The Neonatal Intensive Care Unit (NICU)
The birth of a baby is a wonderful and very complex process. Many physical and emotional
changes occur for both 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 blood supply and
placenta for important body functions.
Before birth, the baby depends on functions from the mother. These include breathing,
eating, elimination of waste, and immune protection. When a baby leaves the womb,
its body systems must change. For example:
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 on their own.
Your baby's body systems must work together in a new way. In some cases, a baby has
trouble making the transition outside the womb. Preterm birth, a difficult birth,
or birth defects can make these changes more challenging. But a lot of special care
is available to help newborn babies.
What is the neonatal intensive care unit (NICU)?
Newborn babies who need intensive medical care are often put in a special area of
the hospital called the neonatal intensive care unit (NICU). The NICU has advanced
technology and trained healthcare professionals to give special care for the tiniest
patients. NICUs may also care 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 moved after birth.
Some newborn babies will require care in a NICU. Giving birth to a sick or premature
baby can be unexpected for any parent. The NICU can be overwhelming. This information
is to help you understand why a baby may need to be in the NICU. 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 preterm (born before 37 weeks of pregnancy),
have low birth weight (less than 5.5 pounds), or have a health condition that needs
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. This is because 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.
Below are some factors that can place a baby at high risk and increase the chances
of being admitted to the NICU. But each baby must be assessed to see if they need
the NICU. High-risk factors are detailed below.
Maternal factors include:
Being younger than age 16 or older than age 40
Drug or alcohol use
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)
Delivery factors include:
Changes in a baby’s organ systems due to lack of oxygen (fetal distress or birth asphyxia)
Buttocks delivered first (breech birth) or other abnormal position
The baby's first stool (meconium) passed during pregnancy into the amniotic fluid
Umbilical cord wrapped around the baby's neck (nuchal cord)
Forceps or cesarean delivery
Baby factors include:
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
Small for gestational age
Medicine or resuscitation in the delivery room
Respiratory distress, including rapid breathing, grunting, or stopping breathing (apnea)
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?
Some of the specially trained healthcare providers who may care for your baby include:
Neonatologist. This is a pediatrician with extra 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. This is a pediatrician getting extra training in the care of sick and premature babies.
They may do procedures and direct your child's care.
Pediatric resident. This is a doctor who is getting extra training in the care of children. They may
do or assist in procedures and help direct your child's care.
Neonatal nurse practitioner. This is a registered nurse with extra training in the care of newborn babies. They
can do procedures and help direct your child's care.
Respiratory therapist. This is a person with special training in giving respiratory support. This includes
managing breathing machines and oxygen.
Physical, occupational, and speech therapists. These types of therapists make sure a baby is developing well. They also help with
care, including positioning and soothing methods. Speech therapists help babies learn
to eat by mouth.
Dietitians. Dietitians ensure the babies are growing well and getting good nutrition. They watch
your baby's intake of calories, protein, vitamins, and minerals.
Lactation consultants. These are healthcare providers with extra 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 the care providers in the NICU choose the best medicines. They check
medicine doses and levels. They keep the team aware of possible side effects and monitoring
that may be needed.
Social workers. Social workers help families cope with many things when a child is ill. They give
emotional support. They help families get information from healthcare providers. They
support the family with other more basic care needs, too. These can include money
problems, transportation, or arranging home healthcare.
Hospital chaplain. The hospital chaplain may be a priest, minister, lay pastor, or other religious advisor.
The chaplain can give spiritual support and counseling to help families cope with
the stress of the NICU.
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