As a nurse in a Neonatal Intensive Care Unit (NICU for short), I’ve cared for a lot of scared new parents who had never even heard of a NICU until their baby needed one.
I mean, nobody likes to think about babies needing intensive care.
Especially not when it’s your baby.
But when it is your baby…it’s all you can think about.
So I want to give new and expecting parents a 50,000ft overview of what exactly a NICU is, why your baby could end up there, what level NICU they may need, how long they may stay, and some common rules you can expect. I’ll also talk about why parents and their NICU care team often become family.
My hope is that by taking away some of the mystery, I can also take away some of the anxiety you may be feeling.
What is a NICU?
NICU is a medical abbreviation that stands for Neonatal Intensive Care Unit. Neonatal is the period of a newborn’s life from birth to one month. Intensive care units are areas in hospitals where critically ill patients are cared for.
So basically, a NICU could be defined as an area of a hospital that provides intensive care for critically ill newborns.
The unit is typically in a different area of the hospital, which unfortunately means baby is separated from mom.
NICU babies require constant monitoring by specially trained doctors and nurses. They are usually hooked up to multiple monitors and we watch their heart rate, respiratory rate, oxygen, and countless other things very closely.
For this reason, baby typically can’t leave the intensive care area.
Why do Some Babies Need to Go to the NICU?
Newborns may earn themselves a NICU stay for a number of reasons:
- Preterm birth (birth before 37 weeks gestation)
- This is one of the most common reasons for an admission to the NICU and there are a lot of complications related to prematurity that can increase the length of stay. Typically the earlier the birth, the higher the risks, and the longer the hospital stay.
- Sometimes babies won’t be admitted for prematurity alone unless they’re under about 35 weeks gestation.
- Breathing problems
- Glucose (blood sugar) issues
- Elevated bilirubin levels (jaundice)
- Certain congenital anomalies or defects (some genetic disorders, heart defects, severe cleft lips/palates, etc.)
- Severe birth trauma or injury (from vacuum-assisted birth, cord prolapse, shoulder dystocia, etc.)
- Neonatal abstinence syndrome (newborn drug withdrawal)
- Intrauterine growth restriction (IUGR) and small for gestational age (SGA)
- Anemia (not enough blood in baby’s body)
- Meconium aspiration (when baby’s stool gets into his/her lungs during delivery)
- Temperature regulation issues (baby is too cold and can’t warm him/her self up)
- Pregnancy complications (preeclampsia, abruption, placental insufficiency, etc.)
- Post-term birth (when a baby is born after 42 weeks gestation)
- And many other things
When you look at a list like this, it’s hard to imagine how anything ever goes right!
In the U.S., about one of every ten babies born are preterm. This means about 10% of babies will likely need a NICU stay – and that’s for only one of those reasons listed above!
So, unfortunately, if you’re expecting – the odds of your baby needing a NICU stay are higher than you may think.
But on a more positive note, neonatology (a pediatric sub-specialty of medicine that deals with newborn infants, especially those who are sick or born prematurely) has made MASSIVE advancements over the last 50 years.
Babies that had virtually no chance of survival just a few decades ago (for example: babies born at 24 weeks gestation) can survive and even thrive today! And we’re constantly learning more.
But not every NICU is created equal.
Depending on the baby’s gestational age at birth and the severity of medical problems, they may require more specialized care than your local hospital can provide.
Levels of Neonatal Care
There are four levels of neonatal care and this will be a basic overview of each (if you want a more in-depth look at these levels with more specific explanations of why a baby would need one over the other, you can read this post on NICU levels).
The first is the newborn nursery, or “well-baby nursery”, which is the minimum most birthing hospitals will have. You can think of this as level 1. These nurseries are only equipped to care for stable, healthy newborns with no serious complications.
Level 2 NICUs have more highly trained nurses and doctors, and more specialized equipment than a typical newborn nursery. They can care for most minor to moderate short-term problems. They’re also typically better equipped to prepare unstable babies for transport to a higher level of care as quickly as possible.
A level 3 NICU, which is the second highest level of care, is where I work! These NICUs have extremely specialized equipment and staff, which allows us to care for preemies born as early as 23 weeks, needing total life support, and weighing less than a bottle of water!
And yes, it is incredibly humbling to have the privilege of caring for such fragile, delicate life.
The highest level of newborn care is the level 4 NICU. These units are equipped to care for the sickest, most unstable babies.
The main difference between level IV and level III is that these units can perform major neonatal surgeries and ECMO (extracorporeal membrane oxygenation). These units require neonatal surgeons, ECMO technicians, and nurses specially trained to care for tiny patients pre-op, post-op, and on ECMO.
The reason every hospital doesn’t have a level IV is because they require A LOT of specialized doctors, staff, and medical equipment that not all hospitals can afford. Plus, the majority of babies will never need this level of care.
