NICU Development and Care

 In the Neonatal Intensive Care Unit (NICU), the staff takes extra care to help provide the right level of rest, stimulation and interaction for each baby. This includes:

• Keeping lights and noise levels low
• Handling babies slowly and gently
• Coordinating activities to give babies the most time to rest
• Creating a womb-like environment with snug bedding, etc. 

Communicating with NICU Babies

The smallest discomfort can be stressful for NICU babies. Be assured that we do everything possible to keep your baby comfortable and with as little pain as possible. Although we continually assess for pain, it can be difficult, especially for premature babies, to let us know what’s wrong. Behaviors we watch for include:

• Crying
• Unexplained high heart rate or blood pressure
• Frowning, grimace or worried look
• Tight fisted hands or feet
• Tense or rigid body

We can treat some pain with medications. And there are many other things that comfort NICU babies, such as quiet, dim light, rocking, soothing talk, massage, pacifiers and snug bedding. However, some babies seem to prefer to be left alone. It’s merely that they have all they can cope with and more stimulation is too much. Discuss your baby’s behaviors with the NICU staff and decide what's best to calm and comfort your baby.

Pain and Medication

If your baby has been on pain medication for more than five to seven days, we will probably decrease the amounts slowly so as to not jar your baby’s system. Sometimes we administer pain medications through an IV. Sometimes we administer pain medications through umbilical lines (a tiny catheter threaded through a vein or artery in the umbilical cord which has no nerve endings and therefore is not painful). In addition to pain medication, an umbilical line may carry nutritional fluids. Umbilical lines also help us measure blood pressure and assist us in taking blood samples without disturbing your baby.

Nutrition and Breastfeeding

All too often, NICU babies aren’t able to be breastfed. We encourage breastmilk for infants as it can boost your baby’s immune system and give your baby strength. We’ll help you use a breast pump and feed it to your baby through an umbilical line. Using a breast pump eight times every 24 hours can enable you to establish and maintain a milk supply. Be assured that as soon as we can get your baby to breastfeed, we will assist you both. Breastfeeding is an important decision you may have made before your baby was born. However, having a NICU baby causes many women to change their choice of bottlefeeding to breastfeeding. The benefits of breastfeeding are many and include:

• Breast milk is easier for your baby to digest than formula
• Breast milk helps build your baby’s immune system
• Breast milk can decrease childhood allergies and asthma
• Breastfeeding time is a comfort bond with you for your baby

We’ll provide you with containers and labels for your breastmilk which will then be stored in a designated refrigerator or freezer to use for your baby. Please be sure to mark the date and time milk was bottled as it can be safely refrigerated for 48 hours. As your baby will be receiving intravenous nutrition initially, the first breastmilk (colostrum) fed will have been stored. Colostrum is rich in antibodies and nutrients, and can help protect your baby from infection. After the colostrum is used, we prefer fresh breastmilk. How your baby receives milk will depend on other conditions. For example, because premature babies are often not strong enough for breast or bottle feedings, these babies begin with gavage feedings—a small, flexible tube in the stomach through the nose or mouth. For very premature babies, breastfeeding or bottlefeeding might not begin for many weeks.

Breastfeeding can begin sooner than bottlefeeding — it’s easier for the baby. But generally, only one or two feedings a day. More times per day can be added as your baby gains strength. If you prefer bottlefeeding, we can help select formulas and teach you how to prepare it on your own before you and your baby go home. Although we’ll give you a lot of detailed information about breastfeeding, please ask a lot of questions. A lactation consultant is available in addition to nurses and physicians.