All About the Neonatal Intensive Care Unit (NICU)

NICU: What is it?

NICU stands for Neonatal Intensive Care Unit. New-born babies who need monitoring and intensive medical care are put in a special area of the hospital called NICU. NICU has specially trained doctors and nurses with advanced technology to give care to newborn babies. Babies who need intensive care do better if they are born in a hospital with a NICU than if they are transported to one after birth.

Which babies need NICU?

Most babies admitted to NICU are preterm (born before 37 weeks of pregnancy), have low birth weight(<2.5kg) or have health conditions (breathing trouble, heart problem, infection or birth defect) that need special care. Preterm babies are born too soon before 37 weeks of gestation. World Health Organization has categorized preterm birth depending on how early a baby is born as: extreme preterm (less than 28 weeks) very preterm (28-32 weeks) moderate and late preterm (32-37 weeks). Preterm babies will likely need a longer NICU stay. Preterm babies have immature respiratory system needing breathing support, may have a common heart problem called PDA related to prematurity, temperature control problems due to lack of body fat and immature skin, digestion problems due to immature intestine, they are frequently prone to infection, frequency of infection is directly related to prematurity.

Who will care for your baby in NICU?

Every NICU will have a team headed by neonatologists, specialised nurses, backed by allied specialists. Your baby will be mainly taken care by –

• Neonatologists (These are doctors who specialize in newborn care. These doctors are paediatricians who are further trained in newborn care)
• Paediatric resident
• Neonatal nurse practitioner and neonatal nurses (An NNP has received advanced training in neonatal care and manages critically ill newborn babies)
• Lactation consultant
• Clinical pharmacist
• Nutritionist
• Physiotherapist

Parents along with the NICU team work together to create a plan of care for their new-born. It is very important for parents and extended family to participate in day-to-day management of their baby along with the NICU team. Essentially it is a family centred approach.

What does a NICU look like?

Your first visit into a NICU can be overwhelming. At the entrance, Sanitizer or wash basin to wash your hands with soap before you enter will be present. Babies in NICU are either under an open warmer or closed incubator. These keep their bodies in right temperature akin to mother’s womb Depending on medical condition, a baby may be on a ventilator to help with breathing. CPAP is a non-invasive gentle breathing support to help babies breathe. Babies are connected to multi-channel monitors to their heart rate, breathing and oxygen level. Feeding may be through a small tube placed in the mouth which opens in the baby’s tummy or they may be on cup feeds or direct breastfeeding depending on their medical condition. All Of this technology keeps the babies well monitored and comfortable.

What are my baby’s nutritional needs?

Breast Milk is the best nutrition for all babies. Preterm babies born before 32 weeks can’t feed straight from the breast. Mother expresses milk and it is given through a tube that goes through the nose or the mouth into the tummy. After 32 weeks they are started on cup feeds initially and then graduated to direct breastfeeding. Sometimes donor human milk from the milk bank may be needed in some babies. Formula is the last option for preterm babies in NICU. Different strategies are used to optimize feeding for preterm babies to improve their short term and long-term health. Human milk alone may not be sufficient to meet the nutritional demands of some preterm babies. Fortification of human milk by adding extra protein and nutrients like calcium, phosphate, multivitamins, zinc and iron are added as an approach which is often taken for feeding preterm infants. This leads to better weight gain, linear growth and head growth in these babies. The milk given is calculated based on the fluid requirement of the baby. For babies who are critically ill and cannot tolerate milk may benefit from starting intravenous nutrition which includes proteins and fats in addition to glucose which is given through IV fluid. Along with nutritional support simple measures such as kangaroo care, encouraging human milk usage and basic infection control measures helps in better preterm birth outcomes An extreme preterm baby or a sick new-born would be receiving the majority of the nutrition intravenously initially. The milk volume is gradually increased to reach full feeding and subsequently IV nutrition is stopped and human milk fortification is done.

When can my baby go home?

This is the most frequently asked question from new-born parents in every NICU every day. If you make most of your time in NICU your transition to home can be less scary. Preparing your new-born to come home will need the baby ready for a discharge, getting yourself ready and getting your home ready. While the answer to this question depends on a number of factors, arming yourself with general knowledge of gestation age and birth weight and discussion with your neonatologist will help you feel more in control and better prepared to handle your baby’s hospital stay. Generally speaking, the earlier, the baby is born, especially extreme preterm babies born before 28weeks are likely to remain in NICU for 6-8 weeks Length of the NICU stay depends on the category of prematurity (extreme preterm, very preterm, moderate and late preterm) and birth weight of the baby and the health problems the baby has during the NICU stay. Babies who are born after 30weeks generally may need 3-4 weeks of NICU stay. But the good news is that advances in medical care and better outcomes for preterm and sick new-born babies have improved in the recent decade, giving a greater chance of survival and living a healthy life. The other milestones to meet before they are allowed to go home with their parents are the babies should be able to breathe room air or should be on minimal oxygen support. Your baby should be apnea free. Apnea refers to periods in which a baby stops breathing for more than 20 seconds. These responses are likely caused by prematurity. Your baby should be feeding by mouth and should have expected weight gain prior to discharge The baby should maintain a stable body temperature in an open crib, before they can go home. Generally, the baby’s weight will be around 1.6-1.8kgs at discharge. You might be anxious and eager to bring your new-born home but trust that the NICU doctors and staff will guide you and let you know when your little one is ready. If you are nervous about caring for them on your own, rest assured that the NICU staff will not send you home until you are comfortable managing your little one. It is equally important that you have a support system in place before bringing your baby home.

DO’s and DON’Ts for parents while the baby is in NICU.

We understand that going home while your baby is in the hospital is stressful for you and your family. Parents are welcome to the NICU at all times. We strongly encourage parents to participate in NICU while caring for their babies. Parents can get involved in day-to-day decision making along with their neonatologist, can participate in feeding schedules including tube feeds, kangaroo care as long as possible daily. We recommend that you do not bring visitors to see your baby. Siblings can briefly visit NICU provided they do not have any cold, cough or other illnesses. We encourage parents to interact with their baby as early as possible. Your baby will recognise your voice and kangaroo care is beneficial for both you and the baby. You can be with your baby in the NICU most of the time. The staff will give you instructions on hand washing methods before entering the area. Handwashing is extremely important in order to prevent infection in NICU. Masks and caps are needed. During any procedures, parents may be asked to wait a while. Parents are encouraged to ask questions during daily counselling sessions and mothers are welcome at all times into NICU.

KMC- what is it?

Kangaroo Mother Care is the care of preterm and term, low birth weight babies. They are carried skin to skin with the mother. It is powerful, easy to use, low cost, high impact, standardized method of care of new-borns with special benefit to preterm and low birth weight babies. It is initiated at the hospital and continued at home. KMC contributes to the humanization of neonatal care and to better bonding between new-born and mother. KMC can be intermittent at least for 1 hour per session and can be practiced as continuous KMC more than 12 hours per day. It is initiated as early as possible even at birth. Mother is the best KMC provider. Alternate KMC providers can be fathers or grandparents. KMC promotes exclusive breastfeeding and post discharge breastfeeding rates are higher in mothers who practice KMC. KMC mothers report being less stressed, increased confidence and feel that they can do something positive for their baby. Fathers too felt relaxed and comfortable while providing KMC.