Premature Infant

Getting to Know the Neonatal Intensive Care Unit (NICU)

If your premature infant (preemie) is admitted to the neonatal intensive care unit (NICU) after birth, you will find out about new technologies, a new medical language, and new rules and procedures. You will depend on the NICU staff members, including neonatologists and nurses, to know how to care for your infant and to be your teachers. With their help, you can quickly learn about the technology, your infant's needs, and what you can do for your infant. Throughout your infant's stay in the NICU, you will want to keep open communication with the medical staff.

NICU technology

After first learning to scrub up before visiting your infant's bedside, you may be surprised by the number of machines and instruments surrounding your child. Thanks to this medical technology, your premature infant has a significantly greater chance of doing well than ever before. At a minimum, your infant will be warmed and monitored with equipment that includes:

• Isolette or overhead heater.
• Temperature probe, to keep track of body temperature.
• Heart monitor, to keep track of breathing and heart rate.
• Pulse oximeter to keep track of how much oxygen is in the blood.

If your infant has additional medical needs, other tests and equipment also may be used, including:

• Transcutaneous oxygen and/or carbon dioxide monitor, to constantly measure these levels in the blood without using a needle.
• Intravenous (IV) site, for giving medicine, fluids, and feedings.
• Umbilical catheter, for giving medicine, fluids, and feedings, and for drawing blood.
• Continuous positive airway pressure (CPAP), for help with breathing (usually for mild to moderate apnea of prematurity and mild lung problems or for weaning from a ventilation machine).
• Ventilator, for help with breathing.
• Cranial ultrasound, to check for brain bleeding or damage, usually between days 3 and 7 after birth.
• Chest X-ray, to check for lung damage and to check the positioning of an endotracheal tube if one is used to assist with breathing.
• Abdominal X-ray, to check the intestines for necrotizing enterocolitis and to check the position of the umbilical catheter.
• Echocardiogram, to check the heart for congenital heart defects or patent ductus arteriosus.

Your role in your infant's care

At first sight, you may question whether and even how to touch your tiny infant. Unless your newborn is very sick or immature, you will be allowed to touch and possibly hold him or her. But your infant's nurse or doctor will first need to show you how to work around the technology and to alert you to your infant's special needs. When visiting with your premature newborn, remember that:

• A premature infant has limited energy for recovering and growing. Try not to wake your infant from sleep.
• A premature newborn is not neurologically prepared for interacting with the world. Be alert to signs that your infant is being overstimulated by your gaze, voice, or touch, or by sound and light in the room.
• A stable, more mature preemie will thrive on periods of cuddling (kangaroo care), infant massage, and calming music.

During this time when you have limited ability to hold or help your infant, you can give him or her an immunity boost by providing breast milk. Regardless of whether you plan to breast-feed or bottle-feed later on, pumped breast milk for tube-feeding reduces your infant's risk of infection. Your hospital's lactation consultant can be very helpful with pumping and breast-feeding questions and problems, both before and after the birth. For more information, see the topic Breast-Feeding.

If your infant is sick or especially immature, you may experience good days followed by not-so-good days as your infant struggles to heal and grow at the same time. By paying attention to your infant's cues as well as your health professionals' recommendations, you will be able to provide the contact or distance that your preemie needs.

As your infant grows stronger, you will be able to take on more caregiving tasks, ranging from holding and feeding to changing diapers to bathing. You can count on the NICU nurses to teach you and answer your questions. If you are breast-feeding, you may be asked to spend the night with your infant to find out if he or she is strong enough to nurse around the clock.

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Author:	Debby Golonka, MPH	Last Updated: May 5, 2009
Medical Review:	Michael J. Sexton, MD - Pediatrics Jennifer Merchant, MD - Neonatal-Perinatal Medicine
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