Parent’s Guide to a NICU Stay

The birth of a new baby is incredibly exciting – and can also be scary. Newborns can be quite delicate. They may also have medical problems at birth or as a result of labour and delivery that requires them to be transferred to a specialized hospital unit, the NICU.

The NICU – or neonatal intensive care unit – may be the best place for a baby who has an infection, birth defect, a medical issue, low birth weight, or who is dealing with the aftermath of a birth injury. In the NICU, they can receive additional medical care to help them grow and develop. Understanding more about the NICU can help give parents peace of mind if their baby is transferred to this unit.

What Is the NICU?

After birth, many infants require some degree of medical care. Doctors and nurses will perform an assessment to determine the baby’s Apgar score,  take their measurements, clamp and clean the umbilical cord, apply eye drops to prevent infection, monitor their heart rate, breathing and activity, perform an assessment, and give a vitamin K shot. They will typically also do some screening tests. 

Newborns who need more intense medical care after birth are often put into the neonatal intensive care unit (NICU). While each baby is different, some common reasons for a baby to be transferred to the NICU include:

• Preterm birth (before 37 weeks of pregnancy)
• Post-term birth  (more than 42 weeks)
• Low birth weight (less than 5.5 pounds)
• Small for gestational age
• Have a health condition that requires special care, including infection (such as herpes, group B streptococcus, or chlamydia), respiratory distress, birth defects, seizures, low blood sugar (hypoglycemia), need for extra oxygen, or need for a special procedure such as a blood transfusion.
• Problems or difficulties during labour and delivery, such as:
  • Birth asphyxia
  • Fetal distress
  • Abnormal birthing position, such as breech birth
  • Nuchal cord (umbilical cord wrapped around the baby’s neck)
  • First stool (meconium) passed into the amniotic fluid during pregnancy
  • Forceps or vacuum delivery
  • Cesarean delivery (c-section)
  • Medication or resuscitation needed in the delivery room

In addition, certain maternal factors increase the risk of a baby being admitted to the NICU. This includes:

• Maternal age of over 40 or under 16
• Drug or alcohol use
• Gestational diabetes
• Hypertension or preeclampsia
• Sexually transmitted diseases
• Bleeding
• Multiple pregnancy (twins, triplets, etc.)
• Premature rupture of membranes
• Too little or excessive amniotic fluid

Like the regular intensive care unit (ICU), the NICU is a special area of the hospital for patients who need a higher level of care. If your baby is taken to the NICU after birth, you might be alarmed – but bear in mind that it may be the best place for them to get the medical treatment that they need to thrive.

NICU Basics

If your baby does not require specialized care after birth, they may be taken to the nursery or stay with you in the mother-baby unit. In this situation, it can be helpful to know what to expect. Below, we outline the things that you need to know if your baby is in the NICU after birth.

NICU Equipment

In the NICU, you will likely see a lot of equipment that you might not see in the mother-baby unit. You can always ask your nurse, doctor, or other healthcare provider if you have any questions about the equipment being used to care for your baby. Some of the more common equipment that you might find in the NICU includes:

