Neonatal intensive care unit (NICU)

The neonatal intensive care unit (NICU) is a hospital ward with specialist medical staff and equipment to care for premature and sick newborn babies. This part of the hospital is sometimes called the intensive care nursery or newborn intensive care unit.

The NICU has highly trained staff and advanced life support equipment designed to meet the unique needs of newborn babies. Not all maternity hospitals have a NICU, so if your baby needs specialised care, you may need to travel to a different hospital.

Babies who need intensive care usually go to the NICU within the first 24 hours after birth. The medical team will discuss with you how long they expect your baby to stay in the NICU.

When babies no longer need the high level of care offered in the NICU, they may move to a special care nursery or special care baby unit.

Babies may need to spend time in a NICU if:

• they are premature (born before 37 weeks of pregnancy)
• there were complications during labour
• there are complications such as breathing problems, infections, birth defects or the baby needs surgery
• they have a low birth weight (less than 2.5 kg)
• they are a twin, triplet or from other multiple births

It may seem overwhelming the first time you see your baby in this highly specialised area of the hospital. Understanding how the NICU works may help you cope better, so you can focus on looking after your baby, and recover from the birth.

Babies in the NICU can easily catch infections like colds, flu and diarrhoea. So it is very important for all visitors to sanitise their hands before they enter. You can use soap and water, or the antibacterial gels provided.

NICUs are usually quiet and calm places, so babies aren't overwhelmed by noise and light. There may be times when the lights are dimmed so the babies can rest. The aim is for staff to handle babies as little as possible.

Each baby is in an incubator or heated cot to keep their body at the right temperature. There may also be equipment such as:

• a ventilator to help with breathing
• machines to give your baby fluids and medicines through tubes in their veins
• monitors attached to the baby's body to check their heart rate, breathing rate and blood oxygen levels

Parents are usually welcome in the NICU 24 hours a day, but other visitors may be limited. Remember, babies in the NICU can get very sick if they catch an infection. If you or someone you have contact with has been ill, talk to the medical staff before you come on to the ward.

Bonding with your baby and helping to care for them will also help them get well. NICU staff will include you wherever possible in your baby's care and will teach you how to look after your baby. This may include how to change nappies, take your baby's temperature, and how to bathe, feed and cuddle them.

You may be able to provide 'kangaroo care', or skin-to-skin care, with your baby. Holding your baby next to your skin is helpful for both parents and babies. For example, it helps to regulate your baby's body temperature, heart rate and breathing rate. It can also help them gain weight and can improve your breast milk production.

Kangaroo care is not suitable for all babies, so ask the NICU staff. Even if your baby is not well enough for kangaroo care, you can still comfort them by stroking them, letting them hold your finger or by talking and singing to them.

Many babies in the NICU may not be able to breastfeed at first. They will feed through a tube in their nose that carries the milk straight to their stomach (called 'gavage feeding').

The NICU staff may ask you to express breast milk to feed your baby. Your breast milk may be stored in the fridge or frozen to use later. Expressing milk will keep up your milk supply so you are able to breastfeed if/when you and your baby are ready.

Holding your baby skin-to-skin can help your baby feel secure and can help to stimulate your milk supply. Skin-to-skin feeding is a good way to help prepare you and your baby for breastfeeding. Ask the NICU staff if your baby is well enough for you to hold.

If your baby is very premature or sick, it may take time for your baby to breastfeed well. In many cases, this may take weeks — this is very normal. Hold your baby skin-to-skin and try to go at their pace. With time, your baby will start to feed better.

When you hold your baby skin-to-skin you may notice them becoming more alert, sucking their fingers or lips and moving closer towards your breast. These are signs that your baby may be ready to feed.

Babies in the NICU usually progress through a number of stages when starting to breast feed. They may start by nuzzling and licking your nipple. They may then move towards your breast and take a few sucks. With time, they will take more sucks and start to swallow, and will do so for longer periods of time. Eventually, they will be looking to breastfeed for every feed.

If you do not want to breastfeed or don't produce enough milk, the staff will discuss formula feeding with you.

If your baby is not able to breastfeed, you can try expressing. You can start expressing as soon as you are able to after your baby is born, ideally within 6 hours of birth.

Try gentle breast massage and nipple stimulation to help to stimulate the let-down reflex, and encourage your milk to flow.

If your baby is in the NICU, you may need to express between feeds. How often you express will depend on your circumstances. You may need to express more often at first, to establish your milk supply.

You can express at home or in the NICU. You can express by hand, or use a breast pump. The nursing staff will guide you — be sure to ask for help if you need it. Breast pumps may be available for you to use in the NICU. Double pumps mean that you can pump both breasts at the same time. You may also need to have a pump at home if you will be expressing after your baby is discharged from the NICU. If you plan to express long term, think about hiring or buying a good quality electric pump, that is comfortable for you.

How do I store and transport expressed breast milk?

Tips on storing and transporting breast milk for babies in the NICU:

• Ask NICU staff for milk bags to store of your expressed breast milk.
• Label all expressed milk with the following information:
  • mother's/baby's names
  • EBM ('expressed breast milk')
  • date and time you expressed.
• If you defrost your breast milk, be sure to label it with the time and date it was defrosted.
• If your baby is not going to have your milk within 4 hours of expressing, be sure to refrigerate it.
• Avoid transporting frozen expressed breast milk — once it defrosts, it can't be refrozen.
• Check that the NICU has space to store your frozen milk before you leave home.
• When you can, try to express while you are in the NICU, so your babies can have fresh, unrefrigerated milk when possible.

Having a baby in the NICU can be an emotional experience. Some parents find it hard to cope with having an unwell baby. It is common to feel sad and frightened, overwhelmed or disappointed. It can be especially hard to go home without your baby.

Parents might be worried that they won't be able to bond with their baby.

Make sure you talk to the staff if you have any concerns. Many NICUs offer parent support groups where you can share your experiences with other families. Don't forget to look after yourself too. Make sure you eat well and try to get enough sleep.

Practical tips for parents managing their feelings

Here are some tips for getting through your baby's time in the NICU:

• Kangaroo care and reading to your baby can help you bond with your baby.
• Seek support from friends, family and mental health professionals.
• Take time to care for yourself — don't ignore your physical and emotional needs.
• Be involved as much as possible with your baby's care.
• Keep a journal of your baby's progress and your feelings.

If you have a baby in a NICU and need support, call the 24-hour Miracle Babies Foundation NurtureLine on 1300 622 243.