No one plans on having their newborn spend time in the neonatal intensive care unit (NICU), but roughly 78 out of every 1,000 babies born in the U.S. each year stay in these specialized nurseries. Most of them are premature babies, as 1 in 10 newborns are born before 37 weeks in the U.S. So it’s worth learning about the place all preemies visit upon arrival. Here’s a quick guide to what you can expect while your baby is there.
What is the NICU?
What does NICU stand for? Simply put, it’s a neonatal intensive care unit — a high-tech nursery with special equipment and highly trained staff who care for preemies and other newborns needing serious medical attention. Sometimes this specialized unit is called the intensive care nursery (ICN).
The NICU is just for the hospital’s tiniest patients. Some are there for jaundice, an infection or low birth weight. Twins and triplets often end up in the NICU because they tend to be premature or have a low birth weight (or both). Or NICU babies might have a heart or breathing condition and need monitoring 24/7.
The high-tech monitors in most NICUs check your baby’s vital signs, like heart rate, blood pressure and oxygen levels. Many also have ventilators to help your baby breathe easier as well as CT and MRIs machines to capture detailed pictures of your baby’s body, including his brain.
What are the NICU levels?
The American Academy of Pediatrics classifies newborn care facilities into four levels. The higher the level, the more care these tiny patients need. Levels III and IV NICUs are designed for newborns who need more medical attention than usual. Here’s a breakdown:
Level I
Level I facilities are also called well newborn nurseries. These regular hospital nurseries take care of healthy full-term or nearly full-term babies. Sometimes preemies and babies who are sick get evaluated here to determine where they go next.
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Level II
Many hospitals have a level II facility for babies who are stable or moderately ill with problems that are expected to resolve quickly. They may need help breathing for a few hours or monitoring of their vital signs. Typically, they’re best for preemies who weigh more than 3 pounds, were born at or after 32 weeks and don’t have serious health conditions.
Level III NICU
Level III NICUs are for preemies who were born before 32 weeks and weigh less than 3 pounds. They’re also for babies who need higher levels of care including ventilators, other specialized equipment or surgery. Not all hospitals have these higher-level NICUs.
Level IV NICU
Level IV facilities, also called regional NICUs, are found in the largest hospitals and they handle the most complex cases: micropreemies, newborns who need major surgery, have complex conditions or those who have birth defects.
PICU vs NICU
There’s another ward that’s similar to the NICU called the pediatric intensive care unit (PICU). Like the NICU, the PICU is for children, including babies, who need extra-specialized care and constant monitoring by doctors and nurses who’ve undergone extra training.
So what determines whether your baby goes to the PICU versus the NICU? Age — the NICU is for newborn infants while the PICU is for older infants and kids younger than 18.
Jobs in the NICU
Many health care professionals, from surgeons to social workers, work in the NICU. All of them are dedicated to your baby’s health and safety. Here are some of the team members you’ll probably meet:
- Neonatal nurses. At your baby’s bedside day and night, neonatal nurses will change diapers, insert and monitor IVs, and navigate tubes so you can pick up your baby (once the doctor gives the all-clear for cuddling). Your nurse will also help you communicate with other members of the clinical team. Since nurses spend so much time with your baby in the NICU, they’ll become your go-to people.
- Neonatologists. These doctors are the world’s experts in caring for newborns — particularly preemies. They’ll oversee your baby’s care and make decisions about the diagnosis and treatment.
- Respiratory therapists. If your baby’s lungs need assistance, a respiratory therapist may monitor supportive breathing machines and his oxygen levels.
- Lactation consultants. Many babies in the NICU have feeding challenges due to physical limitations or their age, so a lactation consultant is there to help you pump and store your breast milk in the meantime. A lactation consultant (or feeding specialist) will also help babies get the hang of breast- or bottle-feeding once they’re ready.
- Occupational and physical therapists. Occupational therapists help your baby with basic developmental milestones like eating, moving and sleeping. Physical therapists are trained to work on your baby’s joint and muscle mobility. Babies born early have low muscle tone, so physical therapists can help position and move them so they don’t develop tight muscles.
