Watching your baby in the NICU could be one of the most challenging things to endure for a parent. Not knowing what is happening inside can be a very stressful time. You cannot stay inside with your baby or visit them anytime you want. Want to know what goes on inside? Read this!
Babies need about 40 weeks in the womb to develop fully before entering the real world. During these 40 weeks, the foetus develops everything necessary to survive outside the womb. At around 37 weeks, the baby will be fully developed, known as a full-term baby. Babies born before the 37th week are known as preterm babies.
Preterm babies can be Extreme preterm i.e. <28 weeks to Late pre term i.e. 34 to 36 weeks.
Late pre terms(34-36 weeks) requires very little support and monitoring, while extreme preterms with all the organs still in the developing phase will require extreme care and support. The situation varies from case to case, and thus the support & care varies.
NICU—The Neonatal Intensive Care Unit is a hospital area that provides intensive medical care for newborn babies. It has advanced technology, equipment, and specially trained medical staff. The doctors and nurses in this unit are specially trained to handle and care for newborn babies.
Extreme Preterm babies have special needs like Surfactant to promote development of premature lungs and mechanical ventilation to support the breathing. Due to premature gut, they have special feeding needs. Also, as the skin is also very immature and fragile, they need extreme care and supportive measures.
Inside mother’s womb, foetus gets required oxygen from mother’s blood. As soon as baby is born, baby has to breath on their own to meet the oxygen demand. Hence the first cry of the baby is very important, as it helps in removing fluid from the lungs & initiate normal breathing. On few occasions despite being full term, babies may have breathing difficulty due to inability to clear this fluid from the lungs, hence require respiratory support.
If your baby needs extra medical support and the hospital does not have a specialised NICU, you need to move your baby to the nearest hospital with a NICU. When a baby does not get the care and support it needs, it may lead to health complications.
The NICU is not only for premature babies. Full-term babies with health issues, breathing difficulties, IUGR (intrauterine growth restriction), or those who require resuscitation at birth will be required to be admitted in the NICU.
Babies born to mothers with health conditions like GDM (gestational diabetes) on oral hypoglycaemic medication/insulin, PIH(pregnancy induce hypertension) or chronic hypertension on antihypertensive medication have tendency get hypoglycaemia, hence may require frequent monitoring in NICU for a short while.
Premature babies may be kept in the NICU until they are off any respiratory support, breathing on room air with no breathing difficulty, have adequate weight gain (weight > 1.8 kg), on full oral feeds and completed at least 36 weeks of gestation.
Since you cannot go inside the NICU frequently, here are some details about what goes on inside:
1. Warmer / Incubator— Newborn babies are kept under radiant warmer or Incubator to maintain body temperature. Incubators has humidifiers which maintains humidity of air so as to prevent insensible water loss. Usually extreme preterm are kept in incubators, while moderate to late preterm babies are usually kept under radiant warmers. Doctors and nurses will care for your baby through the holes in the sides of the incubators.
2. IVs and Lines—Most babies in the NICU will have an IV line in their hands or feet. This helps give fluids and medicines to the baby at regular intervals instead of individual injections. Doctor may insert umbilical venous catheters (UVC & UAC) or PICC line when IV access is required for longer duration.
3. Feeding Tubes—Feeding tubes are inserted in babies who are small or on any respiratory support and unable to take oral feeds. These tubes are inserted into the baby's nose or mouth and reach the stomach. They are secured with tape so they won't move.
4. Special Care—Babies in the NICU receive extra care compared to those in the general paediatric unit. Inside the NICU, your baby is watched over by a neonatologist, a paediatrician, a neonatal nurse, and other specialists. Dietitians, lactation consultants, and various therapists will regularly check on your baby if the admission is for a specific issue. The specialists related to that field will also check on their progress regularly.
5. Monitoring – The nurses will take regular readings of your baby's vitals and record them for the doctor's perusal. General monitors used in a NICU are chest leads, a pulse oximeter, and a blood pressure cuff. A temperature probe helps record the baby's body temperature at regular intervals.
6. Respiratory Support—Babies with breathing issues or low oxygen levels may be put on ventilators. A plastic tube may be put into their windpipe through the mouth or the nose to help them breathe. Some babies may have oxygen cannulas to supply more oxygen to them.
7. Visiting Your Baby – Yes, you can visit your baby in the NICU. Most hospitals even allow the mothers to go in and breastfeed the baby at set intervals (direct or through bottles). The father can also go in and spend some time with his baby. In case of skin-to-skin contact, both parents will be allowed to do so occasionally. However, if your baby is very fragile, weak, or hooked onto many monitors, they may not allow you to hold them for the baby's safety. The protocols differ from case to case and from hospital to hospital.
When your premature baby is in the NICU, as a parent, you may face the following difficulties:
1. Expenses – The longer your baby stays in the NICU, the higher your costs will be. Specialised care, medications, specialists, etc., are all more expensive than regular delivery. Check what expenses your medical policy can cover and make arrangements accordingly.
2. Stress and Depression – Watching your baby in the NICU can be very stressful. For a new mother who could already be suffering from postpartum depression, this can be a lot to take. Talk to your doctor and address your mental health. You need to be in your best health to handle everything.
3. Affects Regular Life – You may be unable to go to work or attend events as planned. You may have to be in the hospital for long hours. If the baby needs to be in the NICU for many weeks or months, the parents can go home and visit the baby multiple times a day.
4. Affects Siblings – If you have another child before this baby, they will need your attention too. It can be challenging for a small child to have their parents away for most of the day or to live with other relatives. Talk to your child and help them understand and adjust to the situation.
The expecting parents long await the birth of a baby. To have your baby in the NICU and not with you at all times can be very hard on the new parents. Remember, your baby is getting the best possible care in the NICU and will come back to you stronger and healthier.
It depends on how early they were born or what complications they are facing. Each baby's duration varies depending on their treatment response and complications.
The NICU is the Neonatal Intensive Care Unit. It offers specialised care for newborn babies who need more time or support to adjust to the real world. Premature babies are born before their development is complete, so they must be in the NICU until they are developed enough to be in the real world.
If your baby is healthy and has reached the suitable weight range, you can go home like any other new parent taking their baby home for the first time. In some cases, the baby will continue to need extra care and support even after going home. Your doctor will guide you accordingly.
