The neonatal intensive care unit (NICU): what to expect

The neonatal intensive care unit (NICU): what to expect

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What a neonatal intensive care unit (NICU) is

A neonatal intensive care unit (NICU) is a hospital intensive care unit that specialises in looking after premature and sick newborn babies.

NICUs have specialist doctors, nurses, other professionals and equipment to care for premature and sick babies.

When babies don't need the specialist care and equipment of the NICU anymore, they move to the special care nursery.

What the neonatal intensive care unit (NICU) looks like

The first time you go into a neonatal intensive care unit (NICU), it can feel overwhelming.

The first thing you'll see is a series of taps or antibacterial hand gel dispensers at the entrance. You need to wash your hands with sterilising soap for several minutes before you go in. Babies in NICUs can very easily catch infections, and proper hand-cleaning cuts the risk of this happening.

The NICU might have quiet periods when the lights are dimmed and it's quiet. Often, babies in the NICU can be overwhelmed by too much noise and light.

Most babies will have either a heated open cot or a covered incubator. These keep their bodies at the right temperature.

Depending on what medical support the babies need, there might be:

  • ventilators to help with breathing
  • machines to give measured amounts of fluids and medicines to the babies through tubes going into their veins
  • monitors attached to the babies with cords to measure heart rate, breathing and the amount of oxygen in their blood
  • special cooling beds to help reduce brain injury in babies who have had a difficult birth.

All of this technology and machinery keeps the babies comfortable, with as little extra handling as possible. It monitors them and lets medical staff know when the babies need extra care.

Other large machines are brought into the NICU when they're needed. These might include machines to:

  • take X-rays and ultrasounds
  • monitor brain function
  • give babies phototherapy, or treatment under lights, for jaundice.

The NICU is usually a calm place, with nurses and doctors quietly looking after the babies and other specialists coming in and out. Monitors will sound to alert the staff if a baby's breathing or heart rate is out of the normal range.

If you know or think your baby is going to be born early, you can prepare for premature birth by asking to see the NICU. This can help it feel less strange when you visit your baby there after the birth.

Neonatal intensive care unit (NICU) staff

Specialist nurses
Every baby in a neonatal intensive care unit (NICU) has an individual bedside nurse. This nurse is highly qualified, having done extra study in nursing newborn babies, on top of a nursing degree.

Your baby's nurse will be able to tell you most things about your baby's medical condition. The nurse will know about recent test results, changes in how your baby is being looked after and your baby's condition over the previous few hours. When shifts change, your baby's nurse will tell the new nurse about how your baby is going and what your baby needs.

There are also managers of NICU sections and usually one nurse who is in charge of the whole NICU.

NICUs also have neonatologists. These are doctors who are specialists in newborn care, which is also called neonatal care. These doctors have first trained as paediatricians and then done further training as neonatologists.

Most NICUs have several neonatologists. One will be in charge of the whole NICU. There's always a neonatologist on duty, and you can ask to speak to this person. Some NICUs are happy for you to be there during ward rounds and to ask questions.

Visiting staff
Laboratory, echocardiogram and X-ray technicians visit the NICU regularly. Other paediatric specialists like cardiologists, ophthalmologists, neurologists or surgeons might also visit some babies.

NICUs also have other health professionals to help both parents and babies, including physiotherapists, occupational therapists, psychologists, psychiatrists, speech pathologists, social workers and pastoral care workers. These staff can talk with you and help you with some of the challenges of having a baby in the NICU - for example, worry and anxiety, family complications, or concerns about your baby's development.

NICU staff often organise information sessions for parents - for example, on baby massage - or social get-togethers.

Your baby's care in the neonatal intensive care unit (NICU)

NICUs in Australia use parts of a nursing program called Developmental Care, or Newborn Individualized Developmental Care and Assessment Program (NIDCAP).

Developmental Care or NIDCAP is a way of caring for premature or sick newborn babies in hospital that focuses on your baby's and family's needs.

It's all about reducing your baby's stress during daily and medical care. It's also about protecting your baby's sleep.

It means that the nurses will watch your baby carefully and use all their observations to get a complete picture of how your baby reacts, copes and settles. The nurses will also think about how and when they care for your baby. For example, your baby's nurse might watch your baby for a few minutes and decide whether to wake her or let her sleep for a little longer.

The nurses might also:

  • do cluster care, which means bathing and feeding your baby in one session
  • schedule care and feeding so that they don't need to wake your baby from a deep sleep
  • do fewer vital signs checks if your baby doesn't need them
  • cut down on stimulation during feeding - for example, by feeding your baby in a quiet, shielded corner, or feeding without talking and looking at the baby
  • let your baby suck something during and after feeds, or give your baby something to hold when he's being handled
  • cover or shield your baby's eyes so that being on the treatment table is less stressful for him
  • avoid patting, rocking and talking to your baby all at once to avoid overstimulation.

After 'cares', the nurse will watch your baby again to see how the handling affected her, and whether she needs extra help to resettle - for example, by being put in a different position.

They'll also change the environment to make sure your baby is comfortable. This might mean making sure his bed isn't near noisy taps or sinks, cutting out telephone and radio noise, or using a water, gel or ripple mattress.

Your baby's hospital might not use all the principles of Developmental Care, but it might use parts of this approach. Research has shown that babies nursed with the Developmental Care approach are healthier, develop faster and go home earlier. Other research suggests there's no evidence that these babies have better long-term development or better short-term medical outcomes.

Your family and the neonatal intensive care unit (NICU)

Hospitals try to make the neonatal intensive care unit (NICU) family friendly. Different hospitals will do things a bit differently, but your hospital will have a policy to make sure that your family is looked after while your baby is in the NICU. You can ask for a copy of the hospital's policy.

Family-centred care in the NICU is becoming the 'gold standard' of care. It's about treating you and your family with respect and working as a team with you to make decisions about your baby's care and treatment in the NICU.

Hospitals also typically have things like comfortable chairs next to your baby, a parent room nearby for meals, teas and coffees, a room for you to stay in overnight with your baby before taking her home, and play materials or play areas for your baby's siblings.

The NICU is a strange environment for your baby, you and your family. But it's also your baby's nursery, his home away from home. There are some suggestions to help you make it as much like a nursery as possible in our article on coping with the NICU.