- Social workers and mental health specialists. While your baby is in the NICU, you’re riding a rollercoaster of emotions, from fear to hope. Social workers can help you through it by offering support groups and other forms of therapy. After all, talking with others who understand what you’re going through can help you to feel less alone. Social workers will also connect you with services your baby may need at home, such as special prescriptions, in-home nursing care or appointments with developmental specialists.
What a NICU looks like
Seeing your baby in the NICU for the first time can sometimes come as a shock. The room is often crowded and brightly lit. Heated incubators help keep the babies’ bodies at a consistent temperature. Depending on a baby’s needs, he may receive oxygen, especially right after birth. Heart rate and oxygen monitors keep tabs on his vital signs, and a tiny IV may run to a hand, foot or scalp.
A preemie may have a nasogastric (NG) tube as well so he can get the precious breast milk or preemie formula he needs to grow. Babies born at less than 34 weeks gestation usually don’t have the strength and coordination to suck or swallow on their own, but these soft tubes deliver valuable nutrition directly to their stomachs.
Visiting your baby in the NICU
In the NICU, medical needs come first, and that includes placing some restrictions on visiting. This is especially true during pandemic times, as COVID-19 has made NICUs impose tighter rules to protect their little patients. Check with your hospital for its most up-to-date visitor policy regarding COVID-19 as protective protocol continues to evolve.
One thing that hasn’t changed: You and your partner can still visit almost any time (though maybe not during shift changes). After all, hospitals realize the important role parents play in their newborn’s well-being. But other visitors often aren’t allowed, including your newborn’s big brother or sister.
It’s important to stay mindful of germs around any newborn — but in the NICU, good hygiene is crucial since preemies’ immune systems are very much a work in progress. For these little guys, even a cold can be very serious. So if you’re sick with anything, stay away. (You can Zoom or phone in for updates on your baby’s progress.)
Even if you feel fine, someone will check your temperature and ask about potential symptoms even before you enter the NICU. And before you go in, you must scrub up at a sink, just like staff members do after handling each baby. You might also have to wear full protective gear (PPE), including masks and face shields as well as gowns, gloves and booties to put over your shoes.
Advocating for your baby in the NICU
A NICU often serves dozens of families at any given time, so you might feel lost in the shuffle as staffers speed through to tend to their next tiny patient. Plus, all those unfamiliar medical terms can make it even harder to keep up. But it’s important to be your baby’s advocate and stay on top of what’s happening. Here’s how:
- Ask questions about any test, procedure or medication you’re unsure of. You also have a right to a clear and complete explanation.
- If you’re committed to breastfeeding, tell the staff. If it’s allowed, hang a note on your preemie’s incubator saying as much. Try to be at the NICU at feeding time as often as possible so you and your baby can get the hang of breastfeeding (and the nurses see you mean business).
- Be respectful of the medical procedures going on all around you, especially if another family has a seriously ill baby. You may need to leave the unit if there’s a medical emergency or shift change or if the staff needs to perform a procedure on another baby.
- Make friends with the nurses. As the nurses get to know you, they’ll teach you how to care for your baby and pass along small but oh-so-welcome details about how he’s doing when you’re not there.
- Take care of yourself — physically and mentally — to be the best baby advocate you can be. Make sure you eat right, drink lots of water to keep up your milk supply and catch all the z’s you can. Beyond those basics, remember that living with a baby in the NICU is one of the most stressful experiences you’ll ever go through, so allow yourself a little personal time — without guilt. You and your baby will both benefit if your battery gets recharged.
When doctors consider your baby to be stable, you’ll finally hear four magic words: “Time to go home!” Your hospital team will provide a written discharge summary with all the details of what your baby will need at home and make sure your little one has an appointment scheduled with a pediatrician and any other specialists.
After such an emotional time, the most important thing to focus on when your premature baby comes home is to give him a warm, calm and loving environment. Call on family and friends for help with chores, so you can focus on what you’ve wanted to do all along: Simply hold your little bundle in the comfort of your own — and your baby’s brand new — home.
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