The Neonatal Intensive Care Unit (NICU)
The birth of a baby is a wonderful yet very complex process. Many physical and emotional
changes occur for mother and baby.
A baby must make many physical adjustments to life outside the mother's body. Leaving
the uterus means that a baby can no longer depend on the mother's circulation and
placenta for important body functions.
Before birth, a baby’s breathing, eating, elimination of waste, and immune protection
all come from the mother. When a baby enters the world, many body systems change dramatically
from the way they worked during fetal life:
The lungs must breathe air.
The cardiac and pulmonary circulation changes.
The digestive system must begin to process food and excrete waste.
The kidneys must begin working to balance fluids and chemicals in the body and excrete
The liver and immune systems must begin working independently.
Your baby's body systems must work together in a new way. Sometimes, a baby has trouble
making the transition to the world. Prematurity, a difficult delivery, or birth defects
can make these changes more challenging. Fortunately for these babies, special newborn
care is available.
What is the neonatal intensive care unit?
Newborn babies who need intensive medical attention are often admitted into a special
area of the hospital called the neonatal intensive care unit (NICU). The NICU combines
advanced technology and trained healthcare professionals to provide specialized care
for the tiniest patients. NICUs may also have intermediate or continuing care areas
for babies who are not as sick but do need specialized nursing care. Some hospitals
don’t have the staff for a NICU and babies must be moved to another hospital. Babies
who need intensive care do better if they are born in a hospital with a NICU than
if they are transferred after birth.
Some newborn babies will require care in a NICU, and giving birth to a sick or premature
baby can be quite unexpected for any parent. Unfamiliar sights, sounds, and equipment
in the NICU can be overwhelming. This information is provided to help you understand
some of the problems of sick and premature babies. You will also find out about some
of the procedures that may be needed for the care of your baby.
Which babies need special care?
Most babies admitted to the NICU are premature (born before 37 weeks of pregnancy),
have low birth weight (less than 5.5 pounds), or have a health condition that requires
special care. In the U.S., nearly half a million babies are born preterm. Many of
these babies also have low birth weights. Twins, triplets, and other multiples often
are admitted to the NICU, as they tend to be born earlier and smaller than single
birth babies. Babies with health conditions such as breathing trouble, heart problems,
infections, or birth defects are also cared for in the NICU.
The following are some factors that can place a baby at high risk and increase the
chances of being admitted to the NICU. However, each baby must be evaluated individually
to determine the need for admission. High-risk factors include the following:
Younger than age 16 or older than age 40
Drug or alcohol exposure
High blood pressure (hypertension)
Sexually transmitted diseases
Multiple pregnancy (twins, triplets, or more)
Too little or too much amniotic fluid
Premature rupture of membranes (also called the amniotic sac or bag of waters)
Changes in a baby’s organ systems due to lack of oxygen (fetal distress or birth
Buttocks delivered first (breech delivery) or other abnormal presentation
The baby's first stool (meconium) passed during pregnancy into the amniotic
Umbilical cord wrapped around the baby's neck (nuchal cord)
Forceps or cesarean delivery
Baby born at gestational age of less than 37 weeks or more than 42 weeks
Birth weight less than 5 pounds, 8 ounces (2,500 grams) or over 8 pounds, 13
ounces (4,000 grams)
Small for gestational age
Medicine or resuscitation in the delivery room
Respiratory distress including rapid breathing, grunting, or stopping breathing
Infection such as herpes, group B streptococcus, chlamydia
Low blood sugar (hypoglycemia)
Need for extra oxygen or monitoring, IV (intravenous) therapy, or medicines
Need for special treatment or procedures such as a blood transfusion
Who will care for your baby in the NICU?
The following are some of the specially trained healthcare professionals who may be
involved in caring for your baby:
Neonatologist. A pediatrician with additional training in the care of sick and premature babies.
The neonatologist (often called the attending physician) supervises pediatric fellows
and residents, nurse practitioners, and nurses who care for babies in the NICU.
Neonatal fellow. A pediatrician currently receiving additional training in the care of sick and premature
babies. He or she may perform procedures and direct your child's care.
Pediatric resident. A physician currently receiving additional training in the care of children. He or
she may perform or assist in procedures and help direct your child's care.
Neonatal nurse practitioner. A registered nurse with additional training in the care of newborn babies. He or
she can perform procedures and help direct your child's care.
Respiratory therapist. A person with specialized training in providing respiratory support including managing
breathing machines and oxygen.
Physical, occupational, and speech therapists. Physical and occupational therapists make sure a baby is developing appropriately.
They also help with developmental care including positioning and soothing techniques.
Speech therapists assist with helping babies learn to eat by mouth.
Dietitians. Dietitians ensure the babies are growing appropriately and receiving appropriate
nutrition including calories, protein, vitamins, and minerals.
Lactation consultants. Lactation consultants are healthcare providers with additional training and certification
in helping women and babies breastfeed. They can help with pumping, maintaining milk
supply, and starting and continuing breastfeeding.
Pharmacists. Pharmacists help in the NICU by assisting the care providers in choosing the best
medicines, monitoring drug dosing and levels, and keeping the team aware of possible
side effects and necessary monitoring.
Social workers. Social workers assist families in dealing with a wide range of emotions they face
when a child is ill. They help families get needed information from doctors, and support
the family with other more basic care needs such as money problems, transportation,
or arranging home healthcare.
Hospital chaplains. The hospital chaplain may be a priest, minister, lay pastor, or other religious advisor.
The chaplain can provide spiritual support and counseling to help families cope with
the stress of the NICU experience.
NICU team members work together with parents to create a plan of care for high-risk
newborns. Ask about the NICU's parent support groups and other programs designed to
encourage parental involvement.