Treatment of problems in newborns

Medical treatment of specific disorders is discussed elsewhere. When possible, the sickest newborns (neonates) are cared for in a neonatal intensive care unit (NICU).

Neonatal intensive care unit (NICU)

The NICU is a specialized facility that brings together the medical term and technology needed to care for newborns (neonates) with various disorders. Newborns may need such specialized care because of,

• Prematurity
• Respiratory disorders
• Low blood sugar (glucose)
• Severe infections (for example, sepsis)
• Heart problems
• Metabolic disorders
• Birth defects that nay require surgery

The NICU team is typically directed by a neonatologist (pediatrician specially trained to manage the problems of newborns). Much of the care is delivered by specialized neonatal nurses. Other team members may include pediatricians, neonatal nurse practitioners (advanced-degree nurses specifically trained to manage newborns), neonatal physician assistants, respiratory therapists, social workers, pharmacists, physical and occupational therapists, speech-language pathologists, and other specialized personnel. Many NICUs also have doctors and students in training. Depending on the care required by the baby, medical and surgical subspecialist physicians are also often involved.

In the NICU, newborns are cared for in incubators or radiant warmers, which keep them warm while allowing staff to observe and treat them. Babies are usually connected to monitors that continuously measure their heart rate, breathing, blood pressure, and oxygen levels in the blood. They may have catheters placed inside an artery or in the vein running inside the umbilical cord to permit continuous blood pressure monitoring, to allow repeated blood sampling, and to give fluids and drugs.

Infant radiant warmers

NICU facilities vary widely. Some NICUs have wards in which many babies share a large space, some have modules with a few babies in a space, and some have private rooms for a family and their baby. Regardless of the layout, NICU personnel are focused on meeting the parents' need for time and privacy to become familiar with their newborn; to learn the newborn's personality, likes, and dislikes; and ultimately to learn any special care that they will need to provide at home. Visiting hours vary but are usually flexible so that families can spend as much time with their newborn as they wish. Some hospitals have sleeping facilities for parents on-site or nearby.

Sometimes, parents feel that they have little to offer their newborns in a NICU. However, their presence, including stroking, speaking, and singing to their newborn, is very important. Newborns hear their parents' voices even before birth and are accustomed to them so they often respond better to their own parents' attempts to calm them. Skin-to-skin contact (also called kangaroo care), in which the newborn is allowed to lie directly on the mother's or father's chest, is comforting to the newborn and enhances bonding.

Kangaroo care

Breast milk significantly reduces the risks of necrotizing enterocolitis (a serious intestinal disorder that can occur in premature infants) and infections in premature infants and has a wide range of health benefits for all infants. NICU  personnel strongly encourage mothers to breastfeed when their infant's condition permits. However, depending on their gestational age and medical problems, infants in a NICU may not be able to breastfeed or drink breast milk from a bottle. Premature infants are not able to suck adequately and are not able to coordinate sucking, swallowing, and breathing. Full-term infants in the NICU may have respiratory problems or other illnesses that make breastfeeding impossible. But, because breast milk is clearly the best food for newborns, mothers are encouraged to pump their breast milk for later use.

NICU personnel understands that parents need to be kept up to date on their baby's condition and expected course, the care plan, and the estimated time of discharge. Regular discussions with the nurses and medical term are beneficial. Many NICUs also have social workers who help communicate with the parents and assist in arranging family and medical services.