All expectant parents hope that their babies will be healthy. Yet sometimes problems arise that require a newborn to be hospitalized. When this happens, the baby may be admitted to the neonatal intensive care unit (NICU) for treatment.
It's very stressful when your infant is admitted to the NICU. The doctors, nurses, and other caregivers in the unit will do their best to provide emotional support for you while caring for your infant's medical needs.
With equipment designed for infants and a hospital staff who have special training in newborn care, the NICU is an intensive care unit created for sick newborns who need specialized treatment.
Sometimes the NICU is also called:
Babies may be sent to the NICU if:
Only very young babies (or babies with a condition linked to being born prematurely) are treated in the NICU — they're usually infants who haven't gone home from the hospital yet after being born. How long they'll remain in the unit depends on the severity of their illness.
Although not all babies in the NICU have the same illness or condition, some diagnoses are common to newborns who need intensive care.
Here's a brief look at those conditions, what causes them, how they're diagnosed, how they're treated, and how long infants usually stay in the unit after they've been diagnosed.
One of the more common blood disorders, anemia is a low number of red blood cells in the blood. Babies who are anemic may:
Premature infants may develop anemia for a number of reasons. In the first few weeks of life, infants don't make many new red blood cells. Also, their red blood cells have a shorter life than an adult's. The frequent blood samples that must be taken for close monitoring of the infant also make it difficult for red blood cells to replenish.
In full-term or preterm infants, hemolytic disease of the newborn (incompatibility between the blood types of the mother and baby) can also lead to anemia.
A doctor can diagnose anemia with a blood test called a complete blood count, or CBC.
Minor cases are monitored closely, whereas severe cases (especially in those premature babies who weigh less than 2.2 pounds [1,000 grams]) may require red blood cell transfusions. Doctors also try to treat the underlying cause of the anemia.
By the time the underlying problem has been treated, the number of red blood cells in the infant's circulation stabilizes. As long as the baby is doing well and no longer has symptoms, then the doctors usually let the infant go home with close follow-up with the child's doctor.
Although it's perfectly normal for everyone to experience occasional pauses in breathing, newborns who don't take at least one breath in 20 seconds or more have a condition called apnea. During an apnea spell:
Apnea is usually caused by immaturity in the area of the brain that controls the drive to breathe (the brain doesn't "remember" to take a breath), although illness can also be responsible. Almost all babies born at 30 weeks or less will experience apnea, but apnea spells become less frequent as the premature infant gets closer to term.
To accurately diagnose apnea, doctors monitor a baby's breathing rate in the NICU and may order a polysomnogram, which involves attaching the baby to several monitors and observing the infant for about 8 to 12 hours. A pneumogram provides information about the baby's heart rate, breathing, and oxygen saturation in the blood.
In the NICU, all premature babies are monitored for apnea spells. The first line of treatment for apnea is simply stimulating the baby to help him or her remember to breathe. This can mean rubbing the infant's back or tapping the feet. However, when apnea occurs often, the baby may require medication (most commonly caffeine) and/or a special nasal device that blows a steady stream of air into the airways to keep them open.
Babies remain in the unit until they've been apnea-free for 48 hours. Some may go home with an apnea monitor and on caffeine so parents can continue to watch for the condition. Many babies outgrow apnea by the time they're 10 weeks past their original due date.
This is an abnormal slowing of the heart rate.
Bradycardia often arises from other problems like low oxygen levels in the blood or apnea.
Taking the baby's pulse and monitoring in the NICU will confirm a diagnosis of bradycardia.
Bradycardia is treated by dealing with the underlying cause, such as apnea. In some rare cases, a heart defect may be responsible for the slower heart rate. For the appropriate care, babies with a heart defect need to see a pediatric cardiologist (a doctor who specializes in treating heart problems in children).
Usually, the length of the stay is determined by the condition causing the bradycardia, not the bradycardia itself.
Babies who still need oxygen at 4 weeks before their original due date are considered to have bronchopulmonary dysplasia — one of the most common chronic lung diseases in infants in the United States.
Bronchopulmonary dysplasia occurs in different infants for different reasons. It can happen in full-term as well as premature infants and doctors believe that it's due to an individual infant's response to a number of possible factors.
