The Sights and Sounds of the NICU

Giving birth to a sick or premature infant can come as a shock to a new parent, yet 10 to 15 percent of all newborns require care in a neonatal intensive care unit, also known as the NICU.

Unfamiliar sights, sounds, and equipment in the NICU can be overwhelming for new parents. Understanding issues faced by sick and premature infants, and the procedures that may be involved in their treatment, can help parents make informed decisions while experiencing the NICU for the first time.

What to Expect in the NICU

Infants treated in the NICU are vulnerable and often unable to regulate their own temperature, breathe, or eat without assistance and require expert care to support these basic bodily functions. The three fundamental issues addressed by healthcare workers when treating an infant are temperature regulation, nutrition and fluids, and medication administration.

Warmth and Temperature Regulation

Infants are unable to adjust to temperature changes and can lose body heat nearly four times as quickly as an adult. Premature and low-birth weight infants often have less body fat, which can cause them to lose heat even more quickly. There are two ways healthcare workers in the NICU are able to regulate the body temperature of an infant.

  • Open bed with radiant warmer. The infant may be placed into a small bed with a temperature probe attached to their hand or foot. The probe takes the temperature and the radiant warmer above the bed adjusts the temperature accordingly.
  • Incubator/isolette. Incubators are small plastic boxes with built in heaters to regulate temperature.

Nutrition and Fluids

It is incredibly common for underdeveloped or sick infants in the NICU to require intravenous feedings, fluids, and medications. Infants may also need frequent lab tests and measurements of blood oxygen levels. There are several ways an infant may be administered medicines and fluids and have their blood drawn. An IV may be placed in a hand, foot, scalp, or other areas such as the umbilical cord location where veins are most accessible.

Gavage or Tube Feedings

When feeding premature or sick infants, there may be issues with electrolytes or other substances in the blood.

For these infants, gavage or tube feedings may be necessary as premature or weak infants in the NICU are often unable to suck, a reflex that develops after 36 weeks. For gavage feedings, a small tube is placed into an infant’s nostril or mouth leading into their stomach. The infant is fed small amounts of milk through the tube until they are able to bottle feed or breastfeed.

Procedures and Equipment

NICUs have complex machines and devices designed for the unique needs of premature infants. The equipment found in the NICU can be intimidating, therefore understanding what the different machines are and what their purpose is can help make parents feel more informed about the status of their infants health needs.

  • Heart or cardiorespiratory monitor. Monitors the infant’s breathing and heart rate.
  • Endotracheal tube (ET). Helps the infant breathe through a tube that is placed in the infant’s mouth or nose.
  • Respirator or mechanical ventilator. Helps infants who can’t breathe on their own or who need help taking bigger breaths.
  • Continuous positive airway pressure (CPAP). Pushes a continuous flow of air to help keep the lungs open.
  • Extracorporeal membrane oxygenation (ECMO). This is a special treatment for infants with respiratory disease that do not respond to maximum medical care. With ECMO, blood from the infant’s vein is pumped through an artificial lung where oxygen is added and carbon dioxide is removed. The blood is then returned back to the infant.

NeoNatal Malpractice

Considering the level of care some of these sick infants require, medical professionals can be held liable for malpractice if they fail to monitor an infant’s condition, misdiagnose or fail to treat any conditions, or conduct or interpret tests improperly.

Though the NICU largely has undisputed and lifesaving benefits for the infants being treated, errors do occur. A 2015 study called, “Adverse events and other incidents in neonatal intensive care units,” showed negligence affects 74% of infants in the NICU. The most common incidents were improper administration of medications accounting for 38% of adverse events in the NICU, intravenous catheter infiltrations (15.8%), healthcare-associated infections (HAIs) (15-41%), accidental extubation (31.5%), and intraventricular hemorrhages and skin breakdowns (21%).

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