Understanding the NICU

Preemie NICU

The thought of having a preemie is not one that crosses the minds of most pregnant parents unless it happens to them! The hospital Neonatal Intensive Care Unit (NICU) is a quiet place out of sight, and can feel like a totally foreign world to the families that end up needing it. This month is World Prematurity Awareness Month, and we are sharing a few facts about the NICU, in the hopes that it helps dispel some of the mystery.

There are different levels of NICU.

Not all NICU's are the same: there are different levels of care for preemies that not all hospitals are equipped to provide. Here are the differences:

  • Level I Healthy Newborn Nursery: This is your standard hospital nursery where care for healthy, term babies is provided. Many local hospitals have phased out the use of these nurseries in favor of babies and mothers rooming-in, and even if the hospital still has a Level 1 nursery, most of the time, it's empty!
  • Level II Special Care Nursery (SCN): Many local hospitals have a Level 2 SCN, which can provide care for babies born after 32 weeks gestation who do not require ventilation, and are otherwise stable. Bethesda North Hospital, The Christ Hospital, Fort Hamilton, and Soin Medical Center are local examples of hospitals with Level II NICUS.
  • Level III NICU: There are a handful of local hospitals that provide level 3 care, including Kettering Medical Center in DaytonGood Samaritan in Cincinnati, University of Cincinnati Medical Center in Cincinnati, and Miami Valley in Dayton. Level III is divided into A and B levels, with Level IIIB providing care to more serious cases requiring more advanced technology for their care, or for babies born before 28 weeks gestation. Babies born between 28 and 32 weeks can get their care from a Level IIIA NICU. Level III NICUS can provide minor surgeries, and continuous ventilation. If you were to go into labor before 32 weeks, you would be transferred to a hospital with this level of care for delivery, or your baby would be transferred shortly after birth.
  • Level IV NICU: A Level IV NICU is for critically ill preemies, or for those who will need major surgery after birth. This is the highest level of care, with the access to the most advanced technology, such as at Cincinnati Children's Hospital.

There are often special considerations for parents recovering with a baby in the NICU.

Talk to your local hospital about what they do especially for your family, but here are a few common things:

  • They will put a note or sign on your postpartum room door so that staff will know right away about your unique circumstances, and hopefully avoid a potentially awkward or uncomfortable conversation.
  • Many hospitals have programs and options for mothers to stay at the hospital, or close by, after they are discharged while the baby is still admitted.
  • It doesn't always work out perfectly, but many local hospitals require the neonatologist making rounds (the doctor who specializes in newborns!) to check in with you every day. There are also other specialists you may have access to, including lactation consultants to help with pumping and breastfeeding, and social workers to help you sort out insurance options.
  • If you aren't at the hospital, or in your baby's room, you will often be able to get your nurse's direct line to call with questions or just to check in.

Remember to ask about their visiting policy.

Each hospital has their own visiting policy, and generally there are some rules about the following:

  • Adults: Parents are usually granted 24/7 access to their baby in the NICU. Other adults, including grandparents, are usually limited to only visiting with at least one of the parents present too.
  • Children: Most places have a minimum age for visitors, and also require proof of certain vaccinations.
  • Number of visitors: There is usually a limit of anywhere from 2-4 visitors at a time, depending on the facility. It's a good idea, though, to limit visitation. It's important for preemies to get plenty of rest so they can heal and grow!

Understand the discharge requirements.

Each baby's circumstance will of course be unique. It's a great idea to grab a notebook and talk to your preemie's doctors and nurses, and write down what you hear! They may be able to give you a general idea of what to expect as fare as discharge, as well as let you know what they are looking for to know that baby is ready to go home. Every baby develops at his or her own rate, so there is no guarantee about exactly when all of these requirements will be met.Here are a few general requirements, but you should talk to your healthcare team for specifics for your baby:

  • The ability to suck, swallow, and breath alone should be well established. Occasionally babies are sent home still on oxygen, and the NICU staff will help you learn about how to care for your baby on oxygen.
  • Baby must be able to maintain a normal temperature on their own, and eat a certain amount of food by mouth. Some babies do go home on a feeding tube, and in this case, some extra education is given to parents for using and caring for the feeding tube.
  • There is a weight limit (usually around 4lbs), and a minimum gestational age for heading home (usually what would have been at least 35 weeks or so).
  • Parents likely will also have several educational pieces to complete before heading home.