When Your Baby Is in Neonatal Intensive Care

Parents must cope with waves of emotions when a newborn needs intensive hospital care. Here’s what you should know about the NICU.

You want to hold your newborn, but that’s not possible right now if your baby is a preemie (born before 37 weeks of your pregnancy) or born with certain problems that require a high level of care. For now, your baby must stay in the hospital’s neonatal intensive care unit (NICU).

You may be overwhelmed by the number of machines and the noises they make, the beeping alarms, the bustle of people coming and going. You want to focus on your child, but for a time you can touch her only spontaneously through an incubator porthole, and you must wait for instructions about when you can hold or feed her.

Doctors, nurse practitioners, and physician assistants visit and perform tests. You hear many terms you don’t understand. Amid all the flurry, you might well have trouble even keeping track of the names of the people on your tiny daughter’s medical team.

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The range of intense reactions many parents experience may seem uniquely painful, from self-consciousness to gripping fear. It helps to know you’re not the only one. The American Academy of Pediatrics offers the following list of emotions.  

• Self-consciousness. The unit is a public place, shared with other babies and their parents and the staff. The nurses will watch when you interact with your baby to see signs of stress. Other parents may take their cue from you. You expected to be home, with loved ones. Over time, the situation may feel less strange.
• Anger. It’s not unusual to experience rage, which could focus on anyone nearby: the hospital staff, your husband, your family and friends, and even the baby. Your mind chatters with “They just don’t know what they’re doing,” “They just don’t understand,” “How can he go to work and just forget about the baby?,” “Why couldn’t you have waited for just a few more weeks?” Coping with the situation is already a huge demand on your energy, and anger will drain you more. It’s a gift to yourself to acknowledge rage and do your best to calm yourself.
• Guilt. If a baby arrives too early or sick, mothers especially may obsess about every day of their pregnancy, second-guessing their choices and blaming themselves. This kind of analysis, which psychologists call rumination, can lead to depression. Try to talk out any guilt feelings and move on.
• Sadness. You may feel cheated and sad that you didn’t have a “normal” childbirth that ended with your baby in your arms and home quickly. You may have planned the birth in detail, but the picture in your head didn’t come true.
• Powerlessness. You didn’t expect to spend all this time in the hospital with other people in charge. To combat a feeling of powerlessness, take charge in the ways you can. Ask the nurses questions, provide breast milk, and manage your emotions.
• Fear. Especially in the first hours, parents are frightened. You may fear that your newborn is seriously ill and will become disabled or even die. You might worry that you won’t be able to care for her properly. Mothers might fear that they are somehow to blame and that their own mothers or mothers-in-law or the baby’s father will be angry with them.  

Most of the time, no one can say why a baby was born too early or sick, or assign blame, even if blame were helpful. Know that the common problems treated in the NICU are not necessarily serious and that hospitals have many methods to solve them.

Here are some of the health issues that can arise for preemies and other newborns, requiring NICU care:

• The fetus normally stores iron towards the end of a pregnancy, which make red blood cells after birth. A premature baby may lack iron and become anemic. Your baby’s doctors can give her iron supplements, drugs that spur red blood cell production, or a transfusion.
• Some babies are born with breathing problems because their lungs haven’t fully developed or because of complications during the delivery, birth defects, and infections. Medicines and sometimes a respirator will help your baby breathe.
• Some babies may take five to 10 second pauses in between breaths, an issue that most outgrow. Sensors on the baby's chest send information about breathing and heart rate to a machine located near the incubator. An alarm beeps whenever the baby isn’t breathing. If a baby stops breathing for 15 seconds or more, the interruptions are called apnea A slow heart rate is called “bradycardia.” A nurse can stimulate breathing simply by touching the soles of the baby’s feet, or a baby may need medicine or a C-PAP (continuous positive airway pressure) machine to deliver air.
• Some babies have high blood pressure in their lungs, or persistent pulmonary hypertension, and may be treated with nitric oxide administered through a tube in the windpipe.
• Pneumonia is common. Your baby’s doctor may insert a tube into the lungs to take a sample of the lung fluid, identify an infection, and choose an effective antibiotic.
• Your doctor may advise you to immunize your baby against respiratory syncytial virus, which affects virtually all children before the age of 2 but can be more serious in babies with heart or lung problems (conditions more common in preemies).
• A baby may have a heart defect that can be corrected surgically or with medication.
• Babies who are very small or sick may need to be fed through a tiny needle placed in a vein in their hand, foot, scalp, or belly button. Once they are stronger, they can receive breast milk or formula through a tube in their nose or mouth, a process called gavage feeding. Babies this small generally don't gag. When the baby can suck and swallow effectively, gavage feedings will stop, and the baby will be able to breast- or bottle-feed.
• A baby born to a mother with diabetes will be monitored for low blood sugar, which can be treated by early feeding.
• Babies born weighing less than 3.5 pounds are more likely to suffer bleeding in the brain, usually in the first four days of life. Your doctor can diagnose a brain bleed with an ultrasound and measure the severity from 1, the mildest, to 4. Most brain bleeds resolve themselves with no or few lasting problems.

A baby born with a yellowish tint in her skin or eyes may have an immature or malfunctioning liver. In these circumstances, doctors monitor the level of bilirubin, a liver byproduct that causes jaundice, or yellowing. They can treat your baby with special blue lights that help eliminate the extra bilirubin or with a blood transfusion. Unusually small or premature babies may not have enough body fat to store heat. The incubator will help your baby stay warm. A tiny thermometer taped to your baby's stomach senses her temperature and adjusts the heat in the incubator.

Medical care for newborns today is sophisticated. The Centers for Disease Control and Prevention (CDC) reports one in 10 infants born in the United States arrives prematurely, but the majority survive.

The earlier a baby is born, however, the higher the risk of death or serious disability. Cooperating with your doctor and following all instructions is critical to help give your preemie the best start in life.

If possible, avoiding a premature birth is best. Quitting smoking and avoiding alcohol during pregnancy can help prevent a premature birth, the CDC says.

If you are pregnant, it’s important to contact your doctor if you experience signs of early labor, which are the same as the signs of impending full-term pregnancy labor:

• Contractions every 10 minutes or more often
• Leaking fluid or bleeding
• Pelvic pressure
• Backache
• Cramps

If you’ve had a previous preterm birth, talk to your doctor about steps you can take, including possible hormone treatment, to help prevent another preterm birth.  

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