As a newcomer to the NICU, it may feel overwhelming and even scary coming into the unit for the first time. Take the time to learn about the equipment in the room and more specifically the equipment that your baby needs. This introduction video and device overview is a good place to start.
Dr. Gerry Cleary explains the NICU environment, the machines and treatments, and the care the staff provides for new NICU parents.
Dr. Cleary continues explaining jaundice therapy, ventilators, display monitors, and the nurses role.
Premature babies are very often placed inside an incubator. An incubator's goal is to mimic the conditions of the mother's womb. An incubator:
Although your baby needs to spend as much time as possible growing in the incubator, newer incubators are now designed to allow both you and medical staff greater interaction with your baby. Kangaroo Care—or skin-to-skin contact between you and your newborn—can also be performed during the baby's stay in the incubator. It has been proven time and again to be extremely important in many ways—not least of all, for the development of that lifelong bond between you and your child.
Much of their treatment will be administered directly from the incubator, further reducing the risk of complications from outside elements such as changes in room temperature and viral or bacterial infection. It is a tightly controlled environment that works toward allowing the baby's nutritional intake to go as much toward growth as possible.
The temperature inside the incubator can be set to air mode or skin mode. "Air mode" would allow you to regulate the air temperature inside the incubator at a specific value. Set to "skin mode", the incubator will add additional heat if it detects baby's temperature is dropping or decrease the amount of heat if it detects the baby is getting warmer.
It is very important to maintain a stable environment in the incubator and avoid, as much as possible, unless it is critically necessary, letting in cold air or letting out humidity. All of the baby's energy should be utilized for growth and development-not trying to stay warm.
An optimal temperature for your baby, sometimes called a "neutral-thermal environment," is perhaps the most important aspect of the time spent in the NICU. Newborns, especially premature babies, have a far narrower window of optimal environmental conditions, which is why they are placed in the NICU. The most fragile of neonates spend much of their time in closed-care incubators, though some clinicians prefer to put them in infant warmers.
As your baby grows stronger, he or she may then spend time developing in an open-care warmer. Here, parents and staff can have unrestricted access to their babies in an open environment that provides them with the warmth necessary for their maturity.
The temperature of the infant warmer can be adjusted to optimize the condition of the infant versus the temperature of the room, again bringing that temperature into the highly desired neutral-thermal environment. Many infant warmers are now calibrated to do this automatically and maintain that optimal temperature, even while the baby is not resting in the warmer.
Proper oxygen flow for growing babies is of critical importance, and ventilation technology has rapidly changed the way neonatal patients are treated. The ventilator administers small puffs of oxygen, and though these "baby breaths" are small, they give underdeveloped lungs a significant advantage over those that receive no assisted breathing and those given oxygen through less advanced ventilators.
As a baby's lungs mature to the point where she can breathe independently, the NICU staff will begin to wean her off the ventilator, a process that can be slow, like many elements of care here in the NICU. In some cases where lung disease is worse, your baby may be placed in a high-frequency oscillator, which can send between 600-900 very gentle breaths per minute into her lungs. Often, babies will then be placed on a C-PAP ventilator, a less invasive breathing assistance that allows your baby to further control the flow of oxygen into their lungs.
Monitors in the NICU display your baby's heart rate, breathing rate, blood pressure, and oxygen levels in the blood. Other parameters can be displayed as well, depending on the baby’s condition and what clinicians might need to monitor.
Newer monitoring technologies allow for data integration across the hospital, and will allow you to see the baby's x-rays, laboratory results, and other information at the bedside that might help clinicians speed up the decision-making process.
Many monitors in the NICU come equipped with a warning signal. These signals are intended not to alarm parents, but to keep everyone informed and aware of your baby's condition. In recent years, technology has advanced and helped reduce—and in some cases eliminate—the need for these sometimes jarring warnings. Rest assured, any warning sound is a far greater benefit than a disturbing bother, and every step is taken to avoid disturbing your baby.
The infusion pump intravenously administers medications and fluids to your baby. It provides the optimal amounts needed, dosages so small that even a slight error can cause complications. For this reason, the pumps are often fitted with safety features that carefully monitor how much medication is needed based on prescribed amounts. A specially trained pharmacist is also on staff to handle the micro-dosing your baby may need during his or her time in the NICU.
If someone says, "your baby has jaundice," it means that the color of your baby’s skin has a yellow tint. But where does this yellow color come from? Newborn infants are constantly making new red blood cells, and breaking down the old ones. One of the waste products of old blood cells is a yellow substance called bilirubin.
Bilirubin is processed by the liver into an easily disposable form and then eliminated from the body in the bowel movements. Some babies make bilirubin faster than they can get rid of it, causing the bilirubin to build up in the body and make the skin appear yellow. The yellow color is most visible in natural daylight (near a window) or under the fluorescent lights like those in the hospital nursery. Sunlight typically breaks down any excess bilirubin. Given the fragile nature of premature babies, however, this is where technology steps in.
Photo therapy systems shine a warm blue light over your child and help break down extra bilirubin, which babies then pass harmlessly through their bowels. Photo therapy lights have proven to be an extremely capable way of helping to process excess bilirubin. Usually, jaundice is not a concern in newborns. But as with everything, extra care is taken with our youngest patients.
ECMO (Extracorporeal Membrane Oxygenation) is commonly used in the NICU if the baby is in pulmonary distress. It is a treatment that provides oxygenation until the baby’s lung function has sufficiently recovered to maintain appropriate oxygen levels. The ECMO machine continuously pumps blood from the baby through a membrane oxygenator that imitates the gas exchange process of the lungs; by removing carbon dioxide and adding oxygen. The oxygenated blood is then returned to the baby.
To better monitor the progress and development of your baby’s internal organs, nurses and doctors look at x-rays. It helps them determine the best course of action to treat your baby’s condition especially if he is having some lung issues. Technologies today allow for x-rays to be done in incubators without having to disturb your baby. You will notice a small tray under the bed that will hold the x-ray film.
Ultrasound imaging is a common diagnostic procedure used in the NICU; it simply gives you a clear picture inside the body. It is performed by radiology or ultrasound technicians or clinicians to check on the baby’s developing organs, blood flow in the brain, and inside the body. The procedure involves using a transducer, which is a small hand held device that sends waves into the body and detects their echoes as they bounce off internal structures. Ultrasound could be performed while the baby is resting in the incubator.