Neonatal Intensive Care Unit and Stepdown
The Neonatal Intensive Care Unit (NICU) at CHKD is the region's largest and most sophisticated critical care facility for newborns. Approximately 550 newborn babies who need intensive medical attention are admitted to CHKD's 70-bed unit every year from hospitals throughout southeastern Virginia, the Eastern Shore and northeastern North Carolina. Most are born prematurely - some as early as 23 weeks gestation. Others suffer from severe heart and lung conditions or birth defects that require early surgical intervention. The NICU combines advanced technology and trained healthcare professionals to provide specialized care for the tiniest patients.
We know from experience that parents often feel anxious when their babies are admitted to the NICU, and we do all we can to help you during this stressful time. The unfamiliar sights, sounds and equipment can be overwhelming, so every parent receives a resource guide filled with e information to help families navigate the NICU. Additional information to help you understand your child’s condition, possible treatments and how you can be involved will come from one-on-one discussions with nurse, doctors and through participation in daily rounds with the your baby's medical team.This team works with parents to develop a plan of care for high-risk newborns. We encourage your active involvement in baby’s care, and welcome parents to spend time with their babies at any hour of the day or night. NICU parent support groups and other programs are also availble to help parents through this journey.
Which babies need special care?
Most babies admitted to the NICU are premature (born before 37 weeks of pregnancy), have low birthweight (less than 5.5 pounds), or have a medical condition that requires special care. In the US, nearly 12 percent of babies are born preterm, and many of these babies also have low birth weights. Twins, triplets and other multiples often are admitted to the NICU, as they tend to be born earlier and smaller than single birth babies. Babies with medical conditions such as heart problems, infections or birth defects are also cared for in the NICU.
The following are some factors that can place a baby at high risk and increase the chances of being admitted to the NICU. However, each baby must be evaluated individually. High-risk factors include the following:
- Age younger than 16 or older than 40 years
- Drug or alcohol exposure
- Hypertension (high blood pressure)
- Sexually transmitted diseases
- Multiple pregnancy (twins, triplets or more)
- Too little or too much amniotic fluid
- Premature rupture of membranes (also called the amniotic sac or bag of waters)
- Fetal distress/birth asphyxia (changes in organ systems due to lack of oxygen)
- Breech delivery presentation (buttocks delivered first) or other abnormal presentation
- Meconium (the baby's first stool passed during pregnancy into the amniotic fluid)
- Nuchal cord (cord around the baby's neck)
- Forceps or cesarean delivery
- Birth at gestational age less than 37 weeks or more than 42 weeks
- Birthweight less than 2,500 grams (5 pounds, 8 ounces) or over 4,000 grams (8 pounds, 13 ounces)
- Small for gestational age
- Medication or resuscitation in the delivery room
- Birth defects
- Respiratory distress including rapid breathing, grunting or apnea (stopping breathing)
- Infection such as herpes, group B streptococcus or chlamydia
- Hypoglycemia (low blood sugar)
- Need for extra oxygen or monitoring, intravenous (IV) therapy or medications
- Need for special treatment or procedures such as a blood transfusion
Who will care for my baby?
The following are some of the specially-trained healthcare professionals who will be involved in the care of your baby:
- Neonatologists - Pediatricians (doctors) who are specially trained and certified in the care of premature and sick newborn infants.
- Resident Physicians - Doctors who are in advanced training in the care of infants and children.
- Consulting Physicians - Doctors who have specialized training in other areas of pediatric medicine, such as cardiology, infectious diseases and pediatric surgery.
- Neonatal Nurse Practitioners - Registered nurses with advanced degrees and training who work with the neonatologists to manage your baby's care.
- Neonatal Registered Nurse – a specially trained nurse who manages the care of premature and critically ill newborn infants. The RN will give you daily information on your baby's progress and help explain procedures.
- Respiratory Therapists - Trained professionals in the operation of respirators and other types of oxygen therapy.
- Social Worker - An individual with a master's degree in social work and specific training in helping parents with the emotional and financial stresses associated with a sick newborn.