The combination of the premature baby's immature lungs and the treatments (including machines and oxygen) to help the little one breathe is thought to cause damage (or scarring) to the lungs. Infections and pneumonia can also lead to the condition. Milder levels of damage are called chronic lung disease of prematurity (CLD). As the babies mature, they grow more lung tissue, which can improve their breathing over time.
The diagnosis of bronchopulmonary dysplasia usually doesn't occur until 2 to 4 weeks into the infant's life. At that point, the doctors make a diagnosis based on whether there was lung damage or an injury at birth and whether the infant has needed extra oxygen for a prolonged period of time. Chest X-rays can also help determine the extent of the lung damage.
Bronchopulmonary dysplasia is sometimes treated with steroids to decrease the amount of scarring. However, because steroids can cause side effects, doctors usually wait as long as possible to begin steroid treatment. Steroids are never used without a complete discussion with the family about potential benefits and risks.
Other, more commonly used medicines include diuretics (which make the baby urinate, or pee, and help eliminate excess fluid that can build up in the damaged lungs) and bronchodilators (which relax the muscles that surround the airways and allow them to open up).
Babies with the disease also sometimes need ventilators (breathing machines) at home to help them breathe. And although it's uncommon, in severe cases, the surgical insertion of a breathing tube in the neck (called a tracheostomy) may be required so the baby can go home on a ventilator. Occasionally, babies need home oxygen therapy for several months.
Bronchopulmonary dysplasia is a serious condition that calls for longer stays in the NICU, sometimes up to several months. The smallest infants are usually the ones who develop the disease, so their stays are longer to make sure they're stable before they're discharged.
Hydrocephalus means "water on the brain."
A buildup of cerebrospinal fluid that surrounds the brain and the spinal cord causes hydrocephalus. It occurs when something — often bleeding from an intraventricular hemorrhage (see below) or an abnormality of the brain or skull — blocks the flow of the fluid. The buildup can create pressure that can damage the brain.
Doctors suspect hydrocephalus if a baby has a particularly large head or if head size increases rapidly. A magnetic resonance imaging (MRI) test can confirm this suspicion.
Less serious cases are usually simply monitored, but more severe ones require a surgeon to place a tube in the brain (called a ventriculoperioneal shunt, or VP shunt) that drains the fluid from the brain into the abdomen.
Again, this depends on the severity of the case. A serious condition may require a stay of several weeks or months, with later monitoring so as to recognize potential long-term side effects like mental retardation and seizures.
Intraventricular hemorrhage is bleeding in the brain. Severe cases may cause a drop in blood pressure or seizures. Many times the hemorrhage is found by ultrasound. Other symptoms could include:
IVH usually occurs in premature babies because the vessels in their developing brains are especially fragile and can bleed easily.
It's diagnosed with an ultrasound of the head so that doctors can look for collections of blood in the brain.
There's no specific treatment for intraventricular hemorrhage, so NICUs try to prevent it by controlling babies' blood pressure. Once diagnosed, the problem is closely monitored with frequent ultrasounds. If serious, IVH leads to severe hydrocephalus, which can be treated with a surgically placed shunt.
This depends on the severity of the bleeding. Infants with serious cases may spend several weeks to months in the NICU and be at risk for conditions like cerebral palsy or seizures later in life.
Jaundice is a high level of bilirubin in the blood (bilirubin is a byproduct of the natural breakdown of blood cells, and the liver usually "recycles" it back into the body). Although mild jaundice is fairly common in full-term babies, it's much more common in premature babies.
Jaundice occurs when a baby has increased blood cell breakdown and the liver can't handle the extra bilirubin, which builds up, giving the skin and the whites of the eyes a yellowish color. Babies with jaundice are sometimes more sleepy than usual and, in severe cases, may be lethargic.
Although the yellow skin is a fairly good indicator, a diagnosis is made with a blood test to measure the bilirubin level.
Extremely high levels of bilirubin can cause brain damage, so infants are monitored for jaundice and treated quickly, before bilirubin reaches dangerous levels. Standard treatment includes providing adequate fluids and light therapy, in which the baby spends time under a special blue-colored light. Some cases may also require a blood transfusion.
