NICU


The neonatal unit

Approved by the BabyCentre Medical Advisory Board
Last reviewed: February 2012
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What is the neonatal unit?

The neonatal unit provides expert, round-the-clock care for newborn babies who are ill or born prematurely. If your baby is in the hospital’s neonatal unit, you are not alone. One in nine babies born in England will spend time on the neonatal unit.

There are different levels of care available on neonatal units. Depending on your baby’s needs, she will be in one of these units:

  • Neonatal intensive care, for the most seriously ill babies.

 

  • High-dependency care, for babies who do not need to be in the NICU but who still require complex care.

 

  • Special care, for babies who are catching up on growth and development after a premature birth. These babies have less serious health problems or are getting better after more complex treatment.

There might also be transitional care. This happens just before your baby is ready to go home. Transitional care gives you a chance to take care of your baby yourself, but with the nurses nearby. Sometimes this means staying in a side room on the neonatal ward with your baby for a while.

Every hospital has a neonatal unit, but some may not be equipped to provide the level of care your baby needs. Your baby might therefore have to be transferred to a unit far from your home. This could also happen if your local hospital does not have enough room.

Why does my baby need to be in the neonatal unit?

Premature babies need extra help while their bodies catch up on the growth and development they missed in the uterus (womb). For example, it’s harder for your baby to stay warm because she can’t regulate her own body temperature yet. A special cot (incubator) can help with this.

If your baby is too small, weak or immature to feed, she might receive fluids and a nutrition mixture through a drip. Or she might need a tube that carries milk into her stomach.

Premature babies also need extra monitoring, treatment and care. They are vulnerable and can have serious health problems. Some of the common problems associated with premature birth are:

  • breathing problems
  • bleeding in the brain
  • heart conditions
  • gut and digestive disorders
  • eye problems
  • jaundice
  • anaemia
  • infections

In the neonatal unit, the nurses and doctors are always checking for the signs of any of these problems. They can treat your baby promptly if they need to.

Who will care for my baby in the unit?

On the neonatal unit, a skilled team from different professions will care for your baby. Some of the people you may meet include:

  • Staff and specialist neonatal nurses.

 

  • The senior nurse in charge of the unit, called the sister or unit manager.

 

  • Consultant paediatrician or neonatologist, who leads your baby’s care.

 

  • Other specialist doctors, such as surgeons.

 

  • Staff grade doctors.

 

  • Junior doctors.

 

  • Physiotherapists to help with your baby’s development.

 

  • Radiographers, who take x-rays and scans.

 

  • Dietitians who advise on nutrition.

 

  • Pharmacists.

 

  • Nursery nurses.

 

  • A social worker to help you with family issues, financial worries, and support that might be needed after you take your baby home.

Last but not least, there’s you, the parents. You know your baby best and are always her most important carers. The professionals will recognise this and treat you as part of the team. They should encourage you to take an active part in your baby’s care, as far as possible.

As well as looking after your baby, neonatal units also try to help you, your partner and your baby’s brothers and sisters. This is called family-centred care.

Most hospitals have an open-doors policy and their neonatal units are open 24 hours a day for parents to visit. Others have more restricted visiting hours.

If you’re not at the hospital, you can call the neonatal unit any time, day or night. Always ask questions or talk to the staff about any worries you may have.

What are all those machines and tubes for?

It can be scary to see your baby attached to all sorts of machines. It can make you feel that you will never get the chance to be close to her. Be reassured that as your baby gets stronger, she will need fewer machines and it will be easier for you to hold her and care for her.

Some of these machines also have loud bleeping alarms and it can be frightening when they go off. Feel free to ask the nurses if you don’t know what an alarm means, and whether it’s anything serious.

Here is some of the equipment you could see in a neonatal unit:

Baby warmers

An incubator is a special cot that keeps your baby warm and sometimes controls the moisture level (humidity) around her. Some incubators have lids, some don’t. Some have overhead heaters.

Monitors

There are various monitors that help the neonatal unit’s team care for your baby.

Vital signs monitors are machines that might be used to keep track of your baby’s heart beat, breathing rate, blood pressure and temperature. Nurses will attach sticky pads to your baby’s chest. The pads are in turn attached to wires, which feed through electronic information to the monitor about how your baby is doing. The monitor alarms can sound off quite often.

