Inside the NICU

The Neonatal Intensive Care Unit (NICU) is a specialised space designed to keep your preterm baby safe, warm and well fed under expert care.

Not all babies born prematurely will have complications but those born before 28 weeks are at greater risk. “When you are about 32 weeks pregnant, your placenta acts as a barrier to infection and allows the transfer of your antibodies to your unborn baby,” says Dr Aziza van der Schyff, a paediatrician at Mediclinic Constantiaberg. “A premature baby loses out on in-utero protection and has an under-developed immune system. This makes them more prone to infection and sepsis.”

As Dr Johard Beukes, Hospital Clinical Manager at Mediclinic Stellenbosch, explains, most common complications from premature birth include breathing problems due to lung immaturity, intraventricular haemorrhage (bleeding in the brain), retinopathy (eye problems), neonatal jaundice, hypothermia and feeding difficulties. Rest assured our NICU staff are expertly trained to provide your baby with the highest degree of care.

IN THE DELIVERY ROOM

“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 in the delivery room, monitoring his or her temperature, blood pressure, heart rate, breathing rates and oxygen levels,” says SPN Lirina Potgieter, ICU and NICU unit manager within the new mother and child unit at Mediclinic Stellenbosch.

INSIDE THE NICU

Once in the NICU, your premature baby is nursed in temperature-controlled closed incubators to prevent hypothermia. Sometimes open incubators are used when easier access to the baby is necessary. There are strict infection-prevention and control measures in place inside the NICU and hand hygiene is very important. Staff and visitors are restricted to reduce the infection risk. As SPN Potgieter explains, “Blood tests monitor glucose, electrolytes, infection markers and anaemia; while bilirubin tests determine whether your baby is jaundiced.”

TREATMENTS MIGHT INCLUDE:

• Administering surfactant (a fluid that is naturally present in babies over 37 weeks’ gestation). Surfactant helps keeps the lungs open and allows them to expand and contract.
• Starting medication to prevent apnoeas (when your baby stops breathing). This is continued until your baby is the equivalent of 35 weeks of gestational age (when the risk of apnoea usually resolves).
• Giving antibiotics if an infection is suspected.
• “Preemies are given electrolytes and glucose via intravenous infusions according to individually calculated values,” SPN Potgieter explains. “The aim is to support your baby’s metabolic function and hydration. Fluid management is specific to water loss, low kidney function and low birth weight.”
• Using phototherapy (ultraviolet lights) if your baby is jaundiced.

NICU staff promote Kangaroo Mother Care, which is skin-to-skin contact with the parents. This technique promotes bonding, growth and feeding. They also practise neuro-developmental care by nursing premature babies in “nests”. This mimics the position in the womb. Light exposure and noise levels are kept to a minimum level.

BREATHING INTERVENTIONS

“In the NICU, your baby will also be assessed for his or her degree of lung support,” says SPN Potgieter. “The most likely respiratory support comes from non-invasive ventilation via nasal cannula or masks, to assist continuous positive airway pressure support (NCPAP) with a machine.”

HELP WITH FEEDING

When oral feeds cannot be given, your premature baby will need intravenous lines (drips) or specialised catheters placed into the umbilical cord to provide fluids. These lines are also used to deliver medications such as antibiotics and to draw blood to monitor electrolyte and glucose levels. To administer expressed breast milk to your baby until he or she develops the ability to suck, a gastric tube is inserted through the nose or mouth and into the stomach. “Breast milk has many advantages for premature babies as it contains antibodies and important nutrients,” SPN Potgieter adds. “If you aren’t able to express, NICU staff will educate you about donor breast milk, when it is available and whether a candidate meets the criteria.”

SPECIAL INVESTIGATIONS

X-rays visualise and diagnose problems within the chest and abdomen. An echocardiogram (ultrasound of the heart) assesses the anatomy of your baby’s heart and checks for Patent Ductus Arteriosus, otherwise known as a hole in the heart. An ultrasound of the brain checks for bleeding or fluid build-up. Ultrasound can also be used to check the abdomen and kidney functioning.

GETTING BETTER

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. Once your baby is able to maintain its own temperature they graduate to an open crib. NICU nursing staff will then help you breastfeed or bottle-feed. They also explain basic infant care including CPR.

TIME TO GO HOME

Before leaving hospital, your premature baby will need an eye examination and hearing test. A neurodevelopmental physiotherapist will assess your baby and teach you strategies to promote the best neurodevelopmental outcome. NICU nursing staff are on hand to assist and reassure you before discharging you and your baby.