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Most babies admitted to the NICU will require extra help to support three very important basic needs, breathing, keeping warm and feeding. This section will give you a brief overview of how we might help to support theses needs and of the equipment you may see being used. Specific pieces of equipment may change slightly from hospital to hospital and not all equipment you see may be used for your baby.

 

Supporting your baby's breathing | Keeping your baby warm | Nutrition for your baby

 

 

 

Supporting your baby's breathing

 

Newborn babies often experience breathing and lung function problems immediately after birth. There are many reasons for a baby to develop lung problems. It may be because they are immature, have an infection, have under-developed lungs or have inhaled something. Some of these babies recover quickly and uneventfully. But others continue to have breathing complications that are more serious and require a longer course of treatment and intensive care. Below is some of the equipment you may see being used to support your baby's breathing.

 

• Headbox: used for babies who can breathe without help but need some oxygen support. Oxygen is piped to a clear perspex box which rests over the baby's head
  
  
• Nasal Cannula: is a way of giving a baby who can breath without help extra oxygen through the nose. Two tiny tubes (one in each nostril) are attached to flexible plastic piping that reaches across each cheek, to the back of the head and to the source of oxygen.

 

Baby with nasal cannula

 

• Continuous Positive Airway Pressure (CPAP): CPAP helps keep the lungs expanded by pushing a small amount of air or oxygen into a baby's airway through little plastic tubes placed just inside the nose, or by a small mask over the nose. The air sacs within the lungs are kept inflated preventing them from collapsing at the end of each breath, thus preventing the inner surfaces sticking together. By using CPAP the baby does not have to make such an effort with each breath.

 

CPAP mask

 

• Ventilators are the machines used to breathe for your baby if he/she is not breathing sufficiently for him/herself. A tube called an endotracheal tube is placed through your baby's nose or mouth and down into the entrance of the lungs, through which a mixture of air or oxygen can be used to breathe for your baby. A number of different ventilators are used on the NICU, and the most appropriate one is chosen according to your baby's condition.

 

Ventilator

 

• Nitric oxide: is added to the oxygen in the ventilator. It dilates the blood vessels and allows more blood flow and oxygen to reach the baby's lungs

 

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Keeping your baby warm

 

When you first visit the NICU you will be faced with an environment that is very warm. This is because premature and sick babies are unable to regulate their own temperature effectively. 

 

 

If your baby is premature or low birth weight

 

If your baby has been born prematurely or has a low birth weight then he has very little fat which enables him to control the rate at which he loses heat.

 

 

The NICU nurses aim to maintain your baby's temperature at around 37'C. This is the optimum temperature at which your baby uses up the least energy to keep warm. In order to provide this you baby may be placed in an incubator. Incubators surround your baby with a curtain of heat. The temperature inside the incubator can be adjusted according to your baby's temperature, which is usually continuously monitored.

 

 

If your baby has been born prematurely then they may be nursed in an incubator with humidity. Humidity reduces the amount of water lost from your baby's skin and helps him to improve the maintenance of his body temperature. It also helps to protect his skin, which, when premature, is very fragile as it has not had time to fully develop. Your baby may be nursed in humidity for 4 weeks or more, by which time his skin will have had time to develop and will be much less fragile. However, you baby may stay in an incubator until they are nearing term so that vital energy can be used for growing.

 

 

If your baby is term

 

If your baby has been admitted to NICU because they are sick or require surgery then his temperature will also be closely monitored because he is also prone to getting cold. A sick baby admitted to NICU may have problems maintaining his temperature because his ability to produce heat is lowered.

 

If your baby has had surgery then he will have his temperature continuously monitored. This is because he may have been in theatre for a prolonged period of time and by maintaining a warm environment he will recover more quickly following surgery. Your baby may be nursed in an open cot which has a heated mattress and an overhead heater in order to help him maintain his own temperature. The heaters can be adjusted according to your baby and how much heat he needs in order to maintain his body temperature. 

 

 

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Nutrition for your baby

 

 

This section aims to give you some insight into the basic nutritional requirements of your baby on the NICU.  However, it must be remembered that each baby’s needs are individual and that not all the information supplied here may be relevant to your baby.  For more information, speak to the doctor or nurse caring for your baby.

 

When your baby is born, whether it be prematurely or unwell, his/her nutritional requirements are no longer provided by the placenta in the womb.  Instead the doctors, nurses and dieticians must assess the best way to deliver you baby’s nutritional needs based on his/her maturity and health.

