Neonatal units have a range of provision for sick or premature babies, usually organized into three areas: intensive care (NICU), high dependency (HDU) and special care (SCBU).
NICUcaters for the most premature. Here most babies will be in closed incubators, possibly ventilated, to help them breathe and have a nasogastric (NG) tube to feed them. Other interventions might include monitors to record their heart rate and blood pressure. Despite all the high tech equipment it is still really important to interact with your baby as much as possible. Techniques such as comfort holding or kangaroo care (outlined below) can be used, so always ask your baby’s nurse about how to interact with your baby.
HDU caters for less sick babies. Some babies will be in closed incubators, whilst others might be in open cots. Your baby will be likely to spend time in HDU following time in NICU. They will still be closely monitored, possibly by getting oxygen through their nose and being fed through a nasogastric (NG) tube.
SCBU caters for the least sick or less premature babies and most will be in open cots. Care might include a mattress which monitors your baby’s breathing, they may be getting oxygen through their nose and being fed by nasogastric (NG) tube. If your baby has been through NICU and HDU, then this will be the next room you are in before being discharged home.
There are a lot of different professionals involved in supporting babies in the neonatal unit, and there is usually a board in the unit that has pictures of all the key clinians. Every healthcare professional should introduce themselves to you and explain their role, but if they don’t, then it is important to ask them to do this.
Some of these include:
Medical doctors (neonatologists) who specialise in care for babies, including consultants, registrars and researchers
Surgeons who specialise in pediatric and neonatal surgery
Anaesthetists who will be involved in any surgical procedures
Nurses ranging from the Matron in charge to sisters and staff nurses
Breastfeeding nurses who help with expressing breast milk, breast-feeding and management of donated breast milk
Occupational therapists or physiotherapists who can help with your baby’s development including movement and play
Play therapists, nursery nurses, community nurses, dieticians or speech and language therapists who specialise in neonatal play and development
Health visitors who plan for your discharge and support at home
Radiologists who may visit to take scans or x-rays of your baby
Family-centered care is something that all neonatal units should be providing to you and your baby. It means that you are actively encouraged, by all staff on the neonatal unit, to take part in your baby’s care and are consulted over any decisions that are made concerning your baby’s medical or developmental needs.
Every baby is admitted as part of a family, with a parent or carer, who are vital to supporting their time in the neonatal unit. It can be a very stressful time for you and it is important that you are made to feel welcome, included and empowered to take an active part in your baby’s care and development. This can have tremendous benefits for your baby, who will feel more secure, nurtured and loved helping them to heal, grow and develop. Being involved in your baby’s care will also help you understand what is happening, find the experience less traumatic, and encourage you to feel ready to take your baby home, when they are well enough.
Kangaroo care, or skin-to-skin, is a way of cuddling and holding your baby close so that they feel the warmth of your skin and can hear your heartbeat. By holding your baby next to your skin, on your chest, with no other materials between you, your baby will feel secure, warm and close to you. This has been shown to have benefits such as lowering blood pressure and increasing oxygen saturation.
It also helps parents develop a bond with their baby, and for mothers, initiates and continues their breast milk supply, which is very important when you have been separated when time is spent in the neonatal unit. Even very sick or premature babies benefit from kangaroo care, so do not be afraid to ask your nurse about it. Both men and women equally can do kangaroo care.
When separated from your baby you can still provide breast milk and plan to breastfeed. By starting to express breast milk as soon as six hours after birth you can provide that vital first milk (colostrum) which can either be fed to your baby through a nasogastric (NG) tube or frozen and given to them when they are ready for it. By continuing to express breast milk (ideally every three hours) you can maintain and increase your milk supply. When your baby is ready, you can initiate breastfeeding, or give breast milk in a bottle, alongside nasogastric (NG) feeding. If you are unable to supply your own milk then most neonatal units will have a donated breast milk supply, which is another way your baby can recieve breast milk.
Speak to your midwife and breastfeeding nurse, who can support you and give you information about breastfeeding including expression and storage of breast milk. Breast milk is the best nutrition for your baby, it is easiest for them to digest, and contains vital antibodies which protect against infections and growth factors which support your baby’s growth and development.
Having a baby in a neonatal unit can make the usual activities of being a parent difficult, such as playing, touching and cuddling your baby. These activities, however, play a vital role in your baby’s development and there are always ways in which you can interact with your baby regardless of how premature or sick they are. Comfort holding, kangaroo care and talking/singing to your baby are always possible. Information about these and other ways of interacting with your baby, can be provided by your baby’s nurse and are available in leaflets from the charities such as Bliss. When your baby starts to get stronger, toys and games are a great way to encourage development and build relationships.
Going home with a baby who has been sick or born early can be a very anxious as well as exciting time for parents. The neonatal unit will help you prepare by establishing feeding and sleeping routines, and any medications or oxygen supplies that your baby needs. You might also ‘room-in’ with your baby for a few nights on the unit before you leave, so that you have the opportunity to spend the night together. If you have any concerns make sure you discuss these with the neonatal staff, and access support through local or national groups and charities.