Babies with this condition stay in the NICU until their bilirubin level drops, usually in about 2 to 3 days.
The most common intestinal condition in newborns, necrotizing enterocolitis occurs in about 1% to 5% of infants in the NICU and happens more commonly in low birth weight and premature infants.
It's thought that a number of factors can contribute to the development of NEC, which is the necrosis, or death, of parts of the intestine.
Although a full-term infant can get the condition, the more premature a baby is, the greater the risk for NEC — perhaps because the intestines aren't developed enough to handle digestion. Factors that are also believed to contribute include the introduction of milk feeding, damage to the intestines from an infection, and poor blood flow.
Babies with NEC may:
An X-ray of the abdomen confirms the diagnosis.
If there's no sign of a rupture in the intestines, doctors treat necrotizing enterocolitis by:
In the case of an intestinal rupture, a surgeon may remove the diseased section of the intestine or make an incision in the abdomen to allow the infected fluid to drain.
Recovering from NEC can take a long time. Babies may spend many weeks in the NICU readjusting to regular feeding.
The ductus arteriosus (DA) is a blood vessel in the heart that connects the aorta (which provides blood to the rest of the body) to the pulmonary artery (which sends blood to the lung). It allows blood to bypass the lungs while a baby is still in the womb.
The ductus arteriosus usually closes shortly after birth, which allows for normal blood circulation. But in some babies, most often premature ones, it remains open, or patent. Then blood flows through the ductus arteriosus and floods the vessels in the lungs, causing respiratory problems.
Those breathing problems are one clue that a baby has PDA. A heart murmur may also lead doctors to suspect the condition, which is then confirmed with an ultrasound of the heart.
Many times doctors just monitor the condition. If it appears that the patent ductus is causing problems,sometimes doctors can close the ductus arteriosus by administering medicine. But if that doesn't work, or if the baby is too sick to take the medicine, the infant will need surgery to close it.
Although recovery time varies from child to child, many babies bounce back from PDA treatment in several days.
A type of brain injury, periventricular leukomalacia occurs in the brain tissue that surrounds the fluid-filled cavities of the brain, called ventricles. This area of the brain is called white matter, in contrast to the grey matter that makes up the rest of the brain. So, the injury occurs to the white matter that provides connections between the brain and the muscles of the body.
PVL is thought to be caused by severe intraventricular hemorrhaging (bleeding in the brain). However, PVL can occur without any previous history of bleeding.
Often no signs of PVL will be apparent in the nursery. Premature infants are at greater risk of having it, so doctors will frequently get studies like a head ultrasound or an MRI (magnetic resonance imaging) to look for periventricular leukomalacia. As the infant gets a little older, he or she may show signs of developmental delays.
There's no specific treatment, only close monitoring and support with therapists if a child does develop significant delays, usually after discharge from the hospital
Babies with this condition may be in the NICU for several weeks or months.
One of the most common and immediate problems facing premature infants is difficulty breathing. Although there are many causes of breathing difficulties in premature babies, the most common is called respiratory distress syndrome (RDS).
In RDS, the infant's immature lungs don't produce enough of an important substance called surfactant. Surfactant allows the inner surface of the lungs to expand properly when the infant makes the change from the womb to breathing air after birth.
Doctors suspect respiratory distress syndrome in any premature baby or in full-term infants who are breathing particularly hard and fast or require extra oxygen. A chest X-ray can confirm this diagnosis.
When premature delivery can't be stopped, most pregnant women can be given a steroid medication just before delivery to help prevent RDS. If necessary, artificial surfactant can be given to the infant through a breathing tube, immediately after birth and several times later. Although many premature babies who lack surfactant will require a breathing machine, or ventilator, for a while, the use of artificial surfactant has greatly decreased the amount of time they spend on the ventilator.
Babies with serious cases usually require many days or weeks in the unit.
The eyes of premature infants are especially vulnerable to injury after birth. A serious complication is called retinopathy of prematurity (ROP), which is an abnormal growth of the blood vessels in an infant's eye (within the retina).