Do Your Research
I would always highly recommend that parents research what level of newborn care their hospital has.
For me, personally…I wouldn’t feel comfortable giving birth in a hospital without AT LEAST a level 2 NICU, but I’d really prefer a level 3 if available. And that’s even if I had a totally healthy, uncomplicated pregnancy.
The unexpected can and does happen, even with perfect pregnancies (I’ve seen it). And when it does, seconds matter.
Think about it, most of those problems I told you about earlier can happen in full-term babies.
I’m seriously not trying to scare you. But I do want you to be informed and prepared in case something does happen so that you aren’t totally blind-sided.
Plus, I’ve seen the worst and it makes me cringe to think about what may have happened if the baby had been delivered in a hospital without a NICU. I truly love babies and just want what’s best for their well-being.
Do your own research, though. Reach out to your local hospital and ask about their neonatal care. Talk to your OB. And then make the decision where to deliver for yourself.
But please keep in mind that even the most meticulously planned births rarely go as expected.
Sometimes moms with a detailed, well-organized birth plan go into preterm labor thousands of miles away from home.
But hey, some moms give birth in a car and everything turns out fine. You just never know. But I would rather err on the side of caution when it comes to mine and my baby’s health.
How Long do Babies Stay in the NICU?
One of the first questions parents always ask me is “when will my baby be able to come home?”. And I’ll tell you the same thing I tell them: when baby shows us he/she is ready to leave.
I know that answer sucks. But it really depends entirely on the individual situation and what complications come up during baby’s stay. (I do have a slightly better answer that I’ll tell you about after I explain a bit).
Some babies may only need to stay in the NICU for two days. Others spend the first six months, or more, of their lives with us.
Some things that will affect how long baby will stay in the NICU include:
- Gestational age at birth (typically the lower the age, the longer the stay)
- Respiratory support needed
- Some babies need a breathing tube attached to a ventilator that breathes for them
- In the most extreme cases, baby could need a tracheostomy (not super common)
- Others may just need a small amount of oxygen through a nasal cannula (like the type you see some elderly people with)
- Babies actually can and sometimes do go home on this type of oxygen if they can’t be weaned off in the hospital
- Presence of infection
- Ability to keep their temperature up
- Need for surgery
- Apnea and bradycardia episodes
- When baby stops breathing and/or drops their heart rate – we definitely don’t want to send them home if they’re doing this.
- This is VERY COMMON for preemies and one of the biggest reasons they end up needing to stay in the NICU longer.
- Ability to eat properly
- This is the other biggest thing that keeps preemies in the NICU longer.
- Being born prematurely, it’s sometimes harder for them to learn to coordinate “suck, swallow, breathe” and they can get choked up or forget to breathe and drop their oxygen – also definitely don’t want to send them home doing this.
- It is possible for babies to need feeding tubes at home because they aren’t able to eat for one reason or another (but this is pretty uncommon).
- This is the other biggest thing that keeps preemies in the NICU longer.
And there are tons of other factors to consider related to prematurity, birth trauma, and all the other issues that they may have been admitted for in the first place.
So here’s my slightly better answer…
For preemies, especially those who had few complications, I’ll usually tell parents to plan on hopefully going home around the expected due date.
Sometimes babies can go home a month earlier. Sometimes they stay months later.
It really does depend on what type of complications baby may have had. Like I said, we have to let baby decide when he/she is ready to go home.
Common NICU Rules
Many babies in the NICU are fragile and have immature, under-developed immune systems. This means it’s very easy for them to get infections that their bodies may not be able to fight off.
A common cold for you and me can mean severe illness or even death for a NICU baby.
For this reason, there are some ground rules that most NICUs will have for baby’s protection.
These rules may include:
- HAND HYGIENE
- I cannot overemphasize the importance of this.
- Anyone coming into a NICU needs to wash their hands for at least 15 seconds with warm, soapy water.
- Alcohol gel must be used before touching any NICU baby.
- Limited visitation
- Other than parents, except under particular circumstances.
- Visitor health screenings/temperature checks
- Visitor immunization records
- Visitor age limits
- Personal protective equipment (PPE)
- Think gowns and masks
Washing your hands thoroughly as soon as you enter the NICU and using alcohol gel before each contact with baby is the number one thing you can do to protect your little one.
Make sure visitors do the same. Everything we touch has germs on it. These germs can be extremely dangerous and even fatal to NICU babies.
Most NICUs have open visitation for mom and dad (or someone else chosen by mom if dad isn’t in the picture). This means that parents are welcome to come and go mostly as they please. This often has a few exceptions, such as during sterile procedures.
