No matter how many prenatal classes you take, or pregnancy books you read, nothing really prepares you for having a baby — and that’s with a normal, textbook delivery. But what about when things don’t go according to plan? If you end up delivering your baby prematurely, or before 37 weeks, your little one may need to spend some time in the neonatal intensive care unit, or NICU. In fact, 1 out of 10 babies are born prematurely (via March of Dimes). The sight of such a frail, tiny infant sleeping in a plexiglass case, attached to various tubes, can be terrifying to new parents, especially mom, who is also grappling with postpartum recovery.
But if you know what to expect, and the purpose of all of that medical equipment, it can make your experience in the NICU less daunting, and also equip you to care for your preemie when it’s finally time to go home. In an interview with The List, Melinda Elliott, M.D., neonatologist, a leader in neonatal intensive care, offered tips for getting through these critical first few weeks of your baby’s life in the NICU. “Like most parents I meet in the neonatal intensive care unit, you probably weren’t planning on being in the NICU with your baby, possibly weeks or months before your due date,” Elliott empathized.
The reason NICU babies are placed in isolettes
You may be curious why it’s so dark in the NICU. “One of the first things you may notice about the NICU is that it is quiet and dimly lit. This helps decrease stimulation and stress for your baby,” Elliott said.
“Full-term babies are born with a layer of fat that helps keep them warm,” Elliott went on to explain. “When a baby is born too soon, this fat layer is missing. In addition, a premature infant is not able to shiver. As a result, the baby may have trouble staying warm, and it is difficult for the baby to regulate body temperature. This is why premature babies are placed in isolettes.” Your little one won’t be living in an isolette forever, though. “When a baby begins regulating his or her own body temperature, the baby is moved from an isolette to an open crib,” Elliott added.
Next to the isolette, you may find a ventilator or CPAP machine to regulate your baby’s breathing. “Often times, premature babies need help to breathe because their lungs have not finished developing,” she explained. “The amount of time breathing support is needed varies depending on how early the baby was born.”
What are all those tubes a baby is attached to in the NICU?
You’ll see wires attached to your baby and coming out of the isolette — these monitors continuously track temperature, heart and breathing rates, blood pressure, and oxygen saturation. It can be frightening when the pumps and monitors send out an alarm if they fall out of range, but there’s no need to worry. “These alarms may go off when your baby is just fine,” she explained. “They serve to alert the caregiver on the status of your baby.”
Meanwhile, the reason premature babies are often fed via IV is because they “usually do not have the coordination of breathing, sucking, and swallowing needed to feed from the breast or bottle,” Elliott said. “When your baby is in the NICU, you can expect that he or she may be given parenteral nutrition (PN) until your baby can consume milk feedings.” PN contains carbohydrate, protein, fat, vitamins, and minerals, and is not the same thing as breastmilk or formula. “As milk feedings increase, the amount of PN required decreases,” Elliott noted.
What about feeding your baby milk? More tubes. “Premature babies are usually first fed milk via something called the gavage feeding method,” Elliott said. “This involves placing a tube through your baby’s nose or mouth to his or her stomach.”
What NICU babies are fed
So what’s going into the feeding tube attached to your baby? Ideally, your breastmilk. “Breastmilk is important for all babies, especially premature infants, because it supports a baby’s developing immune system and helps protect against infections,” Elliott explained. “Providing breastmilk for your baby is one of the best things you can do when he or she is in the NICU.” This means you will likely be spending a lot of time with a breast pump — which can be challenging for moms of preemies, who may have supply issues. “Don’t worry or stress about this, because your NICU should be able to make donor breastmilk available to your baby,” Elliott added.
Unlike a full-term baby, though, breastmilk alone may not be enough for your little one, so the NICU may add something called a fortifier to your milk or donor milk. “Requiring up to 40 percent more calories and protein than a full-term baby, premature infants need to make up for the growth they missed in the womb,” Elliott explained. “This is especially common for premature babies born weighing 3.3 pounds or less.” One such fortifier brand is Prolacta Bioscience — Elliott serves as Chief Medical Officer, and she explains the formula is made of “100 percent donor breastmilk instead of cow milk.”
When your baby will be able to leave the NICU
Before the hospital will allow you to take your newborn home, he or she will need to achieve several milestones, according to Elliott. “Your baby will be given the green light to go home after he or she can breathe without assistance, regulate body temperature, appropriately feed and gain weight, and sit safely in a car seat,” she explained. This means removing those tubes, one by one. “One of the first things required of your baby is the ability to breathe on his or her own, without support from a ventilator or CPAP machine,” Elliott said. “Although some babies may still require extra oxygen when they are discharged, they still must be able to breathe on their own.”
It’s also important for your baby to breastfeed or drink from a bottle before the doctors will discharge your little one from the NICU. The neonatologist will know that your baby is feeding properly if there’s normal growth — including increases in weight, length, and head circumference. “Babies have to be growing well to go home,” Elliott added.
Finally, your baby won’t be cleared to leave the NICU until he or she passes the car seat test. “In this test, your baby will be placed in an infant car seat for 90 to 120 minutes — or the length of your car ride home, whichever is longer — to make sure that your baby can breathe well in this position.”
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