Care in the NICU
A guide for Parents
What is the NICU?
Equipment in the NICU
- Infant Warmers: Beds that have heat radiators to keep the newborn warm.
- Isolettes: Beds that are surrounded by plastic borders. This makes temperature regulation possible for the newborn's preferred environment.
- Feeding Tubes: Small tubes that are places in the newborn's mouth or nose for feeding purposes since the newborn needs adequate nutrition.
- Monitors: Machines that are connected to the newborn to monitor their vital signs.
- Ventilators: Machines that help newborns breathe by being connected with a plastic tube through the mouth or the nose.
The Future to Neonatal Care
A study was conducted incorporating 127 premature newborn babies and placed approximately half of the babies in the collective NICU bed unit and the other half in private rooms. Prior to leaving the NICU, all of the infants underwent brain imaging, neurobehavioral testing, and amplitude integrated electroencephalography. The results showed that there was a difference in cerebral development between the two groups. Not until 2 years later were these babies brought in again, and the babies that were placed in private rooms showed results of lower motor and language scores.
The point of the initiative to move towards private NICU rooms was for the purpose of reducing noise exposure for the newborn. Although studies have shown that increased auditory and light stimulation of the collective NICU bed units are beneficial to the baby's brain development. Sensory stimulation is vital for the proper development of newborn babies. The pros and cons of private NICU rooms are still being observed, and the ongoing efforts of the improvement of neonatal care will surge healthcare into a bright future!
Interview with Nurse Green
What is your full title description as a nurse?
Donna Green RNc-EFM, MSN
Visiting Instructor of Clinical
University of Cincinnati, College of Nursing
Course Coordinator for Childbearing Across the Continuum
Greater Cincinnati Co-Leader for AWHONN
(Association of Women's Health, Obstetrics, and Neonatal Nurses)
Research Committee Co-Chair
Mercy Health Fairfield Hospital
Could you tell me a little more about yourself?
My experience is as a perinatal nurse. I have worked in labor and delivery, postpartum, and a Level II NICU at Mercy Health Fairfield Hospital for 16 years. Related to NICU, I currently work as an educational consultant and research committee co-chair for the Mercy Health Fairfield Hospital. At this hospital prior to the previously described role I held the title description of Perinatal Acute Care Nurse.
Could you briefly describe what your typical day working in the NICU is like?
Please include general tasks from the point you clock in until you clock out.
The first thing I do after clocking in the hospital is get a status report from the nurse that worked the shift before me. I generally care for 2 to 4 babies at a time. Before starting my care for the babies, I first scrub my hands for 2-3 minutes. Then I go around and perform a visual check and make sure the vital signs and breathing of the babies are not irregular. I then plan out feeding schedules and assessment schedules that need to occur every 3 hours for each baby in my care. This assessment includes a head-to-toe assessment and especially looks out for the GI and respiratory system. I do diaper changes, recording intake and output every time. I perform lab draws with a capillary specimen obtained from a heel prick and a blood culture to look for any signs of infection. Then I do admission assessments of new babies that potentially will be admitted into the NICU.
What are some conditions do the babies have to be in to be admitted into the NICU?
For about how long are they in the NICU for?
There are 3 reasons why neonates are admitted into the NICU that I work in. The first reason is because of pre-maturity. Preemie babies have an impaired respiratory system because they are not fully developed yet. The second reason is due to Respiratory Distress Syndrome, and the third reason is because of an infection. The newborn babies stay in the NICU for various amounts of time depending on what they are there for. If the baby is there due to pre-maturity, then they will remain in the NICU up until about the usual 40th week of gestation. If it's for an infection, the newborn babies might only be there for about 3-10 days.
Is there any equipment that is especially/most commonly used in the NICU that you could tell me about?
Isolette beds- This is for extremely low birth weight babies (less than 2000 grams) and pre-mature babies. These beds are thermoregulated to minimize calorie expenditure for the babies.
Radiant Warmer beds- Beds with a heat lamp above and a heated mattress.
Open Crib beds- Normal beds for babies that no longer need temperature regulation.
Temperature Probe- A device placed on the belly to make sure the baby is not over or under heated.
Positioning Aids- A nesting technique used by a mattress pad to support muscle tone. Also soft pillows are used to support the head shape of babies.
How do you best address the concerns that are brought up by the parents?
As a health care provider, I have to make sure that the parents understand the plan of care for their newborn baby. I be sure to include them in the decision making process and make sure to constantly explain to them what is going on. It is important that parents understand that this TAKES TIME. Before leading parents into the NICU to see their baby, I am always sure to first explain to them what they are about to see and why their baby is hooked up to so many devices so they don't panic once they see their baby upon entering the NICU.
Personally, what would you say is the hardest part of your job?
The hardest part of my job is simple. It is writing down the time of death for the babies that don't make it through that is the hardest part for me.
Do you have any inspirational stories that you would like to share?
I once took care of a baby and we all knew that the baby would not end up surviving in the end. I did all that I could. The parents later on wrote a book about their pregnancy journey and what they experienced in delivery. They wrote about the care that they received and mentioned me in their book. Just knowing that they received the best care that we could give them and how thankful they were despite the fact that their baby did not survive showed me how much of an impact our care makes on families. Sometimes we get so caught up that this is our job, but I never forget that this is their life.
Citations (in APA format)
Aschner, J. Future of NICU Care. American Academy of Pediatrics. Retrieved from http://www2.aap.org/sections/perinatal/presentations/FutureofNICUCare_Aschner4-2008.pdf
Jobe, A. (2014). Sensory deprivation in private rooms in the NICU. The Journal of Pediatrics, 164 (issue 1). Retrieved from http://www.jpeds.com/article/S0022-3476(13)01345-0/fulltext
Kid's Health. (2014). When Your Baby's in the NICU. Retrieved from http://kidshealth.org/parent/system/ill/nicu_caring.html#
VCU Medical Center. (2013, April 4). Virtual Tour: NICU Children's Hospital of Richmond at VCU. Retrieved from https://www.youtube.com/watch?v=fbiw9y7IG4Y