What’s inside the neonatal intensive care unit?
Posted on 26 October 2017
Premature birth presents a variety of challenges, but the good news is modern maternity wards are well-equipped to keep your preterm infant healthy and happy.
‘Any infant born before 37 weeks gestation is described as preterm,’ explains Dr Samantha O’Ryan, a neonatologist at Mediclinic Panorama. Birth weight also comes into it, as preterm babies are classified according to what they weigh.
The earlier the delivery and the lower the birthweight, the higher your baby’s risk of developing health complications, says Dr O’Ryan. Some of the more common conditions arising from premature birth include:
- Lung disease
- Low blood pressure, or hypotension
- Intraventricular haemorrhage (bleeding on the brain)
- Neonatal jaundice
- Feeding difficulties and growth failure.
If your baby is born early or at a low birthweight, the maternity ward staff will kick-start a system of procedures designed to keep your baby well cared for. This is where the neonatal ICU (NICU) comes in.
To many new parents, just the thought of the NICU is enough to induce a panic. And while it’s true your new baby is cosiest on your own skin, the reality is that the NICU is a specialised space designed to keep him or her safe, warm, well-fed and under the watchful eye of the experts.
Here’s what happens in the NICU
‘When a baby is born early, the neonatologist or paediatrician will be present in the delivery room, where treatment commences,’ says Dr O’Ryan. This is to ensure they are on hand to provide immediate assistance.
Because premature babies often experience difficulty breathing after birth, and can also suffer from poor circulation and sudden, dangerous body heat loss, the neonatologist or paediatrician will first stabilise your infant before transferring him or her to the neonatal intensive care unit.
Here, they are placed in an incubator. Incubators can either be open or closed. An enclosed incubator is a transparent box-shaped bed, designed to house your new-born in a controlled environment and keep him or her at the optimal temperature for sustained growth. Sometimes open incubators are used, especially in ICU, when easier access to the baby is necessary.
Your baby will be assessed for his or her degree of lung support, says Dr O’Ryan. ‘Some infants require invasive ventilation, where a machine does the work of breathing for the baby, and others require less-invasive assistance from a continuous positive airway pressure (CPAP) machine.’
Next up, if it is indicated, the neonatologist or paediatrician will establish vascular access through the vein and artery in the umbilical cord. This is to measure your baby’s blood pressure and blood-oxygen content. It also provides a route for intravenous fluid, which assists in maintaining hydration and a normal blood-glucose level.
‘Oxygen saturation monitoring is also vital,’ says Dr O’Ryan. ‘This ensures that supplemental oxygen concentrations are not too high – which can be dangerous to a preterm infant.’
Finally, your preterm or low birthweight baby may be given a course of antibiotics if the neonatologist or paediatrician perceives a risk of infection.
The remainder of your baby’s stay in the NICU will include constant monitoring, detecting, preventing and treating specific health conditions, regulating fluid and electrolyte balances, ensuring proper nutrition and gradually introducing milk feeds.
Care of preterm infants is better than ever
A recent study published in the British Medical Journal showed that survival rates of babies born early are on the rise. Plus, more preterm babies are making it to three months of age without signs of a major disability.
Why? Dr O’Ryan references a number of recent improvements in the care of premature babies – from growing bodies of research and knowledge of preterm infants’ physiology to advancements in technology that have led to improved modes of ventilation and CPAP.
What is the Vermont Oxford Network?
You may have seen the Vermont Oxford Network (VON) logo up at the NICU of your local Mediclinic hospital. This is good news for you and your baby. The international initiative brings together data-driven, action-oriented expertise from all over the world to improve the quality, safety and value of newborn care. Established in 1988, with more than 900 centres currently participating around the world, VON aims to improve medical care for newborn infants and their families through a co-ordinated programme of research, education, and quality improvement projects. Mediclinic Southern Africa has been participating in the initiative since 2001 and 27 centres are currently involved.
What can you do for your baby while he or she is in the NICU?
- Don’t panic. Know your infant is in the best possible hands.
- Express your breast milk into a sterile container for the nurses to administer. For your newborn, colostrum is a miracle food.
- Read to your baby. There is no more soothing sound than your voice.
- Keep a diary or scrapbook to document your baby’s growth and progress.
- Be patient. Your baby needs time to grow and get well.