Navigating the NICU


Depending on whether you have your baby in a government or a private hospital, the layout of the neonatal intensive care unit (NICU) can vary. The various machines and equipment can be intimidating to a new parent, but it is important to know that everything in the unit – from the machinery to the staff – is there to help your baby thrive.

What happens after birth?

If your baby has been born prematurely, they may need to be taken to the NICU. Gynaecologist and obstetrician Dr Serilla Moodley from Netcare Waterfall Hospital and Netcare Linkwood explains: “In private hospitals and most public facilities there will be a paediatrician present at the delivery of a premature baby.

The next step really depends on how small the baby is and how well it responds the moment it is born. A very premature baby (less than 1.5kg) may need to be intubated (mechanical ventilation through a tube) in theatre before moving to NICU.

Read: Rooming in? Yes or no

A baby that copes well and is able to breathe on its own with little assistance, or some oxygen by face mask, may be kept in the incubator for observation. If intubation is necessary, the mom may not be able to see baby or do skin to skin immediately after the delivery.

If intubation is required, the baby will have pipes coming out of its throat or nostrils and a drip will be put up. Sometimes this is in the forearm or leg, and sometimes this can even be on the head of a baby.”

It is not only premature babies that may be taken to NICU, but also a baby born with any complications. The duration of the stay depends on each baby and their specific condition. There can be several complications with newborns.

This can vary from mild jaundice to nosocomial (hospital acquired) infections, to feeding and bowel related issues (common in premature babies). Some babies do really well and spend only a few days in NICU, while others can spend a few months.

All units have discharge criteria, which are most often weight dependent for premature babies. This means that once your baby has reached a certain weight, and they are healthy, you can take them home.

Will I stay with my baby?

For a parent to see their newborn in the NICU, whether they have machinery attached to them or not, will never be an easy thing.

Dr Moodley suggests asking a nurse or your partner to take a photo of your baby in the NICU to show you before you see them there for the first time. This will take away some of the shock and leave you better prepared. When it comes to visiting hours, most NICUs like moms to be there as often as possible.

Most hospitals will have lodging facilities for moms to stay over, especially if they are breastfeeding their baby. Initially, it might be difficult to breastfeed but it should be encouraged, as you can express the breastmilk and this can be given to your baby via a nasal feeding tube.

Another good read: My weird and wonderful baby

For those babies that are intubated, there may be something called parenteral feeding which means feeding via a drip. Visitation in the NICU is generally limited to mom and dad. This is to limit the spread of infection and to maintain strict sterility in the ward.

Is my baby in good hands?

The NICU is a very clinical and sterile environment. There is usually one nurse allocated per baby. They are usually very knowledgeable and well trained (NICU staff are generally the most sought after and well paid staff in nursing).

Paediatricians will do rounds at varying times in the day, sometimes every two to three hours for very ill babies. In each cubicle there will be an incubator. This is set at a constant temperature to maintain the baby’s body temperature (as newborns tend to lose heat very quickly). Depending on the severity of the condition there may be a ventilator, which is a machine that helps a baby breathe.

There are varying degrees of ventilation: something called CPAP – which is just high flow oxygen – to full intubation, which means the baby will have a pipe down its throat into its lungs to help it breathe artificially. The duration of this can vary depending on the underlying condition of the baby.

Other machinery that may be used is a phototherapy machine. If the baby develops jaundice, which is extremely common in premature babies and some newborns, there may be a blue light applied onto your baby for a few hours a day.

What about mom?

It is a natural feeling for mothers to feel helpless when their newborn is placed in NICU. One thing you can do is to try remain calm and optimistic. Not only will your calm state be picked up by your newborn, but it will also help your flow of milk.

Dr Moodley explains that if mothers are well prepared, then half the battle is won. And if they can cope mentally, that strength will in some way help with the recovery of their babies. Less stress helps with breastfeeding and combats baby blues, which is very common in woman that have babies in NICU, or after an early unplanned delivery.

Also: Taking your baby home

It is important for you to know exactly what is going on with your baby’s health. So whether you are in a private or government institution, keep asking questions. Talk to your doctor, paediatrician and the nursing staff and find out what is going on.

Sometimes medical terms can be confusing; don’t be afraid to ask them to explain what everything means. The more knowledge you have on your baby’s condition, the better mentally equipped you will be to stay strong until you can take your newborn home.

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