NICU Care, Treatment, and Tests

It may seem that babies in the NICU or SCN 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.

Babies in the NICU and SCN 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.

When your baby is ready to eat

When your baby wants to eat, he will give you cues to show you how hungry he is. It’s best to feed your baby when he is ready to eat rather than trying to follow a set schedule. Babies who are premature or sick need extra attention at feeding time. They may eat less than you think they should. They may get tired or stressed while feeding and need to take a break.

Weight changes

It is very normal for a baby to lose weight right after birth. In the NICU or SCN, your baby is started on IV fluids to make sure she doesn’t lose too much weight. The NICU or SCN 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 babies

National health organizations recommend mother's milk for all newborns including premature and sick infants. You can give your baby mother's milk by breastfeeding or by pumping your milk and giving it to your baby in a bottle. Talk to your NICU or SCN staff and lactation consultants about finding the best way to give your baby the best nutrition.

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
• Newborn 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 (CRP) to help check for infection
• Chemical (electrolyte) balance
• Blood sugar (glucose) level
• Bilirubin level to check for jaundice
• Hemoglobin [HEE-muh-gloh-bin] or Hematocrit [hi-MAT-uh-krit] 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.

Imaging Studies

Your baby may have occasional imaging studies while she is in the NICU or SCN. 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 include:

• 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. For some conditions, your baby may have several x-rays a day. This may make you feel concerned, but there’s no need to worry. An x-ray is painless for your baby, and experts agree that the amount of radiation used is too low to harm your baby.
• 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 medicine is sometimes given.