Blood saturation monitors measures how much oxygen is in your baby’s blood. Sticky pads might be strapped to your baby’s foot or hand to feed information to the machine.

Help with breathing

A ventilator can help your baby’s lungs do the work of breathing. Your baby might need a ventilator if she is very premature or weak. The doctor will gently insert a tube into your baby’s windpipe. Via the tube, the ventilator feeds a mixture of air and oxygen mixture into and out of your baby’s lungs, mimicing a breathing pattern.

A CPAP machine (the capitals stand for continuous positive airway pressure) is another piece of equipment that can help your baby breathe. A CPAP machine gently inflates your baby’s lungs and helps to keep them open. Air goes in through a mask or via a tube in your baby’s nose called a nasal cannula.

If your baby just needs extra oxygen, her incubator might have a see-through head box to help with this or she might receive oxygen through a mask or a nasal cannula.

Tubes

The unit’s team may place a fine needle attached to a tube in your baby’s veins to make sure she receives the fluids, medicines or nutrition she needs. The team may also insert tubes in her arteries to test her blood pressure, oxygen and carbon dioxide levels.

An infusion pump is a machine that makes sure that your baby receives her medicines and fluids via tubes at the right rate and speed.

A feeding (gastric) tube enables your baby to have milk fed straight into her tummy if she is not ready to feed from the breast or bottle. Nurses will gently insert a soft, flexible tube through your baby’s mouth or nose and down into her stomach.

Special lights

Phototherapy lights help your baby to recover if she has jaundice. Many newborns have jaundice. Their skin turns yellow because a substance called bilirubin builds up faster than their bodies can break it down.

Phototherapy lights helps your baby’s body to convert the bilirubin to a harmless substance until her body can do this by itself. The lights also convert the bilirubin to a form that is more easily excreted. Your baby is placed under the lights and wears a mask to protect her eyes.

What about visiting my baby in the unit?

Parents are usually allowed to be with their baby any time, day or night. Brothers and sisters are often encouraged to visit, too. Other people may be able to visit but not too many at once.

Generally speaking, it’s not a good idea for people with colds and flu to visit the unit. Ask one of the nurses about your unit’s policies.

How can I help my baby while she is in the unit?

Your premature baby needs all the things that other babies need from their parents. Your touch, your voice and your presence all help a great deal. There are many things you can do to help your baby while she is in the neonatal unit. Here are just some of them:

Kangaroo care

Once your baby is strong enough, one very good way to help her development is kangaroo care. You simply hold your baby inside your shirt, against your bare skin. Kangaroo care is soothing for your baby, and can improve her health and development.

In studies, kangaroo care has been shown to reduce infections, encourage breastfeeding and promote bonding. Staff on the unit can show you how to hold your baby when she is ready.

Feed your baby

As your baby gets stronger you can start feeding her, too. If you’re keen to breastfeed let the nurses know. They should make every effort to help you with this.

The nurses should help you to express your milk in the early days before your baby is strong enough to breastfeed. The expressed milk will be stored and used to feed her when she is ready.

Giving your premature baby breastmilk can encourage her brain development and help her to fight illness. Breastfed babies also go home from hospital sooner.

It’s not always easy to breastfeed when your baby is premature, for all sorts of reasons. It’s especially hard when you are stressed and worried about your baby. So do make sure that you get lots of help and support.

Care for your baby

It may take some time, but as your baby gets stronger you can start doing all those ordinary things that most parents take for granted, such as changing her nappy and giving her a bath.

Speak up for your baby

Like all parents, sometimes you have to speak up for your child and be their advocate. If you think something is wrong, trust your instincts. Talk to the staff. Don’t be afraid to ask questions and to voice your worries or concerns.

Look after yourself

One of the most important things you and your partner can do for your baby is look after yourselves. Get some sleep, eat regular, balanced meals, and take a break from it all.

It’s exhausting having a baby in the neonatal unit, especially if you have other children or if you’re recovering from a difficult birth. It’s natural to put your baby first but be good to yourself, too.

When can my baby come home?

It’s hard to say because all babies are different. It depends on how your baby’s doing. Babies who are smaller and those born sooner tend to have more problems and so tend to stay longer on the unit.

A premature baby who is otherwise well usually stays in the neonatal unit until around the date she was due to be born. If your baby is doing really well, she might even be able to come home sooner than this.
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