The NICU Experience for Preemies

It's what all expectant parents fear the most - a baby born either too early or with complications and rushed off to a neonatal intensive care unit (NICU), where their newborns are placed in strange-looking bassinets and attached to tubes and wires instead of being able to nestle in their parents' arms.

While this is a frightening and stressful time for new parents, understanding what a NICU is and what you should ask if you find yourself there with your new baby can help make it a bit less scary.

"A neonatal intensive care unit provides specialized health care to newborn infants and their families," explains Charles F. Simmons Jr., M.D., director of the Division of Neonatology at Cedars-Sinai Medical Center in Los Angeles and a professor of pediatrics at the David Geffen School of Medicine at UCLA. "Selected infants may require intensive care due to prematurity, congenital anomalies or other acquired conditions that threaten the health of newborns."

And how serious the situation is will also determine what type of NICU a baby will be admitted to; there are three different levels of NICUs.

"At the lowest level (Level I), a child might have a minor problem and just be treated with antibiotics because of the possibility of infection, but yet the child looks completely well," explains Richard Polin, M.D., director of neonatology at the Children's Hospital of New York-Presbyterian Hospital/Columbia and a professor of pediatrics at Columbia University. "At the other extreme (Level III) are children with very complex problems - some of them relate to prematurity, some relate to surgical issues, some relate to heart disease and some of those are cared for in the most sophisticated NICUs."

What Parents Can Do
Once a baby is admitted into a NICU, there will be a number of people helping your baby, and you'll undoubtedly have a slew of questions. Child-life specialist Gail Klayman, M.Ed., advises parents to write everything down - people's names and all your questions - to minimize how overwhelming it all can be.
"We really encourage parents to be their baby's advocate, to be assertive and try to be informed and involved," Klayman says.

Parents should also expect clear communications from the staff overseeing their baby as well, according to Simmons. "Parents should understand the reason for their baby's admission to the NICU, who the health-care professional responsible for the care of their child is and the process involved with establishing a treatment plan."

Although good communication can help to relieve some stress, the fact that parents are now watching someone else provide for their child can only add to it.

"It's very stressful to have a sick newborn baby and it's a very abnormal relationship if you have a baby and suddenly you're not able to provide parenting for that infant, and they are relying on all kinds of other care providers," says Polin. He encourages parents to be as much a part of the care of their baby while in the NICU as they can.

"When a premature baby recovers from his or her initial problems, the parents can hold the child and learn the skills involved in feeding the child and certainly talking to and touching the child," he adds. "And gradually, as the child become more and more independent, the family will assume more and more responsibility for care."

And even with babies who are very sick, Polin says, parents can still find ways to bond with and parent their new child. "Even the sickest babies benefit from light touching and being spoken to," he explains. "You have to try, even in the minimal fashion, to be a parent - that means touching, reading, talking, being there for the baby and holding the baby as soon as it's possible."

When a baby is stable enough, parents can provide "kangaroo care," also known as skin-to-skin care.

"We have the parents sit on reclining chairs behind a curtain and open up their shirt and the baby just has a diaper on and they lay skin-to-skin," Klayman explains. "It's a really awesome thing that helps to promote bonding."

Research shows the importance of parents' involvement and bonding with their babies in the NICU, notes William Rhine, M.D., medical director of the NICU at Lucile Packard Children's Hospital in Palo Alto, Calif. "Studies show that babies often calm down and their heart rate may decrease because they're calmer and their oxygen levels go up. And some agencies say the babies grow faster if they get held regularly."

"So the idea that parents can be involved and should be involved is increasingly important," Rhine adds. "Even though these babies are requiring a lot of intensive care support, they also need their families, especially their parents."

The Transition to Home
How long a baby stays in a NICU depends on what they were admitted for, Rhine says. "A premature baby often has to stay in until he or she would be fairly close to term. So if you're born at 26 weeks gestation, you may have to stay in the nursery for 14 weeks or so. If you're born at 36 weeks gestation, some of those babies are healthy enough to go home in a couple of days. But the more premature you are, it's a little bit more challenging to catch up growth-wise, so those babies tend to stay a little bit longer compared to when their due date was supposed to be," he says.

Once a baby is well enough to go home, it can be both a happy and anxiety-ridden experience for parents.

"There is a joyful transition to the comfort of a home, but it is sometimes filled with parental concerns regarding the family's ability to meet their baby's needs," Simmons explains.

"The philosophy is to start working on discharge when a child is admitted because you do have your goals and your planning and a lot of this stuff takes time," Klayman notes. "We go over all the medical information with the parents and we'll talk about some developmental issues and what to expect with the other children at home, how to make that transition a bit better."

Corrie Pelc is a former special sections editor for

©, used with permission.

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