• Incubator: a clear plastic bed that can be used to keep a baby warm. Incubators have ports on the side through which parents can touch their baby.
• Radiant Warmer: an alternative to an incubator, this is an open bed with overhead heating that can be used to keep a baby warm.
• Apnea Monitor: this machine will detect when a baby stops breathing momentarily. If that happens, then it will alert the NICU staff through an alarm.
• Pulse Oximeter (pulse ox): this small device is placed on a baby’s foot or hand to measure oxygen in their blood.
• Continuous Positive Airway Pressure (CPAP): this machine uses a small tube placed in a baby’s nose or windpipe to send air and oxygen to the lungs.
• Nasal Cannula: small plastic tubes can be inserted into your baby’s nose to provide air and oxygen.
• Oxygen Hood: when a baby can breathe on their own but still needs extra oxygen, this clear plastic box might be placed over their head to give them oxygen.
• Endotracheal Tube: this small plastic tube is inserted through a baby’s mouth or nose to the trachea to send air and oxygen to the lungs through a mechanical ventilator.
• Tracheostomy Tube: a curved plastic tube may be inserted in a baby’s windpipe to allow them to breathe through the tube instead of their nose and mouth.
• Mechanical Ventilator: a machine that helps a baby breathe by pushing warm air and oxygen into the lungs through an endotracheal tube.
• High-Frequency Ventilator: this machine can be used when a baby needs extra help breathing, as it breathes for a baby at a faster rate than typical ventilators.
• Central Line: if a baby requires medicine and/or fluids, they might have a central line inserted into a large blood vessel. This small plastic tube can also be used to draw blood. Frequently, NICU providers will use a peripherally inserted central catheter (PICC line).
• Intravenous Line (IV): a tube that is inserted with a needle into a baby’s vein through which a baby can get fluids, medicine, and blood.
• Cooling Blanket or Cap: if a baby suffers brain damage due to lack of oxygen, then cooling therapy might be necessary to prevent further damage. This blanket or cap is used to lower body temperature to about 33.5 degrees Celsius. When the treatment is complete (after up to 3 days), their temperature is slowly increased to a normal body temperature of 37 degrees Celsius in the incubator.
• Bili Lights: if your baby has jaundice, then they might have bright lights placed over a clear plastic bed (incubator) as a form of phototherapy.  A baby with jaundice might have this treatment for 3 to 7 days until their liver has time to develop and work properly.
• Cardiopulmonary Monitor: this machine tracks a baby’s heart and breathing rates through small sticky pads (leads) connected to the infant’s chest. An alarm will sound if the infant’s heart or breathing rate becomes too fast or too slow.
• Gastrostomy Tube (G-tube): this tube is used to feed a baby who cannot take food by mouth, as the tube goes directly into the stomach. Liquids then go through the tube to provide nutrition to an infant.
• Nasogastric Tube (NG tube): this tube is inserted through an infant’s nose into the stomach via the esophagus. An NG tube can be used to provide breast milk, formula, and/or medicine to the baby.
• Orogastric Tube (OG tube): this feeding tube is inserted into a baby’s mouth and goes through the esophagus to the stomach. Like an NG tube, it can be used to feed a baby liquids or give it medicine.
• Arterial Line: this thin tube is inserted into a baby’s artery to check their blood pressure and measure blood gases (acid, oxygen, and carbon dioxide). This information is important as a measure of a newborn’s overall health.
• Blood Pressure Monitor: in addition to an arterial line, a baby in the NICU might have a small blood pressure cuff wrapped around their arm or leg to measure their blood pressure.
• Extracorporeal Membrane Oxygenation (ECMO): a machine that oxygenates a baby’s blood by removing it from their body, putting oxygen into it, and then sending it back to the body.
• Umbilical Catheter: this is a thin tube that can be inserted into the arteries in a baby’s umbilical cord to provide fluids, blood, medicine, and nutrients. It can also be used to take blood for tests and check blood pressure.

The specific equipment that your baby might need will be based on their medical needs. You should always ask if you have any questions about your baby’s treatment.

NICU Specialists

Babies in the NICU require specialized care, so it makes sense that these units are staffed by healthcare providers with extra training and expertise. During a NICU stay, your baby might be taken care of by the following providers:

