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Care, Treatments, and Tests
It may seem that babies in the NICU are almost always receiving some sort of test or treatment — including medicines, feedings, lab tests, or x-rays.
Yet, you should know that each baby is treated as an individual. Doctors try to keep lab draws and other tests and procedures to a minimum, while meeting your baby’s specific needs. Feedings are also decided and adjusted according to your baby’s cues. Following is an explanation of what to expect.
The most common medicines given to your baby in the NICU are for pain, infection, or sedation.
- Antibiotics for infection: If an infection is suspected, your baby will be started on an antibiotic. Your baby will be given an antibiotic that effectively gets rid of the most common kinds of bacteria seen in the NICU. A blood sample (culture) will be taken to identify the type of infection present. The antibiotics will be stopped, kept the same, or changed depending on your baby’s clinical condition and what the blood culture shows after 48 to 72 hours.
- Pain medications: Your caregivers will use several tools to help determine if your baby is in pain. These tools are based on factors such as your baby’s vital signs, facial expression, body movements, skin color, and level of activity. The staff will evaluate and record this information at least every 4 hours. If they feel your baby is in pain, the staff may try comfort measures such as rocking, music, firm touch, repositioning, or offering a pacifier. They may also give your baby sucrose solution to soothe him. Your baby’s physician will choose a pain medication that will be the most effective for your baby. Pain medications will be gradually reduced and stopped as your baby gets better and no longer needs them. If you feel your baby is in pain, please tell the nurse.
- Sedation: If your baby is on a ventilator or has a chest tube in place, he may require a sedative — a medication that will keep your baby calm. The amount of sedation needed by your baby will depend on his condition. Sedation medication will be weaned gradually as your baby’s condition permits.
Nutrition and Feeding
Babies in the NICU often need extra help getting the nutrition they need to grow and develop.
- NPO and IV line: At first, your baby may be too small or too sick to take in any food by mouth — this is called NPO. When your baby is NPO, she receives all her nutrition through an IV line. In a day or two, your baby will receive solutions consisting of sugar (dextrose) and protein, vitamins (which give the fluid a yellow color), minerals, and salts dissolved in water. This is called total parenteral nutrition (TPN) or hyperalimentation (HAL). Parenteral fat, a white fluid called intralipid, is usually given as well. These solutions can contain all the nourishment that your baby needs to grow until oral feedings are established.
- Gavage feedings: Even when your baby is able to take food by mouth (is no longer NPO), she may still be on a ventilator or may not have enough sucking strength to breastfeed or bottle-feed. If this is the case, she may be put on tube feeding — also called gavage feeding. For gavage feeding, a tube will be placed through your baby’s nose or mouth, and guided down her throat into the stomach. Feedings of breast milk, formula, or a combination of these can be put through the tube into the baby’s stomach. This will provide nutrition and help the baby’s digestive system start working. To help promote the sucking response, your baby may be given a pacifier while being gavage-fed.
- Oral feedings: When your baby is ready, she will be started on oral feedings by breast, bottle, or a combination of the two. Babies need to learn to coordinate their feeding skills. It is important that they learn how to suck, swallow, and breathe at the proper times. This comes with maturity and practice. Your nurses will help you learn the cues and skills you’ll need to help your baby coordinate feedings.
It is very normal for a baby to lose weight right after birth. In the NICU, your baby is started on IV fluids to make sure she doesn’t lose too much weight. The NICU staff closely monitors your baby’s weight. The nurses will measure and record the exact amount of fluid and nutrients your baby gets. They will record her stool output and weigh her diapers to measure urine output. As your baby grows and matures, she’ll need more calories. Feedings will be adjusted to give your baby the calories she needs to continue to gain weight.
Best Nutrition for All Babies
National health organizations recommend breastfeeding for all newborns, including premature and sick infants. If you plan to breastfeed, talk to your NICU staff and lactation consultants. They can help you get off to a good start with breastfeeding, even if your baby isn’t strong enough to nurse right away. They can help you pump and store your breast milk. They can also help you and your baby take steps toward breastfeeding.
Premature babies have fragile skin that is very thin and absorbent. Until the skin matures, it doesn’t offer a good protective barrier for your baby, and needs to be handled with care to prevent tearing or bruising.
- Nutrition and water loss: Your baby’s nutrition plays a big role in healthy skin development and optimal healing. Your baby’s nutrition will be carefully watched. To help prevent water loss, humidified air may be delivered into your baby’s bed.
- Lotions and creams: Dry, flaky skin is normal for premature babies. However, lotions and creams should not routinely be used. If the skin becomes too dry or starts to crack, a tiny amount of prescribed cream that does not contain fragrances or alcohol may be used to condition the skin.
- Bathing: Your baby will be bathed only when necessary. A heat lamp may be used during the bath to keep your baby’s temperature from dropping.
- Use of tape: Premature skin is very sensitive to tape, and can be easily irritated or torn when tape is removed. Therefore, tape will be used only when necessary. The tapes and adhesives that are used have been chosen because they are best tolerated and least damaging to your baby’s fragile skin.
Many lab tests will be performed to give your baby’s caregivers information about your baby’s condition. Blood samples may be taken and sent to the lab to measure the following:
- Complete blood count (CBC) to measure the level of different cells in your baby’s blood
- Newborns screening tests to check for some inherited disorders such as PKU and cystic fibrosis
- Blood gases to check levels of oxygen, carbon dioxide, and acids in the blood
- Blood cultures and C-reactive protein to help check for infection
- Chemical (electrolyte) balance
- Blood sugar (glucose) level
- Bilirubin level to check for jaundice
- Hemoglobin/Hematocrit to check for anemia (an abnormally low number of oxygen-carrying red blood cells in the blood). If the number is low, your baby may require a blood transfusion.
A blood transfusion is a procedure to put blood or blood products from a donor into your baby’s body. The donor blood comes from a blood bank and is tested to make sure it’s right for your baby. If your baby needs a blood transfusion, you doctor will give you more information.
Your baby may have occasional imaging studies while she is in the NICU. Imaging procedures allow your doctor to track your baby’s progress and be aware of any special conditions that may be present. Some common imaging studies are described below.
- X-rays: An x-ray is the most common type of imaging scan. An x-ray can show the condition of the lungs and other organs, and check the positions of any tubes or catheters inside your baby’s body.
- Ultrasound: An ultrasound picture is somewhat like an x-ray, except that it’s made by using sound waves that are directed at organs in the body. The sound waves produce different images that tell your doctor more about your baby’s tissues. Ultrasound scans are simple, painless procedures that use no radiation.
- MRI: MRI (magnetic resonance imaging) uses a large magnet, radio frequencies, and a computer to create highly detailed images of internal organs and structures. Because a baby must stay completely still during an MRI study, sedative medication is sometimes given.
For more information, check out our Guide to NICU.
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The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns. More health information is available at www.intermountainhealthcare.org.