Two days past her due date, Jennifer Pileggi finally went into labor. After several hours, the baby monitor showed that each time the 32-year-old from Orlando, Florida, had a strong contraction, her baby's heart rate dropped. Worried, the doctor recommended a Cesarean section. Pileggi was relieved when Anson was born the next day and seemed perfectly healthy, weighing 7 pounds 13 ounces. But soon a nurse noticed the baby seemed to be breathing too rapidly and took him for further evaluation. Within two hours, Anson had landed in the neonatal intensive care unit (NICU, pronounced “nick-you”). “I was shocked,” says Pileggi. “Nothing seemed wrong with him.” Anson had retained fluid in his lungs, a condition called transient tachypnea of the newborn, or TTN. When Pileggi next saw her newborn, he was hooked up to monitors and had an IV in his hand and an oxygen tube in his nose to help him breathe. After two nights he was released back to his mom's room, and the family left the hospital together.
No pregnant woman expects her baby to wind up in the NICU, but every year 10 to 15 percent of babies born in the United States (roughly half a million) do for reasons including prematurity (born before 37 weeks gestation), heart problems, birth defects, breathing irregularities and infections, among others. One in eight babies born in the United States are preterm, making that the number-one reason babies are admitted to the NICU; of those, 98 percent survive. If you're an expectant parent, it's good to know what goes on in these special hospital units — just in case.
Not All NICUs are Created Equal
Whether yours is a high-risk pregnancy or not, it's a good idea to learn where the nearest NICU is located and what level of care it provides. Each is rated level I to III, depending on the health problems the hospital can treat and the availability of specialized equipment. For instance, only NICUs rated level III are equipped to care for babies born before 32 weeks or those born with serious health issues.
The NICU's tubes, ventilators, IVs, incubators and high-tech monitoring equipment may look scary, but they're part of what makes the NICU the safest place for a sick or premature baby. The NICU's incubators (unlike the regular nursery bassinets) regulate their body temperatures for them. A (nasogastric) tube delivers breast milk or formula directly into baby's stomach via the nostrils. Immature lungs and respiratory complications are a common reason for NICU admission, so babies may also require oxygen hoods, a clear plastic box that fits over the baby's head and supplies oxygen. IV needles provide fluids to keep babies hydrated and deliver medication. Monitors taped to the baby's skin keep track of vital signs. Of course, if there's any kind of emergency, help is available instantly; the NICU nurses and doctors are experts in treating the tiniest patients, plus nurses are often assigned to only one baby for close monitoring, though they may care for up to four babies.
The Parents' Role
Brand-new moms and dads with babies in the NICU often feel helpless, but their role in their baby's care is vital. Bonding, holding and breastfeeding are as important as the medical care infants receive. You may not have the chance to hold your baby right away because he needs immediate medical attention. But once he's safely ensconced in an incubator, you'll probably be able to touch him gently, while wearing latex gloves. Each time you enter the NICU, you'll scrub as if preparing for surgery and wear a disposable hospital gown on top of your street clothes to prevent passing germs on to your baby. You may also be asked to wear a mask.
Make it a habit to be at the NICU for feeding times if you can. Breastfeeding is encouraged. “Nursing [including feeding baby breast milk] helps to mature premature babies' digestive system and their lungs and helps with brain development,” says Brenda Jennings R.N., a NICU lactation consultant at Baptist Memorial Hospital for Women in Memphis, Tennessee. “Breastfed babies tend to grow better and go home sooner.” Even if you can't breastfeed, you can take over feeding the baby for the nurse and bond with your infant. Keep in mind, though, that there are certain times of day the NICU is off-limits, usually when doctors are doing their rounds and during shift changes. Remember, the nurses are in charge and can be your lifeline to your baby. Adrienne Fulk, mom of baby Hunter who spent 22 days in the NICU, says, “Being on [nurses'] good side counted for a lot, whether it meant giving Hunter the incubator near the window or letting us hold him despite complicated wires/catheters. In addition to providing small favors, they were a wealth of information, not only in terms of explaining complicated medical terminology but also to handle and care for a newborn. In a way, we were lucky to have such amazing training on diapering, bathing, swaddling and nursing a newborn.” Today, Hunter is a vivacious, happy and healthy 2-year-old.
What Else Can You Do?
- Pump: If your baby is too weak to nurse, you can express breast milk with a pump, which will be fed to him via a feeding tube.
Cuddle: When baby is strong enough to be held outside his incubator, place him skin-to-skin on mom's or dad's chest. The proven benefits for a preemie or sick baby of this “kangaroo care” include warmth, stability of heartbeat and breathing, increased time spent in deep sleep and quiet alert states, less crying, better weight gain and increased breastfeeding.
Go cloth: Laundering tiny cloth diapers is a chore that can help you feel involved in your baby's care. Happy Heinys makes special preemie-size diapers.
Be there (even when you're not): Tape a picture of your family to baby's incubator — it's a sweet way to “be there” all the time. Plus, it lets new shifts of hospital personnel know who you are when you visit. Make sure your cell phone numbers are clearly visible and taped to his bed — it can help ensure immediate calls in case of emergencies or treatment changes.
Linger: Bring a blanket, a few one-piece bodysuits and a small stuffed animal from home so he can learn your smell and hopefully be comforted by it.
Take care of yourself: Accept help, take naps at the hospital and go out for fresh air and meals.
While it may seem like you're waiting forever, eventually you'll be able to take your baby home. Before you do, the NICU staff will make sure you know how to take care of your baby, particularly if she still has special needs. You may be required to learn infant CPR (important for all new parents), how to administer medication or how to operate monitors or any other special equipment. Many hospitals let parents spend a night or two in the unit in a special room where the NICU nurses can watch you care for your baby and answer any questions. Then, eventually, you'll go home as a family, your baby will grow and the NICU will be just a memory.