Guide for Hospitalization in the NICU

The hospitalization of an infant in the NICU (neonatal intensive care unit) raises fears, concerns and occasional uncertainty. Many parents, however, find themselves visiting their premature infants every day, so the best way to understand what you are dealing with is to ask questions about your infant's unique condition, ask about your hospital’s policies, and keep the lines of communication open with the staff caring for the infant. Remember that you are not alone.

In this article, we will try to review what you need to know about a possible stay in the NICU, and we will try to address questions and concerns you may have.

Medical devices and equipment

The NICU is full of machines and sounds that most people have never seen or heard before. It is difficult to see infants connected to so many machines, but understanding what they do can help reduce anxiety, especially when there are different flashing alerts and sounds on each device.

Introducing the devices

• Monitor: to monitor the vital signs of the premature infant, a monitor is required - a screen that displays numbers, largely in different colors that refer to pulse, respiration, saturation (a value that measures the percentage of oxygen saturation in the blood), blood pressure and other data.
• Medical ventilators: to help an infant breathe, parents may see several devices including a medical ventilator that is connected to a tracheal tube or connected through goggles or mask to the infant’s nose. The machine displays the number of breaths per minute with measured and controlled pressures to the lungs and in synchronization with their spontaneous breathing. If necessary, it will be possible to enrich oxygen solely through “nasal glasses”.
• Incubator: to keep infants warm and regulate their body temperature, they will lie in a humidified incubator or an open heated bassinet, depending on the week of birth and their weight.
• NG tube: infants who cannot yet eat through the mouth will be fed through a NG tube - a thin tube that is inserted through the nose or mouth directly into the stomach and to which syringe drivers are connected, through which the babies are fed. An NG tube is occasionally inserted to drain secretions from the digestive tract.
• Infusion pumps: infusion pumps are used for the intravenous infusion of fluids and medications. Some of the infants will be given an intravenous infusion directly through the navel because of the large vein that may be used for a more long-term treatment than an intravenous infusion in the infant’s limbs.

Tips for navigating the NICU

If your infant is hospitalized in the NICU, the department will likely provide you with basic information forms at the time of admission, including information on the policies and procedures: inter alia, the NICU rules regarding visits, the staff that will take care of your child, and key medical terms that you are likely to hear.

Visiting policy

Most NICUs currently encourage parental involvement in the care of their infants, 24/7, and therefore allow visits 24 hours a day. There are, however, guidelines to remember: some units only allow two people at the infant’s bedside at a time, one of whom must be the parent. Sibling visits may be restricted (based on criteria of age, vaccination and season, due to concerns of spreading of infections) according to the policy of each NICU.

It is important to remember that even if the parents are invited to the NICU 24/7, sometimes the parents' status does not allow for frequent visits, whether due to work schedules or long trips. Ask the NICU of the option of visits on camera or via chat.

Daily physician rounds

Every day, the staff of physicians conducts rounds to discuss the condition of the infants. Parents are invited to participate, ask questions and feel as if they are part of the care. It helps parents a great deal emotionally and reduces the feeling of helplessness. You can ask what time the physicians’ rounds will take place and prepare to be there.

Practical infant care experience

The medical staff will care for your infant around the clock, but this does not mean that you cannot perform some of the tasks yourself and become involved. Depending on the infant’s condition, some things will have to be left to the professionals, but if the infant is sufficiently stable, you may be able to perform tasks such as diaper changing, feeding, bathing and so on.

Personal equipment at the infant’s station

Make sure to write a name on your items (clothes and textiles) so that they are not thrown away with the laundry in the NICU. Items such as books and photos may be permitted but must first be approved by the NICU staff.

Lodging

One of the most difficult aspects when an infant is in NICU is the distance. Particularly for those who do not live near the hospital, this can be a significant emotional and logistical challenge. Ask the hospital about available options - some NICUs have several private rooms, where a parent can spend the night next to the baby, while other hospitals have apartments for the families of patients sponsored by associations. Social workers can help families organize sleeping arrangements.

Support of lactation consultants

Breastfeeding significantly contributes to the health of infants (and mothers) and is even more important for premature infants. Breast milk lowers the risk of complications in premature infants such as NEC. Concurrently, breastfeeding or pumping milk are skills that must be learned and can be particularly challenging when the infant is in an incubator or connected to a device found in the NICU. Ask to immediately speak with the hospital’s lactation consultant. They will guide you through the process of pumping breast milk so that the body produces milk even before the infant is ready to eat and will help you learn to breastfeed according to the baby's progress.

The NICU can provide you with an electric pump, a place to pump milk and equipment such as syringes or bags to store the pumped milk in the refrigerator. The nurses can defrost and heat the milk when it is time for the infant to eat. If the amount of breast milk is still not enough, it is possible, with the parents' approval, to supplement the necessary amount from donated breast milk, from a breast milk bank. The NICU should supply milk from a breast milk bank to every infant born before week 32 or who is under 1,500 grams, for at least 6 weeks after birth. The department director can approve use of this milk in other medical situations.

For more information about lactation consultation and assistance

Coping with stressful situations in the NICU

The hospitalization of an infant in the NICU can be an extremely stressful experience, regardless of the infant’s condition. There are several sources of support for parents of premature infants: inside the hospital, you can, for example, rely on social workers. Outside the hospital, you can rely on, among others, LAHAV Association.

The discharge process

The criteria for discharge vary slightly between NICUs but there are signs indicating imminent discharge and these are usually the infant reaching a weight close to 2 kg, regulated and consistent oral feeding, a corrected week over 35, at least two full days without apnea episodes or a drop in pulse and other indications depending on the condition.

In most NICUs, when the infant is about to be discharged, a meeting will be held before the discharge in accordance with NICU policy. During this meeting, you will receive an explanation about the special care of the infant following discharge. In certain cases, the parents will be trained on infant CPR before the discharge.

Before being discharged, make sure that you feel comfortable caring for your infant, and that you have all the necessary information before starting your new life at home. Make sure that you have purchased all the baby products you need for caring for your infant.

On the day of discharge, you must arrive at the hospital with clothes, a car seat suitable for a premature infant, a blanket and a hat. You will receive the discharge letter and a brief explanation from the nurse. Do not forget the vaccination booklet as well as the refrigerated and frozen milk.