Specialized care for your baby

Newborn babies need close observation and care when they are sick at birth or born too early (premature). Neonatal Intensive Care Units (NICUs) and Special Care Nurseries (SCNs) provide this extra care during the first weeks, and sometimes months, of a baby’s life.

Learning that your baby needs a special care unit is stressful, especially after a difficult birth. It will feel strange at first, but for a while this will be your baby’s home, and you will be an important part of their healthcare team. Your baby will be looked after by experienced medical and neonatal nursing staff with the skills to support feeding, breathing and early development.

NICUs and Special Care Nurseries#

If your baby needs care that cannot be provided in the maternity ward, or in the hospital where they were born, they may be transferred to a higher level of care.

• A Neonatal Intensive Care Unit (NICU) cares for newborns who need treatment for critical illness straight after birth. NICUs are usually found in larger hospitals.
• A Special Care Nursery (SCN) looks after babies who are healthier and stronger than those in the NICU but still need extra care. They may be premature, have a low birth weight, or need specific care for other newborn health issues.

If the level of care your baby needs changes, this can sometimes mean moving to another hospital. Specialized newborn retrieval and transport services coordinate expert advice, referral and transfer between hospitals around the clock. This includes urgent transfers, as well as non-urgent transfers and “back transfers” to a special care nursery closer to home.

Equipment and monitoring#

At first you may be worried by the amount of equipment, cords and monitors on or near your baby. Keeping your baby warm and comfortable is very important. To hold them at their ideal temperature, they will be in an incubator — which looks like a see-through plastic box on wheels — or in a heated open cot with overhead or mattress heating.

Depending on what they need, your baby may have:

• leads on their chest to monitor their heart and lungs
• breathing support through a ventilator
• a fine tube and needle in their hand or foot for intravenous (IV) fluids
• feeding tubes and a pump
• sensors on a hand or foot to monitor oxygen
• a catheter in the umbilical cord

A nurse will explain each piece of equipment, what it does and how you can help.

Your baby’s healthcare team#

Your baby and family will be supported by a team that may include:

• specialist doctors (neonatologists and paediatric specialists)
• specialist nurses
• technicians (for laboratory tests, echocardiograms and x-rays)
• physiotherapists, speech pathologists and occupational therapists
• lactation consultants
• social workers, mental health professionals and pastoral care workers

Each member brings different skills. A care manager usually looks after the “big picture” and helps coordinate the team. You will meet them soon after you arrive, and they will help you settle in, show you around and explain how things work.

You are an important member of your baby’s healthcare team. You can usually call the ward at any time to check on your baby and ask questions, though each hospital has its own system for communication — often there are whiteboards near the cot for messages.

In the NICU, each baby usually has an individual bedside nurse who knows most things about your baby’s condition and can update you on recent results or changes in care. A neonatologist is also on duty at all times. Medical staff share information during daily rounds, where each baby’s progress is discussed, and you can ask questions and share information then. More complex matters are better suited to a dedicated family meeting with a health professional.

Visiting the unit#

Parents can usually visit at any time, and you may be given a swipe card for around-the-clock access. The space around your baby’s cot is yours; you may like to bring photos, toys and cards to make it more personal.

Each hospital has different arrangements for parents who need to stay overnight. There may be accommodation nearby, or a family room where you can sleep. Ask your care manager or nurse about the options.

There is often a daily period when visitors are limited — for example, during ward rounds or a “baby rest time”. Hospitals usually limit how many people can be near the cot, commonly a maximum of three (one parent and two others) at a time. If you have a larger group, ask the nurses whether there is a family room nearby where you can meet. Children under 12, other than your own, are usually not allowed to visit.

Illness, food and infection control#

Anyone who is unwell or has an infection should not visit your baby. This includes colds, fever, diarrhoea and vomiting. If you are unsure about the risks or symptoms, talk to your care manager or your baby’s doctor.

For hygiene and safety reasons, hospitals usually do not allow you to bring your own food and drink into the unit. There is often a family room nearby where you can eat, drink and store food.

Infection control is especially important in neonatal and special care units. Hand washing is one of the best ways to limit the spread of germs, and staff will show you how to wash up to the elbows for the best results.

Immunization against common infectious diseases such as whooping cough, influenza, chickenpox and measles can also reduce the risk of infection to babies in a special care unit. All of the routine immunizations are safe for premature and low birth weight babies and should be given according to the standard schedule. Some preterm babies may need extra doses because their immune system is immature at birth, although most develop full immune maturity in the third trimester. Reactions to immunization can occur, but the risk is similar for all infants, whatever their birth weight, gestation or age at the time.

Premature babies are at higher risk of infection than babies born at term, and are also more likely to develop serious complications from these illnesses.

Feeding your baby#

At first, your baby may not be able to breastfeed while in intensive or special care. A tube may be used to feed them until they are stronger and can feed by mouth. Breastmilk contains all the nutrients your baby needs and can help protect them from infection, so you will be encouraged to provide it whether your baby is tube-fed or feeding by mouth.

After birth, your breasts produce colostrum. This first milk can be collected in syringes and given to your baby — even small amounts have great benefits. A nurse or lactation consultant will show you how to express by hand soon after the birth, and how to use a breast pump for larger amounts. Expressing every few hours feeds your baby now and helps keep up a good supply for when they can breastfeed directly. Any excess milk can be stored and used later, which is helpful for times when you cannot be at the unit.

If you choose not to breastfeed, the healthcare team will discuss feeding with formula. Sometimes, even when you are breastfeeding, there is not enough milk for your baby; a nurse or lactation consultant can talk to you about adding formula feeds and ways to increase your supply.

Emotional support#

A long hospital stay can place great strain on parents and the wider family. A social worker can talk with you about the support available while your baby is in hospital and after you go home, and can provide:

• information on topics such as parenting, bonding with your baby and coping strategies
• counselling and emotional support
• referrals to internal and external services

Leaving the unit#

Finding out that your baby can leave intensive or special care is exciting news. Often it means you can take your baby home. Sometimes it means moving to a hospital closer to home because your baby is more stable.

Leaving the security of the hospital can feel daunting. The healthcare team will not arrange discharge until they are confident your baby is well enough to stay healthy at home and that you are able to give the care they need. They will look at a range of things first; babies are often ready when they:

• no longer need intravenous medications
• have reached their original due date
• can maintain a normal temperature in an open cot
• have gained enough weight
• can take all or most feeds by breast or bottle

The team will explain how to access services in your community to help you care for your baby at home, and your hospital may have a home visiting service if you live within a certain distance.

Some babies go home needing extra care and ongoing support. If you have to use any special equipment, you will be given training and detailed instructions. If the unit has the facilities, you may also get the chance to stay overnight with your baby for a short period, to get used to caring for them without the healthcare team close by. Community support groups can help you connect with other parents and families who have had similar experiences.

Key points#

• Keeping your baby warm and comfortable is very important.
• You are an important member of your baby’s healthcare team.
• If you are unsure about any risks or symptoms, talk to your care manager or your baby’s doctor.
• Infection control is especially important in neonatal and special care units.
• Premature babies are at higher risk of developing infections than babies born at term.

Where to get help#