NICU 101 - The Top 5 Things to Know when you are New to the NICU
Hey, Mama. If you are anything like me, you like to feel prepared. Maybe you read instruction manuals before putting things together (and re-read when they don’t make sense), or maybe you like having some guidance when you are doing something for the first time. Whether it be following a recipe when you are cooking something new, or reading reviews before making a purchase, some of us like to have a base understanding before diving right in. If you can relate to that feeling, then this blog post is for you! I’ve taken my experiences as a two-time NICU mama and boiled it down to the top 5 things you need to know if you are new to the NICU.
What is the NICU? The NICU stands for neonatal intensive care unit, and in simple terms, it is a secure area of the hospital where babies with critical needs stay to get healthy. Many hospitals have a NICU, and it is usually near the Labor & Delivery section. There are different levels of NICUs, ranging from Level 1 to Level 4, with a Level 4 NICU taking care of the most critical issues that babies can experience. Many people think of preemies when they think of NICU, and certainly, premature babies do spend time there. But any baby regardless of size that has respiratory, feeding, or other health concerns can be admitted to the NICU.
What to expect when I go to the NICU for the first time? The NICU will have a secure entrance, where you will likely need to show identification and sign in or get buzzed in by a NICU staff member. Until the staff gets to know you, you will likely need to sign in and show identification every time you visit your baby. Also, NICUs have very strict policies about who is allowed in. You may be allowed to bring visitors (as long as they are healthy), but they will likely need to be on an approved visitor list and show ID as well. Another thing is many NICUs will not allow siblings if they are under the age of 18, just due to the risk of germs. Once you get checked in and step inside, there will be a sink with hand soap; plan to spend at least a few minutes thoroughly washing your hands up to your forearms and elbows. There will also likely be a clear plastic bag or screen wipes for you to clean off your phone or place your phone in the bag, as phones carry lots of germs. Once you’ve cleaned your hands and phone, you can now go to your baby. Depending on the hospital, the NICU may have multiple rooms, each room with multiple cribs or isolettes (a clear, encased temperature controlled bed that imitates the womb) that can be separated with curtains for privacy; or one large room with multiple cribs and isolettes; or even in some cases, hospitals may have private rooms where your baby will not have a roommate. No matter how it is set up, it is important to respect the privacy of other families and babies by trying to stay near your baby’s bed side. Once you are near your baby, depending on your baby’s situation, you may notice that your baby’s isolette is covered with a baby blanket. This is to help replicate the womb, and babies sleep much better when it is darker. You will also notice a monitor with a few different metrics on it that will likely beep while you are there. That monitor is watching your babies vitals. Do not panic if you hear it beeping - the nurses will help educate you on what the different beeps mean, and please rest assured that they keep a very close eye on your baby’s vitals and know when to intervene if necessary. Near the baby’s crib or isolette, there is usually a recliner chair for you, a breast pump (if you plan to pump), hand sanitizer, and of course other equipment and machines that are intended to help your baby through their NICU stay.
Who are all of the medical professionals that will interact with my baby in the NICU? You will become very close to your baby’s medical team, and do not feel afraid to ask what they are doing when it comes to your little one. Your baby will be assigned a main nurse each shift (and normally they work on 12-hour shifts) that will take care of your baby. They will be able to provide detailed updates to you about how your baby is doing, any change in medical plan for the day, perform medical procedures such as blood draws, IVs etc, as well as answer any questions you may have about the NICU or medical status of your baby. The nurse practitioner or advanced nurse practitioner oversees a few babies, but because they work longer shifts (usually 24 hours), they have a really good pulse on any changes that are occurring with your little one and can make a change to the medical plan if needed. The nurse practitioner will often lead the rounds that happen with the doctors, nurses, therapists and parents, to provide the neonatologist with a detailed update on each of the babies and provide recommendations for course of action for that day. The neonatologist is the main doctor within the NICU. Sometimes there are a few neonatologists that go to different NICUs in the area, so you may have a different neonatologist each day. They will assess your baby, order tests and labs, make diagnosis’s and provide course of action for the medical team to follow. The neonatologist will update you on your baby’s health status, the medical priorities the team has for your child, and will explain any procedures or changes in the medical plan. Depending on your child’s needs, another person you will likely encounter in the NICU is the respiratory therapist. They will set up all things breathing related for your baby. Other therapists that may be involved with your child are speech therapy (when it comes to feeding) and occupational therapy (to asses and move your baby to try to avoid muscle tightness or head flatness).
When and how can I interact with my baby in the NICU? As a mama, you are allowed in the NICU 24/7 to be with your baby and can be there as much as you want (assuming you do not have any cold/cough symptoms); though I would not recommend being there 24 hours, 7 days a week due to the emotional and physical toll it would take on you. Depending on your baby’s situation, you may not get to interact with he or she whenever you please. For both of my preemies (30 and 26 weeks), I had certain ‘care times’ each day where I could do a number of things with my baby during those windows. The care times are usually every 3 or so hours, and during this time, the nurses will show you how to take your baby’s temperature, change your baby’s diaper, do ‘oral care’ (cotton swab of breast milk around the lips), and depending on how your child’d situation, you may also be able to do skin to skin/kangaroo care during a care time. The reason I keep saying ‘depending on the situation’ is in the NICU, things can change by the minute. You may have a plan to hold your baby at a certain care time, but if your baby needs to rest in the dark/quiet instead, your nurse will let you know. You can always sit by your baby’s bedside, and read or sing quietly to your little one (or even just watch him or her rest!) Another way to interact with your baby, especially if they are a preemie, in the NICU is through containment. Containment is when you rest your hands on your baby’s body and/or head, to give them a sense of comfort and security as many early kiddo’s do not like to be stroked.
How long will my baby be in the NICU? This is a question you probably have yourself, but rest assured you will also get asked by well-intended family members and work friends. The answer that the nurses will sometimes give you is most babies come home ‘around’ their due date, but this is dependent on a number of factors that are outside of anyone’s controls (can your baby maintain their body temperature, can your baby ‘suck, swallow, and breathe’ in that order (aka feed), can your baby gain weight every day, etc). I also heard that the earlier your baby is born, the longer NICU stay you can expect and the closer to the due date (or even after the due date) is when to expect your baby to come home. The true answer though is that nobody has a set date. It is truly dependent on your baby, and each baby is so different. My 30 weeker came home 2 weeks prior to his due date, and my 26 weeker came home 2 days after his due date. Try your best to focus less on the date and more about the small milestones and wins that your baby is meeting and when the day comes, it will be amazing!
I hope this post gave you insights into what to expect if you are new to the NICU. Welcome to this roller coaster ride! You got this, mama!
