What the Beep - Decoding the Noises in the NICU

While I was pregnant with my first baby and as my belly was growing, I recall imagining what those first few hours would be like after giving birth. I imagined myself in a sunny hospital room, with my husband by my side. I imagined myself holding my sleepy baby, bonding through breast feeding (which of course came super naturally in my dreams), and I envisioned my husband and I enjoying watching our sleeping baby making soft and calm breathing sounds, in and out. I truly envisioned a quietness, a calm, a moment of peace and serenity, for those first few hours after birth when it was just us and our baby in our own little world.

I think back on that thought years later, and I’m not sure if that dream is realistic even for full term healthy babies. But now as mama to a 30-weeker and a 26-weeker, this is certainly not the reality for preemies who needs to spend time in the NICU. For me, the reality for both kiddos was having my babies being immediately taken to the corner of the room to be ‘worked on’ by the neonatologist, respiratory therapist, and other specialists, and within a few minutes after that, my baby was being quickly wheeled away to the NICU where I was told I could visit them in an hour or so once the baby was more stable.

Walking into the NICU for the first time is sensory overload, especially for new mamas who do not know what to expect. You get used to the visuals pretty quickly (the machinery, the isolette, the monitors, the privacy curtains), and even the smells you come to know (think hand sanitizer meets dish soap meets rubbing alcohol and all things sterile). But the hardest part and one of the most triggering parts of the NICU for me was the sounds. I did not expect all the bleeping beeps.

So what sounds can you expect when you enter into the NICU, and specifically regarding your baby? I’m here to help you decode them from a non-medical lens with some very non-medical terms (but if you know, you know…):

1) Baby Monitor on or near isolette - This is a critical machine that is hooked up to your baby and will allow your medical team to keep a close eye on your baby’s real-time vitals. The machine has different beeps, and different series of beeps. I remember hearing the machine go off for the first time and looking around like, “Why isn’t anyone running to come help my baby?” Please trust that not every beep means something urgent, not every beep means your baby is hurting or in danger. Sometimes it beeps when your baby’s heart rate drops below a certain threshold, even for a brief moment; sometimes it beeps if your baby’s oxygen dips for a moment for different non-threatening factors. It could even beep in error, meaning that maybe one of the leads wasn’t attached quite right. The most important thing I want new mamas to walk away with on this one is - you WILL hear a lot of beeps, not just from your baby’s monitor, but all the monitors around you. The nurses, even if they are not directly next to your baby, are always watching and listening via other monitors they have - and your nurse or a medical professional will come over to help your baby should your baby’s vitals indicate that they are in distress. Also, when in doubt, please ask! Your nurses will be more than happy to explain what the various noises mean and what they are watching for, and they are more than happy to explain it over and over if you need it. Do not be shy - ask; and please do not worry; not all beeps are bad.

2) The Isolette Itself - If your baby is in a closed isolette (one with a top on it), every day or so (whatever the hospital protocol is), your baby’s bedding will be changed which requires the top of the isolette to come off. Or when you get to the point that you are able to do kangaroo care with your baby, your baby’s nurse will open the top of the isolette. Either way, if the closed isolette is open for too long, the isolette itself makes some pretty loud beeps. This may occur as well when the isolette temperature drops below a certain threshold. That isolette is intended to replicate the womb as much as possible - so they keep it nice and warm for our kiddos to help them sleep and grow. If the isolette has any issues, it will beep loudly. Do not be alarmed - your nurse or other medical staff will address the monitor, or if needed, will literally swap out the old isolette for a brand new one.

3) Respiratory support, including ventilators and CPAP - Did I mention, the machines are LOUD? So far, I’ve just mostly talked about beeps. But let’s talk about bubbles and breaths (or what sounds like puffs of air) now. Certain types of respiratory support, which many preemies need to be on for varying periods of time, have their own sounds. There are different types of ventilators, and to me, those sounded a little bit like puffs of air. One of my son’s (the 26 weeker, Max) was on different types of respiratory support, and one was called ‘Bubble CPAP’ - which sounds like its name, water bubbles. These sounds are kind of in the background and a bit more ‘regular’ than the baby monitor beeps and the isolette beeps, which sometimes happen ‘at random’. Just know that if your baby is on some type of respiratory support, the sounds they make might turn into ‘white noise’; not really noisy or super noticable, but not quiet either.

4) Hospital Grade Breast Pumps - If you are pumping, good for you! And if you aren’t, that is okay too! I attempted to pump with both babies of mine; and both times, I hardly produced whatsoever. That said, there was always a hospital grade breast pump near the isolette. The lactation consultant told me that it could help my production to pump while I was looking through the isolette at my little one, so that is what I tried to do while at the NICU. One thing I will say is, they again make noise. Not just the constant 20 minutes of the ‘weh-wah’ noise of the pump trying to pull the milk, but then the short yet loud jingle to let you know when it is done. This noise didn’t really bother me so much, but it was additional stimuli in an already loud and sometimes chaotic environment.

5) Milk tube machine that nurses ‘gavage’ - When your baby gets to the point they are trying bottle feeds, your baby not be able to take the full amount of milk that they need for nutrition because preemies tire easily. When this happens, your nurse will have to ‘gavage’ the rest of the feed - meaning they put the remaining milk or formula in a syringe looking tube that is connected to your baby’s NG tube, and they put this in an electronic machine that basically dispenses the milk/formula over a certain period of time, which the nurse can control based on what your baby can handle. This machine will beep when it is close to finishing the feed, and then of course if it has finished. I remember there was a time that this machine kept beeping. It would beep once or twice, then be silent for about 90 seconds, then beep again. I remember having my son in his own room at this point and not wanting to bother a nurse, but finally the intermittent beeping got to me so I had to have a nurse come in end it. One other word to the wise - please do not attempt to press buttons on the machines yourself. Your nurses know how to work them, and are happy to help shut them off (if they are able and it is okay to do so).

I’m sure there are other noises I could be forgetting - but I am now 5 months removed from my youngest son being in the NICU, and those were the ones I could remember off the top of my head. Please share any additional noises you picked up on that I may have missed by leaving a comment!