• Neonatologist: a pediatrician with specialized training in the care of premature and otherwise sick babies, this doctor will supervise other doctors, nurses, and providers in the NICU. 
• Neonatal Fellow: a fellow is a doctor who has completed medical school and residency and is seeking extra training in a specialty field. In this case, the doctor is going through training to become a neonatologist. 
• Resident: a resident is a doctor who has completed medical school and is going through practical, hands-on training. In the NICU, you will likely interact with pediatric residents. 
• Neonatal Nurse Practitioner: nurse practitioners are registered nurses with additional training who can do certain procedures and help to direct your baby’s care (with supervision).
• Pharmacist:  they coordinate with NICU staff by helping the doctors choose the best medication, checking medicine doses, and altering providers to any side effects and monitoring that may be necessary.
• Respiratory Therapist: this healthcare provider has special training in providing respiratory support, including managing oxygen and breathing machines.
• Other Therapists: during a NICU stay, your baby might be seen by physical, occupational, and/or speech therapists. They aid in a variety of ways, including by helping your baby eat by mouth (speech therapists) and with positioning and soothing. 
• Dietitians: these healthcare professionals will monitor your baby’s calories, protein, vitamins, and minerals to ensure that they are getting sufficient nutrition. 
• Lactation Consultants: if you choose to breastfeed, a lactation consultant may visit to help with pumping, maintaining milk supply, and more.
• Social Workers: these professionals can provide emotional support and practical support (such as transportation or home healthcare) for families who are coping with many stresses when their baby is in the NICU.

In addition to these providers, you may be visited by a hospital chaplain during your NICU stay. A chaplain can provide spiritual support and counseling.

Get Help from an Experienced Birth Injury Lawyer

There are many reasons why a baby might be transferred to the NICU. In some cases, it may be due to medical negligence, either during pregnancy or during labour and delivery. If you believe that your baby might have been injured because of medical negligence, we can help.

The Birth Injury Lawyers Alliance (BILA) advocates for families throughout Canada whose lives have been affected by medical malpractice. We work hard to help families get justice, along with the compensation that they need to move forward after a birth injury. To learn more or to schedule a free initial consultation with a birth injury lawyer in your province, give us a call at 1-800-300-2452 or fill out our online contact form.

What Should I Do If I Suspect Medical Negligence?

NICU stays are not always caused by medical negligence. In some cases, however, improper prenatal care, failure to monitor and treat, and/or problems during labour and delivery are the direct cause of a baby’s health condition or birth injury. If you believe that your baby might be in the NICU because of medical malpractice, there are things that you can do to help protect your child’s rights and their future.

The first step is to reach out to an experienced birth injury lawyer in your province to schedule a free consultation. A lawyer can help you determine if you may have a potential legal claim – and can work with you to pursue financial compensation for your losses.

Who Can Visit the NICU?

Babies in the NICU are often more susceptible to illness. For this reason, visits to the NICU may be more restricted than in other areas of the hospital. Parents can visit the NICU to spend time with their babies. Other family members may only be allowed to visit during certain times. There may also be a limit on the number of non-parent visitors.

Children – such as siblings – might be able to visit the NICU if they are not currently sick and are up-to-date on their immunizations. Each hospital has its own policies on visitors. Many NICUs will require visitors to wear a gown, gloves, and mask, and/or to wash their hands before they enter. These procedures are designed to protect the babies from any viruses or bacteria that visitors might bring in with them. If your baby is in the NICU, ask their nurse or the social worker about visiting policies. 

What Should I Do If My Baby Is in The NICU? 

If your baby is in the NICU, you should come prepared with a notebook to take notes. You should also ask lots of questions, especially if there is something that you don’t understand. 

You might also be able to help care for your baby. Moms may be able to pump breast milk, and both parents can offer formula or breast milk in a bottle if their baby is capable of feeding that way. Otherwise, you can focus on talking and singing to your baby, touching them gently, and simply being there for them.

You should also take some time to focus on your own needs. Having a baby in the NICU is stressful. When you can, do things for yourself – like taking a bath, reading a book, or talking to other NICU parents. You can also talk to the hospital’s social worker or chaplain for support.

Can I Hold My Baby When They Are in The NICU?

Your ability to hold your baby will depend on their health. There are many benefits to physical touch, particularly skin-to-skin contact. However, for some premature infants, physical touch can actually be stressful.

Even if you can’t physically hold your baby, you can still hold their hand (often through the ports on an incubator), stroke them, and talk or sing to them. Simply being present and with them can also be reassuring and help you bond with your baby. Your doctors and nurses can help you determine how much and what type of physical touch is best based on your baby’s unique needs.

Related: Rights as a NICU Parent