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 stay in the unit depends on the severity of their illness.
Not all babies in the NICU have the same illness or condition, but 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, newborns don't make many new red blood cells. Also, their red blood cells have a shorter life than an adult's. Frequent blood samples taken for close monitoring of a baby can 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 lead to anemia.
A doctor can diagnose anemia with a blood test called a complete blood count, or CBC.
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. Minor cases are watched closely.
When the underlying problem is treated, the number of red blood cells should stabilize. If the baby no longer has symptoms and is doing well, the doctor usually will let the baby go home and have the parents follow up with the child's doctor.
Although it's perfectly normal for everyone to have 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 also can be responsible. Almost all babies born at 30 weeks or less will have apnea, but apnea spells become less frequent as the premature infant gets closer to term (the baby's original due date at 39 weeks).
The health care team continuously monitors a baby that's at risk for apnea. Sticky pads on the baby's chest are attached to a monitor that detects the baby's heart rate and breathing, which lets the health care team detect and respond to apnea as it happens. The monitor also stores data about the baby's heart rate and breathing.
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 baby's back or tapping the feet. But if apnea happens often, a baby may need medicine (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 will 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. 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 (BPD) — one of the most common chronic lung diseases in infants in the United States.
Bronchopulmonary dysplasia happens for different reasons. It can happen in full-term as well as premature infants. Doctors believe that it's due to an individual infant's response to a number of 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 also can lead to BPD. As the babies mature, they grow more lung tissue, which can improve their breathing over time.
BPD usually isn't diagnosed until 2 to 4 weeks after birth. At that point, doctors make a diagnosis based on whether there was lung damage or an injury at birth and whether the baby has needed extra oxygen for a long period of time. Chest X-rays also can help determine the extent of lung damage.
Bronchopulmonary dysplasia is sometimes treated with steroids to decrease scarring. Because steroids can cause side effects, doctors usually wait as long as possible to begin steroid treatment. Steroids are generally not 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 BPD also sometimes need ventilators (breathing machines) at home to help them breathe. And although it's not common, in severe cases the surgical insertion of a breathing tube in the neck (called a tracheostomy) may be done so the baby can go home on a ventilator. Some 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 sent home.
Hydrocephalus means "water on the brain."
A buildup of cerebrospinal fluid that surrounds the brain and the spinal cord causes hydrocephalus. It happens 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 head ultrasound, CT scan, or magnetic resonance imaging (MRI) test can confirm this.
Less serious cases are usually simply monitored, but more severe ones require a surgeon to place a tube in the brain (called a shunt) that drains the fluid from the brain. Sometimes the fluid is drained to the scalp and sometimes into the abdomen.
This depends on the severity of the case. A serious condition may require a stay of several weeks or months, with continued monitoring to watch for potential long-term side effects like developmental delay 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 affects 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 common in full-term babies, it's much more common in premature babies. Bilirubin comes in two types, direct and indirect. Indirect bilirubin is the most common type seen in preterm infants, but doctors will measure both types. Only the indirect type is treated with lights.
Indirect bilirubin jaundice happens when a baby has increased blood cell breakdown and the liver can't handle the extra bilirubin. The bilirubin 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 yellow skin is a reliable sign, 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 plenty of fluids and light therapy (when a baby spends time under a special blue-colored light). Some cases may require a blood transfusion.
Babies 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 happens in about 1% to 5% of infants in the NICU and is more common in low birth weight and premature babies.
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. Introducing milk feeding, damage to the intestines from an infection, and poor blood flow also might play a role.
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 patent ductus arteriosus, it remains open, or patent. Then blood flows through the ductus arteriosus and floods the vessels in the lungs, causing respiratory problems. PDA is most common in premature babies.
Those breathing problems are one clue that a baby has PDA. A heart murmur also may 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 happens 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 affects 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 happen without any previous history of bleeding.
Often no signs of PVL will be seen in the nursery. Premature infants are at greater risk of having it, so doctors often order tests 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, a baby'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 goes from the womb to breathing air after birth.
Doctors suspect RDS in any premature baby and in full-term infants who are breathing particularly hard and fast or who need extra oxygen. A chest X-ray can confirm the diagnosis.
When premature delivery can't be stopped, most pregnant women can be given a steroid medicine just before delivery to help prevent RDS. If needed, artificial surfactant can be given to a newborn through a breathing tube immediately after birth and several times later. Many premature babies who lack surfactant will require a breathing machine, or ventilator, for a while, but 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) are 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. It's usually done 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 getting worse.
ROP alone doesn't usually determine the length of a newborn's stay in the unit. ROP often happens along with other problems, and those will be a greater influence on when a baby can go home. 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:
When doctors suspect sepsis, they'll treat the baby with antibiotics until the lab results come back (usually in 48 hours). If those results are positive for sepsis, the baby receives antibiotics for 7 to 14 more days while being closely watched.