- Speech or Occupational Therapists - Pediatric trained professionals who assist in helping your child develop feeding skills.
- Case Manager/Discharge Planner - Registered nurse specially trained to monitor your baby's progress while in the NICU and to assist with insurance needs or questions that arise. She will coordinate medical follow-up and home care needs at the time of discharge.
- Lactation Consultants - Nurses with advanced training to help mothers meet their goals for breastfeeding or provide comfort measures to those mothers who will not be pumping.
- Developmental Care Specialist - A registered nurse that oversees the developmental needs of sick preterm and term infants, promoting normal growth, development and attainment of developmental milestones.
- Others - Many people are here to assist you, including our clinician I’s,chaplains, nutritionists, lab technicians, X-ray technicians, parent support coordinators, unit secretaries, receptionists, housekeepers, educators and clinical nurse specialists.
We also offer families the following comforts:
- A meditation room is available across from the family waiting room. There's also a hospital chapel on the first floor.
- Drink and snack machines are located behind the elevators.
- Parent sleep rooms are available for emergencies.
- Hospital-grade breast pumps are available for use while visiting. We also offer private rooms for pumping.
What are the visiting hours?
At CHKD, we understand how hard it is for parents and babies to be separated. So we make sure that parents feel welcome at all times.
Can I check on my baby when I can't be at the hospital?
When you are away from the hospital, you are welcome to call the unit to ask questions or find out how your child is doing. Please identify two people who may call us for information (usually parents and/or grandparents, etc.). We'll refer other relatives and friends to you for medical information, so please let them know. We may ask you to identify yourself in a special way to make sure we are giving information to the proper person.
How can I help my baby?
Rocking, touching, holding, singing and playing with your baby are so important for normal development. Please talk with your nurse to decide when and for how long to do these activities with your baby while here in the NICU.
- Gentle massage - Touching and gently massaging your baby's legs, arms, head and body will help you get to know him. You will also be able to help comfort your baby who learns that touching feels good.
- Talking softly - Your voice may be very soothing to your baby and may help establish the infant-parent bond. Many babies enjoy being talked to or sung to while being touched. Thus, even before they understand the words, they will learn the association with your voice and gentle loving touch.
- Pictures - Preemies begin to focus at about 33 weeks gestation and see objects best at a distance of less than 10 inches from their eyes. Therefore, when touching or talking to your baby, put your face just a few inches from hers. You may also wish to bring in pictures of your family to be placed in the crib or isolette.
- Tape recordings - Once your infant is at least 30 weeks gestation, music can be soothing and will break the monotony of the mechanical sounds heard in the NICU. Recordings can help your baby learn familiar voices and is an excellent way to involve siblings, grandparents and other important individuals. The NICU can loan you a tape recorder for this purpose.
- Holding your baby - We encourage you to hold your baby whenever possible. However, babies that weigh less than 1,500 grams may have a difficult time maintaining their temperature. Please ask your baby's nurse if you have any questions.
- Kangaroo Care - This is skin-to-skin contact between you and your baby that lets you provide soothing warmth, security and comfort. Ask your nurse when your baby will be ready for this.
- Clothes - Babies can almost always wear caps and booties. Gowns, dresses, shirts and pajamas may be worn by babies in cribs and sometimes by infants in isolettes. Remember that at times your baby may not be able to wear clothing. You can bring in colorful sheets and blankets to help provide a more home-like atmosphere for your baby.
- Feeding your baby - Nutrition is essential for your baby's growth and development. In the beginning, we may need to feed by IV or by using a tube into the stomach (called gavage feeding). As your baby gets bigger, he will be able to nurse from your breast or bottle-feed. During times when tube feedings are needed, you can still learn to help. Participating in your baby's care will strengthen that very important parent-infant bond. Human milk contains many factors that help protect babies from certain illnesses and is almost always the best type of nutrition for preemies and sick babies. Mothers can pump breast milk for their babies during the hospital stay, or donor milk can be provided to supplement mother's own supply.