The neonatal intensive care unit (NICU): what is it?
A neonatal intensive care unit (NICU) is a hospital intensive care unit that specialises in looking after babies who are born sick or premature.
NICUs have specialist doctors, nurses, other professionals and equipment to care for sick or premature babies.
When babies don’t need the specialist care and equipment of a NICU anymore, they move to a special care nursery.
What a NICU looks like
The first time you go into a NICU, it can feel overwhelming. But the staff at the NICU will be there to support you as you get to know the place.
At the entrance, you’ll see a series of taps or hand sanitiser dispensers. You need to wash your hands with sterilising soap for several minutes or apply hand sanitiser before you go in. Babies in NICUs can very easily catch infections, and proper hand-cleaning reduces the risk of this happening.
The NICU might have periods when the lights are dimmed and it’s quiet. This is because babies in the NICU can be overwhelmed by too much noise and light.
Most babies will have either a heated open cot or a covered incubator. These keep their bodies at the right temperature.
Depending on what medical support babies need in the NICU, there might be:
- machines to help with breathing
- machines to give measured amounts of fluids and medicines to babies through tubes going into their veins
- monitors attached to babies with cords to measure heart rate, breathing, blood pressure and the amount of oxygen in their blood
- a soft small tube that feeds babies through their nose and directly into their stomach
- special cooling beds to help reduce brain injury in babies who have had a difficult birth
- staff wearing special gowns to reduce the risk of infection.
All these things keep babies safe and comfortable, with as little extra handling as possible.
Other large machines are brought into the NICU when they’re needed. These might include machines to:
- take X-rays and ultrasounds
- monitor brain function
- give babies treatment under lights, or phototherapy, for jaundice.
The NICU is usually a calm place, with nurses and doctors quietly looking after the babies and other specialists coming in and out.
Monitors will sound to alert the staff if a baby’s breathing or heart rate is out of the normal range. Sometimes monitors will sound even when babies are fine. If an alert sounds on a monitor attached to your baby, you can ask your baby’s nurse what the alert means.
If you know or think your baby is going to be born early, you can prepare for premature birth by asking to see the NICU. This can help it feel more familiar when you visit your baby there after the birth.
Each baby in a NICU has a highly qualified bedside nurse assigned to them. This nurse has completed a nursing degree and then done extra study in nursing sick or premature babies.
Your baby’s nurse will be able to tell you most things about your baby’s medical condition. The nurse will know about recent test results, changes in how your baby is being cared for, and your baby’s condition over the previous few hours. When staff shifts change, your baby’s nurse will tell the new nurse about how your baby is going and what your baby needs.
There are also managers of NICU sections and usually one nurse who is in charge of the whole NICU.
You can ask to speak to the nurses in charge.
NICUs also have neonatologists. These are doctors who are specialists in newborn care, which is also called neonatal care. These doctors have first trained as paediatricians and then done further training as neonatologists.
Most NICUs have several neonatologists. One will be in charge of the whole NICU. There’s always a neonatologist on duty, and you can ask to speak to this person. Some NICUs are happy for you to be there during ward rounds and to ask questions.
Laboratory, echocardiogram and X-ray technicians visit the NICU regularly. Other paediatric specialists like cardiologists, ophthalmologists, neurologists or surgeons might also visit some babies.
NICUs also have other visiting professionals to help both parents and babies, including physiotherapists, occupational therapists, psychologists, psychiatrists, speech pathologists, social workers and pastoral care workers. These staff can talk with you and help you with some of the challenges of having a baby in the NICU – for example, worry and anxiety, family complications, or concerns about your baby’s development.
NICU staff often organise information sessions for parents – for example, sessions on baby massage – or social get-togethers.
The NICU might feel like a strange environment for your baby, you and your family. But it’s also your baby’s nursery, their home away from home. Our article on coping with the NICU has tips to help you feel comfortable in the NICU.
Your baby’s care in the NICU
NICUs in Australia use parts of a nursing program called Developmental Care, or Newborn Individualized Developmental Care and Assessment Program (NIDCAP).
Developmental Care or NIDCAP is a way of caring for sick or premature babies in hospital that focuses on your baby’s and family’s needs.
It’s about reducing your baby’s stress during daily and medical care. It’s also about protecting your baby’s sleep by keeping noise down.
It means that the nurses will watch your baby carefully and use their observations to get a complete picture of how your baby reacts, copes and settles. The nurses will also think about how and when they care for your baby. For example, your baby’s nurse might watch your baby for a few minutes and decide whether to wake them or let them sleep for a little longer.
The nurses might also:
- do cluster care, which might mean bathing and feeding your baby in one session
- schedule care and feeding so that they don’t need to wake your baby from a deep sleep
- do fewer vital signs checks if your baby doesn’t need them
- cut down on stimulation during feeding – for example, by feeding your baby in a quiet, shielded corner, or feeding without talking and looking at your baby
- let your baby suck something during and after feeds, or give your baby something to hold when they’re being handled
- cover or shield your baby’s eyes so that being on the treatment table is less stressful
- avoid overstimulation by not patting, rocking and talking to your baby all at once.
After ‘cares’, the nurse will watch your baby again to see how the handling has affected them and whether they need extra help to resettle – for example, by being put in a different position.
Nurses will also change the environment to make sure your baby is comfortable. This might mean making sure your baby’s bed isn’t near noisy taps or sinks, cutting out phone and radio noise, or using a water, gel or ripple mattress.
Your family and the NICU
Although your baby needs care from specialist staff in the NICU, you’re the most important person in your baby’s life. Your bond with your baby is important for their development in the NICU and beyond.
Hospitals try to make the NICU family friendly. Different hospitals will do things differently, but your hospital will have a policy to make sure that your family is looked after while your baby is in the NICU. You can ask for a copy of the hospital’s policy.
Family-centred care in the NICU is considered the best approach to care. It’s about treating you and your family with respect and working as a team with you to make decisions about your baby’s care and treatment in the NICU.
Hospitals also typically have things like comfortable chairs next to your baby, a parent room nearby for meals, tea and coffee, a room for you to stay in overnight with your baby before taking them home, and play materials and play areas for your baby’s siblings.
Some hospitals have specific types of neonatal units. For example, there might be a neonatal cardiac care unit, a neonatal high dependency unit or a neonatal surgical care unit. Depending on your location and your baby’s needs, your child might stay at the NICU or they might go to one of these units. Talk to hospital staff to find out more about your baby’s unit.