An Overview- Your baby's stay in the NICU

The Kaiser Santa Clara Neonatal Intensive Care Unit (NICU)

Introduction

Mission Statement

Our mission focuses on family centered care. In order to manage an infant's complex medical requirements and the needs of the family, we work together as a team. Many disciplines are involved in the care of your baby, but you as the parent are a central part of the team. The NICU team meets together every week for Multidisciplinary rounds to discuss each baby's progress and plan how to optimize the care provided for each baby and family.

The NICU team includes:

• Neonatologist- a doctor who specializes in newborn care.
• NICU Nurse- a nurse who specializes in newborn care.
• Respiratory Therapist- delivers respiratory support and treatments, maintains ventilator/oxygen equipment.
• Social Worker-organizes needed services (e.g. resources for parents, support groups), lends emotional support.
• Patient Care Coordinator-coordinates and helps establish readiness for discharge home, orders medical equipment needed for home use, and arranges for home health if indicated.
• Development Case Manager- evaluates infant's developmental status and needs, consults with parents thoughout hospital stay regarding their baby's cues, temperament and develpmental milestones.
• Nutritionist-evaluates nutritional needs to ensure optimal growth
• Pharmacist-manages medications.
• Physical and Occupational Therapists-help with movement, positioning and feeding issues.

Your Baby in the NICU

A staff member will greet you when you enter the NICU. Initially, you will be shown proper hand washing/gel techniques. Please wash your hands each time you enter and leave the NICU as well as after diaper changes, personal hygeine, and feeds. In between washings, you will be asked to use the germicidal gel at the bedside. The nurse caring for your baby will explain the "NICU routine", such as the physical layout of the unit, visiting policy, equipment and important phone numbers. The doctor will explain why your baby is here, and generally what to expect in the course of treatment. Please click on "Learn more about Neonatology" on the menu at left for information concerning some medical conditions commonly treated in the NICU.

There are many words you will hear in our NICU that you may not be familiar with. Please click on "NICU Terminology" on the menu at left for a list of words commonly used in the NICU. Feel free to ask any questions if you do not understand or have any concerns related to your baby.

Newborn Screening tests

Every baby in every state is tested routinely for certain genetic, metabolic, hormonal and functional disorders. These disorders are rare but early detection and treatment can be life saving. The test only takes a few drops of blood from the infant's heel. For more information about the Newborn Screening Program and the most current list of diseases that can be detected through the program, visit the website at California Newborn Screening

Some of the equipment you may see around your baby:

• Infant Warmer/isolette- bed with removable plastic enclosure that provides warmth via radiant heater (when plastic top is open), or heat circulating at a constant temperature (when top is closed)
• Cardio-respiratory monitor- a machine that keeps track of the heart rate and respiratory rate.
• Pulse oximeter- a probe attached to the hand or foot that keeps track of the oxygen level in the blood.
• Temperature probe- a wire attached to the skin to monitor the baby's temperature.
• IV- a small tube in the vein to give the baby fluids, nutrition, and medications.
• Ventilator- a machine to help the infant breathe.
• Phototherapy- a special light over or under the infant that helps reduce the Bilirubin level in the blood (jaundice).

Treatments your baby may be receiving:

• Breathing with a ventilator or receiving oxygen through a tube placed just inside the nose.
• Use of an IV, umbilical line (special catheters placed into the umbilical blood vessels), or arterial line (a catheter placed into an artery and used to measure blood pressure and draw blood).
• A medication regimen (e.g. antibiotics to treat infection, medications for blood pressure, medications to stimulate regular breathing patterns).
• A feeding schedule- breast or bottle feedings or tube feedings from the mouth/nose to the stomach (gavage). At times, your baby may not be feeding at all and may rely solely on IV fluids for nutrition.
• Lab tests, X-rays and ultrasound diagnostic tests.

Bonding

There are ways that you can help your infant become more familiar with you. Bonding can help both you and your baby become closer. It can also provide clinical benifits, including helping to stabilize your baby's heart rate, breathing and oxygenation.

One important method of bonding is through kangaroo care, also referred to as skin-to-skin contact. Once your baby has stabilized, you can hold him/her in this fashion. Your baby can still be on a ventilator or have an IV. In order to do kangaroo care, you will want to wear or change into a shirt that can button down in front. You will sit in a comfortable chair by the bedside and your baby will wear only a diaper and a hat. At first you will need to have the nurse help you place your baby on your chest, skin-to-skin. You will cover your baby with your shirt and your body heat will keep him/her warm. Skin-to-skin holding may increase the mother's milk supply.

Other methods of bonding include: gently singing or talking to baby; holding (not stroking) baby's head or hand; laying your hand against baby's back; bringing a little blanket from home that has been washed with your clothes (this will provide baby with your scent when you're not there).

Milestones

Depending on the reason your baby is in the NICU, there are certain milestones that we expect to see as your baby improves. Please keep in mind that there can be fluctuations in your baby's condition. Your baby may take two steps forward and one step back on his/her road to recovery.
Your baby is getting better when he/she is:

• Breathing on his or her own
• Starting to breastfeed or bottle feed
• Gaining weight consistently
• Becoming more active and getting stronger

Your baby is expected to achieve certain milestones before he/she can be considered ready for discharge from the NICU. Depending on the degree of prematurity and individual variation, some babies will progress through the milestones quickly, whereas others will take weeks, or even months.
These milestones include:

• Maintaining normal body temperature in open crib conditions
• Taking all feeds by breastfeeding or bottle without help from a feeding tube
• Breathing regularly and consistently without any need for medications, external stimulation or assistance.

Please click on "Preparing for going home" on the menu at left for more information regarding discharge from the NICU.

Disclaimer
If you think you have a MEDICAL OR PSYCHIATRIC EMERGENCY, CALL 911 IMMEDIATELY or go to the nearest hospital. DO NOT attempt to access emergency care through this web site. An emergency medical condition is a medical or psychiatric condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in any of the following: serious jeopardy to your health, serious impairment to your bodily functions, or serious dysfunction of any bodily organ or part. An emergency medical condition is also "active labor," which means a labor when there is inadequate time for safe transfer to a Plan hospital (or designated hospital) before delivery or if a transfer poses a threat to the health of the member or unborn child.

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