Walking into the NICU can feel like stepping onto another planet — the environment is probably unlike anything you've experienced. The unit is often busy, with lots of activity, people moving around, and beeping monitors.
Once settled in the unit, your baby will receive care tailored to your little one's specific needs. Most NICU babies are on special feeding schedules, depending on their level of development or any problems they have. For instance, some infants are too premature or too sick to eat on their own, so they have a feeding tube that runs through the mouth and into the stomach. Others need high-calorie diets to help them grow.
Medications are another crucial part of NICU care — your child may take antibiotics, medicine to stimulate breathing, or something to help his or her blood pressure or heart rate, for example.
To ensure that your baby's care stays on track, the doctors also will order various tests, possibly including periodic blood and urine tests, X-rays, and ultrasounds. For infants whose care is complicated and involved, the doctors or nurses will place a line into an artery or vein so they can draw blood without having to repeatedly stick the baby. NICU staff try to make the infants' stay in the nursery as comforting as possible for the infant as well as the families.
The nurses can explain what all of the monitors, tubes, tests, and machines do, which will go a long way toward demystifying the NICU.
In the meantime, here's a brief look at what some of the unfamiliar equipment does and how it may help your baby, depending on your little one's condition and diagnosis:
Feeding tubes: Frequently, NICU babies are unable to get as many calories as they need through regular feeding from a bottle, so the nurses will use a small feeding tube to deliver formula or breast milk (that the mother pumps). The tube is either placed into the baby's the stomach through the mouth or by the nose.
If an infant is able to take some milk from the bottle, the nurse will just give the rest through the feeding tube. Sometimes, the babies get all their nutrition through the feeding tube so that they don't use excess energy trying to feed from the bottle.
The feeding tubes shouldn't be painful — they're taped in place so they won't move around and cause friction. However, if they're in place for a long time they can cause erosions in the stomach or nose where they rub, so are changed routinely to avoid this.
Infant warmers:
These are beds with radiant heaters over them. Parents can touch their babies in the warmers, but it's always a good idea to talk to the NICU staff about it at first, just in case.
Isolettes: These are small beds enclosed by clear, hard plastic. The temperature of the isolette is controlled and closely monitored because premature infants frequently have difficulty maintaining their body temperature. Holes in the isolettes allow access to the infants so the nurses and doctors can examine the infants and parents can touch their babies.
IVs and lines:
An intravenous catheter (or IV) is a thin, flexible tube inserted into the vein with a small needle. Once in the vein, the needle is removed, leaving just the soft plastic tubing.
Almost all babies in the NICU have an IV for fluids and medications — usually in the hands or arms, but sometimes in the feet, legs, or even scalp. At first, the IV may be inserted in the baby's umbilical cord. In the first hours after delivery, the umbilical cord provides a way for the doctors to insert arterial or venous lines into the infant without having to use a needle through the skin.
Instead of giving your baby injections every few hours, IVs allow certain medications to be given continuously, several drops at a time. These are known as drips or infusions. Doctors may use these medications to help with heart function, blood pressure, or pain relief.
Some situations require larger IVs to deliver larger volumes of fluids and medications. These special IVs are known as central lines because they're inserted into the larger, more central veins of the chest, neck, or groin, as opposed to the hands and feet. They're inserted by a specially trained pediatric surgeon.
Arterial lines are very similar to IVs, but they're placed in arteries, not veins, and are used to monitor blood pressure and oxygen levels in the blood (although some babies may simply have blood pressure cuffs instead).
Monitors: Infants in the NICU are attached to monitors so the NICU staff are constantly aware of their vital signs. The nurses will often place the infants in positions that seem the most soothing, like on their tummies or on their sides.
The single monitor (which picks up and displays all the necessary information in one place) is secured to your baby's body with chest leads, which are small painless stickers connected to wires. The chest leads can count your child's heart rate and breathing rate. A pulse oximetry machine (or pulse ox) may also display your baby's blood oxygen levels on the monitor. Also painless, the pulse ox machine is taped to your baby's fingers or toes like a small bandage and emits a soft red light.
A temperature probe, a coated wire adhered to your baby's skin with a patch, can track your little one's temperature and display it on the monitor. And unless blood pressure is being directly monitored through an arterial line, your baby will usually have a blood pressure cuff in place.
Phototherapy: Often, premature infants or those who have infections have jaundice (a common newborn condition in which the skin and whites of the eyes turn yellow). Phototherapy is used to help get rid of the bilirubin that causes jaundice. The infants might lie on a special light therapy blanket and have lights attached to their beds or isolettes. Usually, they only need phototherapy for a few days.
Ventilators:
Babies in the NICU sometimes need extra help to breathe. The infant is connected to the ventilator (or breathing machine) via an endotracheal tube (a plastic tube placed into the windpipe through the mouth or nose). Babies who've been in the NICU for a prolonged stay — months at a time — may have a tracheostomy (a plastic tube inserted directly into the trachea) that's connected to the ventilator on the other end. There are many different kinds of ventilators — different situations call for different machines — but they all accomplish the same basic purpose: to help a baby breathe.