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 actually can 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 eases within a few days with treatment. Babies are helped to breathe or receive oxygen, if needed, and their oxygen levels are closely watched.
A stay of 24 to 72 hours is normal while NICU staff monitor the baby's condition.
Besides specific diagnoses, infants in the NICU can have 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 also can 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 yet physically coordinated enough 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 at risk for infections. Their skin and mucous membranes — the body's main lines of defense against bacteria and viruses — aren't developed enough to protect them well. With several immune-compromised babies in a small space, and with nurses caring for multiple babies, infections in a NICU can spread easily. That's why NICU staff are careful to keep 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 2014
|National Heart, Lung, and Blood Institute (NHLBI) The NHLBI provides the public with educational resources relating to the treatment of heart, blood vessel, lung, and blood diseases as well as sleep disorders.|
|Congenital Heart Information Network The Congenital Heart Information Network's goal is to provide information and resources to families of children with congenital and acquired heart disease, adults with congenital heart defects, and the professionals who work with them.|
|Neonatal Jaundice This Web site contains information about jaundice, treatment options, and links.|
|Maternal and Child Health Bureau This U.S. government agency is charged with promoting and improving the health of mothers and children.|
|American Academy of Pediatrics (AAP) The AAP is committed to the health and well-being of infants, adolescents, and young adults. The website offers news articles and tips on health for families.|
|Medical Care and Your Newborn By the time you hold your new baby for the first time, you've probably chosen your little one's doctor. Learn about your newborn's medical care.|
|Looking at Your Newborn: What's Normal When you first get to see, touch, and inspect your newborn, you may be surprised by what you see. Here's what to expect.|
|Meconium Aspiration Meconium aspiration can happen before, during, or after labor and delivery when a newborn inhales a mixture of meconium and amniotic fluid. Although it can be serious, most cases are not.|
|Bronchopulmonary Dysplasia (BPD) Babies who are born prematurely or who experience respiratory problems shortly after birth are at risk for bronchopulmonary dysplasia (BPD), sometimes called chronic lung disease.|
|Anemia Anemia, one of the more common blood disorders, occurs when the number of healthy red blood cells decreases. This can result in a variety of symptoms, including fatigue and stress on all the body's organs.|
|Pregnancy & Newborn Center Advice and information for expectant and new parents.|
|Transient Tachypnea of the Newborn (TTN) For some newborns, the first few breaths of life may be more rapid and labored than normal because of a lung condition called transient tachypnea of the newborn (TTN).|
|Neonatal Infections The vast majority of newborns enter the world healthy. But sometimes, infants develop conditions that require medical tests and treatment.|
|Necrotizing Enterocolitis This gastrointestinal disease is the most common and serious intestinal disease among preemies. With medications and therapy, many babies can be cured.|
|Hydrocephalus Often called "water on the brain," hydrocephalus can cause babies' and young children's heads to swell to make room for excess cerebrospinal fluid. Learn how this condition is managed.|
|When Your Baby's in the NICU The neonatal intensive care unit may seem like a foreign place, but understanding what goes on there can help reduce your fears. Here's how to familiarize yourself with the NICU.|
|A Primer on Preemies Premature infants, known as preemies, come into the world earlier than full-term infants and have many special needs that make their care different from that of other babies.|
|FAQs: Prenatal Tests Find out what tests are available to keep you informed of your -- and your baby's -- health throughout pregnancy.|
|Patent Ductus Arteriosus (PDA) The ductus arteriosus (DA) is a blood vessel that connects two major arteries before birth and normally closes after a baby is born. When the DA stays open, a condition called patent ductus arteriosus (PDA) results.|
|Taking Your Preemie Home If you're about to begin caring for your preemie at home, try to relax. With some preparation and planning, you'll be ready.|
|When Your Baby Is Born With a Health Problem If you're expecting a baby, it's important to understand that certain health problems and complications can't be prevented, no matter how smoothly the pregnancy goes.|
|Retinopathy of Prematurity Retinopathy of prematurity, which mostly occurs in premature babies, is a disease that causes abnormal blood vessel growth in the retina. Sometimes surgery is needed to prevent vision loss or blindness.|
|Apnea of Prematurity Apnea of prematurity (AOP) is a condition in which premature infants stop breathing for 15 to 20 seconds during sleep. It's frightening while it's happening, but AOP usually goes away on its own as a baby matures.|
|Managing Home Health Care When kids need intensive health care after they're discharged from the hospital, it's important that family and caregivers learn about the devices, equipment, and support they'll need.|
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