Mom and dad will sometimes be allowed to list a certain number of people who can visit the baby when they aren’t around. And usually a limited number of visitors can go back to visit at once. This is to help minimize infection risk but also because these little ones can be overstimulated by noise.
Overstimulation can actually stress the baby, even to the point of causing their oxygen levels to drop. The environment should mimic the womb – dark, quiet, and warm.
Visitors may be required to fill out a health screen stating that they haven’t had symptoms of being sick.
They also may have their temperature taken before being allowed in the unit. It’s vitally important that visitors, and even parents, be honest about possible illnesses.
Visitors should avoid visiting if sick. Parents may need to wear a mask or avoid direct contact with baby if they’re sick.
I know that’s hard, but
NICU babies can be days from going home and end up back on total life support if they get sick. It’s tragic, but it happens.
I’ve seen it numerous times. And even if they overcome the illness, they still end up in the hospital for months longer.
Younger visitors (under 16 or 18) may only be permitted to visit in the unit if they are baby’s siblings. (In some units they may not be allowed to visit at all).
If they can visit, they will likely require proof of immunizations and may not be allowed back if they’re too young to have received all the required vaccines.
Younger visitors also may not be allowed back during flu/RSV season (~October-May in most of the U.S.). This is to protect not only your baby, but all the babies in the NICU. These somewhat mild illnesses for adults are often devastating for NICU babies.
That last one can be so hard for parents with other kids. You want your kids to get to meet their little brother or sister so badly, but the risks can be so high.
We usually encourage parents to do live videos and take lots of pictures!
Sometimes the sibling wants to give baby a drawing or stuffed animal which could possibly be kept at the bedside (again, depending on the unit).
Personal Protective Equipment (PPE)
Depending on the layout of the NICU, your health status, and baby’s health status…you may be required to wear a gown, mask, or other PPE. This may be for the safety of you, your baby, and the other babies in the unit.
This may seem like a lot of rules, but they are so important because not following them can literally be life or death.
If your nurse seems a little neurotic about the rules, it’s likely just because she truly, deeply cares about your baby’s health. We’ve seen the worst and we don’t want that for your family.
The NICU Family
The NICU can be a scary place but it can also be a magical one. I’ve seen my fair share of both pain and miracles as a nurse on this type of unit.
I’ve cried both happy tears and sad ones – sometimes with families, sometimes with coworkers, and sometimes when I’m by myself.
Having a baby in the NICU can be a truly traumatic experience for parents. Even in the best scenario – you still have to give your baby to strangers soon after birth. And then trust that these strangers are going to take care of your entire world.
But back to those strangers I was talking about. It can be scary having to trust people you don’t know. But I’d estimate at least 95% of the people who work in the NICU (myself included, obviously) do so because we truly love babies and are incredibly passionate about what we do.
And spending so much time with these people during such a traumatic, stressful experience often brings you closer to them than you would ever imagine.
The team of people caring for you and your little one can include:
- Respiratory therapists
- Doctors (Neonatologists)
- Occupational therapists
- Speech-language pathologists
- Social workers
- Lactation consultants
- Music therapists
- Nursing assistants
- And more!
This huge team is a family. And despite starting out as strangers, our patients and their parents often become a part of that family, too.
There are few other areas in a hospital where patients continue to come back years later to see their healthcare team.
But parents regularly bring their little ones back to visit, whether at NICU reunions or special milestones (like birthdays). It’s hard not to feel a strong connection when you spend the first days, weeks, and sometimes months of your baby’s life with these people.
And that goes both ways. There is nothing that makes me happier than watching the tiny babies I’ve cared for grow into little people! It’s seriously the highlight of this profession.
Being in the NICU is hard. But the bonds created while you’re there can sometimes last a lifetime.
Have you seen this video on Facebook about the NICU nurse who met the preemie she cared for when she was young? He ended up becoming a resident at the hospital where he was born…and she still worked there! It’s worth a watch.
“I actually had to text my parents. I had to be like “So I think I met this person who is the person you keep telling me about””
Now I’m a super emotional person anyway, but I cried watching this because I can only imagine what a reunion like this would be like.
You Got This
If you have a baby in the NICU, trust me when I say you’re already stronger than you think.
Because it’s hard.
It’s hard to have your plans fall apart.
It’s hard to miss out on time with your new baby.
It’s hard to watch your little one fight and struggle.
It’s hard to watch other families take their babies home.
But you will come out of this even stronger than you ever imagined.
Every NICU is different but I hope you found this general overview helpful.
If you currently have or previously had a baby in the NICU, I’d love to hear your story in the comments.
If you’re an expecting parent worrying about the possibility of a NICU stay, comment and let me know what worries you the most. I’d love to talk with you!
“Babies used to make me nervous, but these squirmy things are awesome once you’ve read the manual”,
(-David Z. Hirsch)
Carol-Ann, the NICU Nurse