NICU: What to Expect

By Alesha Glowicki

September 3, 2020

Alesha is a mama of two girls, Registered nurse, Lactation counsellor and Sleep coach in the Edmonton area committed to supporting mamas through their pre and postnatal journey.

“NICU.” It sounds like a frightening word, especially after you have just given birth to your bundle of joy. However, most NICU admissions are required because your baby just needs a little extra time and support to grow (ie.born prematurely) or to transition to the outside world. While your NICU experience will probably make you feel anxious and overwhelmed, knowing what’s going on can help you feel more in control and let you stay focused on your little one. This article will cover the top topics of discussion regarding your baby’s NICU stay and help you to feel more prepared for what is to come.

  1. Monitoring: Upon arrival to the NICU your baby will most likely be placed on monitors. 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. A large screen above your baby’s bed will display these values and alarms will be set to notify the nurse’s and doctors of any abnormalities. Additionally, your baby may be placed under a radiant warmer or in an incubator, also called an isolette, which is designed to monitor your baby’s temperature and keep your baby warm. When babies can regulate their body temperature and stay warm on their own, they are placed in an open crib.
  2. Breathing Support: If your baby is having difficulty breathing on his/her breathing support will be used until lung function resumes. Breathing support includes low flow oxygen, high flow oxygen, CPAP, or an endotracheal tube. When being given low flow or high flow oxygen you will notice that tiny prongs may be placed in your baby’s nostrils to provide oxygen. With CPAP (continuous positive airway pressure) either tiny progs or a small mask will be placed over your baby’s nose to provide constant air pressure that is transmitted down into your baby’s lungs, helping them to become inflated and to stay inflated. In some cases, a breathing tube also called an endotracheal tube, may need to be used to provide mechanical ventilation to your baby.
  3. Feeding: The method of feeding will depend on your baby’s gestation and respiratory status. Breastfeeding is highly recommended and supported in the NICU as soon as your baby is able to. If your baby is not able to breastfeed or orally feed to begin, he/she will feed via a feeding tube. A feeding tube is a thin, flexible tube that is placed into your baby’s nose or mouth and goes down into your baby’s stomach. Your baby will receive milk and some medications through this tube. Mother’s milk is the nutrition of choice, so even if your baby is feeding via a feeding tube your milk can be pumped and given. Your Dr., nurse, and lactation consultant on the unit will assist you with pumping and breastfeeding and support you through your feeding journey.
  4. Bonding: 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. The NICU team will teach you ways to hold your baby and help you know when and how long your baby can be touched. Skin-to- skin (kangaroo care) is highly encouraged. Your baby knows your scent and voice, so will feel comforted. Skin-to-skin care helps your breast milk production, will maintain your baby’s temperature, keep the 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.
  5. Tests: 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, electrolyte levels, metabolic abnormalities, and cultures to rule out infection. A portable X-ray machine may make an appearance in the NICU to get a better idea of the baby’s lung development. Sometimes more specialized testing is needed, such as ultrasounds, CTs, or MRIs to look at the brain, echocardiograms to see how the heart is functioning, and radiographs to look for problems associated with the gastrointestinal tract. Prior to discharge, your baby will likely receive a hearing screen as well. Treatments: While treatments vary from baby to baby the most common include breathing support, medications, and phototherapy. Medications may be given through an intravenous catheter or central line (generally inserted into your baby’s umbilicus), via a feeding tube or orally. Phototherapy is a common treatment in the NICU and is used to treat jaundice. If your baby bilirubin (jaundice) level is above the normal range for newborns he or she will be put under a special UV light with eye protection in place. The skin absorbs the light, which changes the bilirubin so that the body can more easily get rid of it.
  6. Discharge: The most commonly asked question in the NICU by parents is “how long will my baby be here for.” While it is usually difficult to give a concrete answer, it is good to understand the criteria for discharge. Generally speaking, your baby must be breathing on his or her own without any difficulties, feeding orally, gaining weight at an expected rate, and have appropriate bilirubin levels. In addition to this, discharge teaching by the medical team must be completed for the parents prior to discharge.

The NICU fosters family-centered care which is a partnership approach to health care decision- making between the family and the health care team. The health care team in the NICU generally consists of doctors, nurses, lactation consultants, dietitians, pharmacists, and social workers who visit the bedside daily to discuss your baby’s plan of care. You can rest assured that your baby is in a specialized area of care dedicated to providing competent care for your child.

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