oz.
• Women, Infants and Children Program (WIC): A nutrition program that helps pregnant women, new mothers and young children eat well and stay healthy.