 

 

The premature baby

 

If your baby has been born prematurely then it is unlikely that he/she will be fed before day 2 or 3 of life. When feeds are started, they will be a tiny amount each hour. Premature babies cannot coordinate sucking and swallowing so a small tube is passed via the nose or mouth into the stomach. This is called a naso- or oro- gastric tube, and milk will be passed down the tube using a small syringe.

 

Your breast milk is ideal for your baby. Mums of premature babies are able to express milk which has a higher protein content for the first 2-3 weeks of their baby's life. This is essential to help with your baby's growth and development. It also helps to stimulate his/her immune system, gut activity and is easier to digest. Expressed breast milk can be stored in the milk kitchen on the unit and is used according to your baby’s requirements. Nurses and midwives on the unit can help you to express your milk for your baby.

 

If you choose not to express breast milk, or you are finding expressing adequate amounts of milk difficult, then your permission may be sought to use donor breast milk (DBM).The NICU has a bank of donated breast milk. All donated milk goes through screening for bacterial and viral infections, and is also pasteurised. We have a bank of donated breast milk because we are aware of the benefits of breast milk, that small babies tolerate breast milk better, as well as benefiting from the protective antibodies found in breast milk. When you are ready, you can participate in feeding your baby via the naso- or oro- gastric tube. 

 

Once your baby is receiving full feeds via his/her tube, his/her weight gain will be assessed on a daily basis to ensure optimum growth. Daily vitamins, an iron supplement and a folic acid supplement will be added to your baby’s milk. Some premature babies require extra calories to be added to your expressed breast milk to ensure sufficient weight gain and Breast Milk Fortifier (BMF) may be added to your milk. These are small sachets of powder that contains energy, protein, calcium, phosphorous and vitamins and minerals. These fortifiers are only used until your baby is strong enough to breastfeed effectively. In some cases we may need to add formula milk to support breast milk, especially where supplies of expressed breast milk are low, or where an infant's growth has not been optimal on fortified breast milk. We have special formula milk on the NICU which has been designed to meet the nutritional needs of preterm infants. These formulas contains higher amounts of energy, protein, calcium and phosphorous than normal term infant formulas in order to support growth and development. The main preterm formula we use in the NICU is Nutriprem 1.

 

If your baby starts on a very small amount of milk or is too unwell to have any milk, then it is likely that he/she will need alternative forms of nutrition. Initially your baby will have a small plastic tube (a cannula) inserted into a vein where he/she will receive sugary water. For longer term nutrition however, a longer, finer tube is passed into a vein in the arm or leg. This tube is called a long line and can stay in place for a much longer period of time. Through this line your baby can receive total parenteral nutrition (TPN) which is a mixture of nutrients containing glucose, salts, amino acids, fats and vitamins. Your baby can grow well on TPN until he/she can receive milk feeds. When receiving TPN your baby will have his/her blood sugar levels closely monitored so that all of his/her organs can get sufficient energy.

 

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The unwell term baby

 

If your baby has been born at term, but has been admitted to the NICU, then it is unlikely that he/she will receive milk feeds initially. Instead a small plastic tube (a cannula) will be inserted into a vein whereby he/she can receive sugary water. If your baby has undergone surgery then feeding may be delayed for some weeks. In this case, a long, fine tube (long line) is passed into a vein in the arm or leg so that total parenteral nutrition (TPN) can be given. TPN consists of all the glucose, amino acids, salts, fats and vitamins for your baby to grow until he/she is well enough to feed.

 

 

Once your baby is showing signs of improvement, feeds may be commenced. These may start through a small tube inserted via the nose or mouth into the stomach, a naso- or oro- gastric tube, until your baby is feeling well enough to feed.  Your breast milk can be fed this way and is ideal for your baby as it boosts his defences against infections and provides growth factors and hormones that help your baby develop. A nurse or midwife can help you to express your milk, which can then be stored until your baby needs it. If you had decided to bottle feed your baby, or cannot express your breast milk, then formula feeds of your choice will be introduced in exactly the same way.

 

When your baby is ready he/she can begin to try breast or bottle feeding. You will be assisted by a nurse to do this. If breastfeeding your baby, he/she may initially be given a 'top up’ feed following a trial at the breast. This is to ensure that he has received enough fluid until he becomes proficient at breast feeding. If commencing bottle feeding, then a top up of formula milk may be given via a naso- or oro- gastric tube if your baby has not got the energy to finish a bottle.

 

Whether your baby has been admitted to the NICU for a short period of time, or has been born prematurely and faces weeks on the NICU, you will be able to assist and support with his/her nutritional requirements until he/she is proficient at your chosen method of feeding.

 

 

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