Expecting a Preterm Infant in the NICU

When a mother has a high risk pregnancy, there is a possibility that her baby could be born prematurely, and would need to be placed in the NICU, or neonatal intensive care unit. There is also the chance that a baby could be delivered early to a mother with a normal pregnancy.  Regardless of how the preterm delivery happens, many parents are faced with the reality of having a baby admitted to the NICU.

The goal of this article is to prepare parents for what they can expect to see when they walk into the NICU to visit their baby for the very first time. It is this first impression that leaves the greatest impact on a parent, a very serious reality of how fragile their baby is at this early age.

No matter how prepared a parent thinks they are, either from their own research, or from information from their doctor, there is nothing like laying their own eyes on their new baby. Having the information can help, though, and can lessen the severity of the impact, especially if they have a beginning understanding on care and treatment in a neonatal intensive care unit.

The First Visit to the NICU

Photo by Josh Hopkins

As a parent arriving  in the NICU, be prepared to scrub your hands thoroughly before entering. This is a thorough handwashing, usually with a special type of handwashing soap.  A parent may also be required to use a hand santizing soap or foam as well.  Neonatal staff will want to make sure everything is especially sterile and clean, as babies have very low immune systems.

Once the hands and arms are scrubbed and clean, walking up to a baby for the first time in their NICU bed can have varying degrees of impact on parents, depending on the severity of the prematurity. For the extremely premature infant (around 23 to 29 weeks gestational age), be prepared to see a very tiny baby inside an incubator or open warmer bed. The neonate may also be connected to one or several lines and tubes. Also nearby may be a ventilator, or another similar machine used to help the baby breathe. A monitor will also be close by to help monitor the baby’s vital signs, including respiratory rates (breathing), and heart rates. All of these things are critical for the care of the neonate, but can prove difficult for the parents to see. Any parent understands that seeing your tiny, precious baby in any sort of situation like this is painful, especially if seeing the baby for the first time.

As blunt as all this sounds, it is important to remember that this is a very serious and very real situation. Parents around the world go through this on a day to day basis, so being as prepared as possible can help lessen the impact (however small, any help is still help).

Understanding NICU Equipment

One of the most common questions a parent asks when first visiting their baby in the NICU is what all the equipment does. Often, it is overwhelming to see the tiny neonate surrounded by such large machines, and attached to so many lines. But once explained, the concern is lessened, as knowledge is a strong tool easing uncertainty.

The first thing to notice would be the bed the baby is in. More than likely, it is an incubator or an open warmer bed. The open warmer bed provides a warm environment for the baby, as preterm infants generally are unable to regulate their own body temperatures. Without the warmer, the baby could become dangerously cold.

The incubator bed allows not only for a warmer environment, but can allow for a specific humidity for the baby to be in. Depending on how early the baby was born, he or she could be in one of these beds for an extended period of time.

Babies that are born prematurely often have difficulty breathing on their own, as their lungs are still immature. So, breathing machines, such as ventilators, are often used to help the baby breath. These will have tubes running to the baby’s lungs to breathe for them until their lungs are mature enough to breathe on their own. Other methods of oxygen management are available as well, some less invasive than others. If a baby is born preterm, it is best to expect to see a tube of some sort from the baby’s mouth helping him or her breathe. Though it can look imposing, it is absolutely crucial to the survival and continued growth of the infant.

Finally, one of the other common pieces of equipment to notice would be the monitor that is displaying the infant’s heart rate , respiratory rate, among other vital signs. These monitors are set to sound an alarm if the vital signs go above or below a normal range for the baby.

Many parents do not realize how often some of these monitors will alarm, as babys’ vital signs tend to fluctuate. It is natural to feel alarmed if a monitor alert sounds off, but it is a common occurence in the NICU. Rest assured the neonatal nurse is monitoring these alarms very closely. Often, a neonate will recover on it’s own, thus silencing the alarm. If immediate response is needed, a neonatal nurse should be close by.

Visitation

For both families and NICU staff, parents viewing their infant for the first time can be a tough situation, so there may be varying needs of comfort. Some parents will want to be with their baby alone for awhile before any visitors are allowed to come in. This gives the parents an opportunity to adjust to the condition their child is in. Others may want family close by for emotional support. Either way, it is important to anticipate these needs, and discuss with the parents what their wishes are for these first moments with their baby.

Sibling visitation is very important for families to be together when a baby is in the neonatal intensive care unit, but the severity of prematurity can have an effect on younger children, so it is best for the parents to talk to their other kids about what is going on with the new baby before bringing them to visit.

Support

Whether the premature birth is expected or unexpected, it is a very difficult situation for many parents. However, medical advancements and new technologies are allowing for premature infants to have a much better chance for survival, as well as reducing complications later on in life.

As imposing as a neonatal intensive care unit may seem, many parents adapt to the environment quite rapidly. They become a part of the NICU family, as they and the medical staff continuously work together to give the best love and care to these tiny infants.

Updated: June 2011