About 7% of babies weighing 2.8 pounds (1,250 grams) or less at birth develop the condition, and the resulting damage may range from mild (the need for glasses) to severe (blindness).
The cause of ROP in premature infants is unknown. Although it was previously thought that too much oxygen was the primary problem, further research has shown that oxygen levels (either too low or too high) play only a contributing factor in the development of the condition.
Because many very premature babies have some level of ROP, an eye exam by a pediatric eye doctor is standard at 8 to 10 weeks before the premature baby's original due date.
For slight damage, the eye doctor may just follow the baby with frequent exams. But if the damage is greater, laser surgery will be needed to prevent it from progressing.
ROP alone doesn't usually determine the length of a newborn's stay in the unit. It often occurs in conjunction with other problems, and those will be a greater influence on when a baby can leave. But babies generally recover from the laser surgery in 24 to 48 hours.
Sepsis is the body's response to infection that has spread throughout the blood and tissues.
Babies with sepsis may:
Sepsis is an infection caused by bacteria growing in the blood. The bacteria can get into the blood:
A blood culture — sometimes along with a urine test or spinal tap — is used to diagnose the illness.
When doctors suspect sepsis, they'll treat the baby with antibiotics until the lab results come back — usually for 48 hours. If those results are positive for sepsis, the baby receives antibiotics for 7 to 14 more days while being closely monitored.
Cases of sepsis are often severe (the infection can lead to meningitis, organ damage, and occasionally, death) and require a fairly long NICU stay, sometimes several weeks.
Rapid breathing in a full-term newborn (more than 60 breaths a minute) is called transient tachypnea. Until about 4 hours after the delivery, this can actually be normal.
After 4 hours after delivery, doctors start to look for a cause of the rapid breathing, such as pneumonia, a blood infection, or problems with the lungs, including underdevelopment.
Blood tests and X-rays can help diagnose the underlying condition.
The lung condition usually subsides within a few days with treatment. Babies are helped to breathe or receive oxygen, if needed, and the NICU staff closely watch their oxygen levels.
A stay of 24 to 72 hours is normal while NICU staff monitor the baby's condition.
In addition to specific diagnoses, infants in the NICU can experience general problems. For instance, newborns lose heat easily, and preemies in particular have trouble regulating their body temperature, as they lack the energy or fat reserves to generate heat and the body mass to maintain it. So NICU babies must be kept warm in warmers or isolettes.
High or low blood pressure can also be a risk for premature babies because their developing blood vessels can't handle changes in blood pressure and may tear more easily.
Some preemies have trouble feeding because they aren't physically coordinated enough yet to do it. Eating is the most energy-consuming process for a newborn, and babies in the NICU often don't have the strength or energy to feed on their own. Instead, they have to be fed through an IV line or a tube. And if the digestive tract isn't sufficiently developed to handle food, that can cause problems too, as seen with necrotizing enterocolitis.
A related condition is reflux. Although all infants have some reflux in the early months (hence all the spitting up), preemies have a particular problem with it because they have poor muscle tone. Sphincters are muscles, and when the one between the esophagus and the stomach is weak, it allows the acidic stomach contents to bubble back up into the esophagus. (A preemie's immature nervous system has trouble controlling the sphincter as well.) The acid irritates the esophagus, which can lead to feeding problems. Inhaling and choking on the reflux is a more serious risk.
Newborns who need intensive care are also vulnerable to infections. Their skin and mucous membranes — the body's primary lines of defense against bacteria and viruses — aren't well developed enough to provide adequate protection. With several immune-compromised babies in one space, infections that are introduced into the NICU can spread easily, and with nurses caring for multiple babies, the possibility of communicating infectious agents increases. That's why NICU staff are vigilant about keeping that environment as clean as possible.
If your baby is admitted to the NICU, you'll want to find out as much about his or her care as possible. Some questions to ask the doctor are:
You may also want to talk to the nurses to find out more about your baby's daily care and what to expect when you spend time with your little one.
Once you have the answers to these questions, you'll be on your way to helping your baby during his or her time in intensive care.
Reviewed by: Jay S. Greenspan, MD
Date reviewed: October 2011
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