What is Neonatal Care and the Neonatal Intensive Care Unit (NICU)?

Every year, around 60,000 babies in the UK are born prematurely (before 37 weeks). Neonatal care units are specialised units in a hospital that provide a range of services for premature and sick newborns, from intensive care in the NICU for critically ill infants to routine care for healthy newborns. Neonatal care units are staffed with a team of professionals, each with specialised skills and knowledge. In this article, we will explore the different types of neonatal care units and the levels of care that you can expect daily, as well as how the neonatal care team supports you and your baby.

What is Neonatal Care?

Neonatal care is provided for babies born prematurely, with low birth weight or in need of medical attention. The meaning of the word neonatal is ‘newborn’, therefore, neonatal care is all about providing care for your new arrival – especially if they arrived into the world a little early.

Neonatal staff in all levels of neonatal care – from low dependency to NICU – will support and work with you to ensure your baby has the best possible outcome. They will also provide you with the support you need for transitioning from one level of care to the next or to another speciality, or from the hospital to home, so you can feel confident and comfortable as your baby’s primary caregiver.

Which Babies Need Neonatal Care?

As mentioned above, some newborn babies need neonatal care, provided by the neonatal unit in a hospital. Here are some of the reasons your baby might need specialist neonatal care:

• Born prematurely (more than 3 weeks before due date). A premature baby is classed as a baby born before 37 weeks of gestation.

• Low birth weight. Babies weighing less than 1700 grams may require specialist neonatal care.

• Medical condition. If a baby is born with a medical condition, such as a birth defect, needing support with breathing, infections, heart problems, or anything else that may require specific/specialised monitoring or treatment.

• Delivery factors. Complications around delivery may result in your baby being cared for in the neonatal unit.

• Twins, triplets, multiples. They are often born prematurely or smaller than a single-birth baby(singleton), so may need time in the NICU.

• Maternal factors. Sometimes maternal complications may result in your baby requiring neonatal care.

Levels of Neonatal Care

Different levels of neonatal care may be required in a neonatal unit, depending on your baby’s needs and the type of specialised care they need. The level of your baby’s care may also change during their time in the hospital as their needs change. Read on to find out the different levels of neonatal care in UK hospitals and the difference between high-dependency unit and NICU:

• Low Dependency. Also known as special care, where your baby may receive low dependency care if the need for less intensive care is required, or they were born less prematurely (e.g. after 32 weeks gestation). Your baby will be monitored and treated according to their needs.

• High Dependency. This unit is for babies who need a higher level of care and treatment than low dependency. Your baby may need this level of care if they need some support to assist them with breathing independently. Or if they need specialist IV nutrition or post-operative treatment.

• Neonatal Intensive Care. What does NICU stand for? NICU stands for Neonatal Intensive Care Unit. NICU care is for babies requiring intensive treatment, which may include needing mechanical ventilation, specialist surgical and medical care and some babies that require cooling. It may be that you’re transferred to a different hospital with a NICU if your baby needs intensive care or specialist services.

• Transitional Care. This type of care allows a baby to stay with their mother in the hospital whilst receiving treatment. This is usually for babies with conditions, such as mild jaundice, those born between 34- and 37 weeks gestation, or babies that are establishing breastfeeding and those nearly ready for home.

Remember, the neonatal care staff can help you further understand the level of care that your baby needs and discuss any changes in your baby’s condition during their stay in the neonatal care unit.

What Happens in a Neonatal Care Unit?

The neonatal environment can seem overwhelming; however, the staff are very aware and are trained to support you and your family during your journey. We have gathered some important information about neonatal care units to help you understand more about the staff, equipment, and how your baby will be cared for.

What Do Neonatal Staff Do?

During your baby’s time in a neonatal care unit, you will get to know some of the staff members that oversee your baby’s care. The nurses are with the babies 24/7, and parents and families will be encouraged and supported to be part of the team. Here’s a list of the staff you may meet and their role within the neonatal unit:

• Nurses. Your go-to people and the ones you will meet most frequently within the neonatal unit are the nurses. They will support you to care for your baby, answer your questions and arrange meetings for you with the doctors. All nurses will be qualified or working towards speciality (QIS) and range in experience and grade.

• Doctors. A consultant neonatologist or paediatrician will be an integral part of the team alongside you in caring for your baby. They can answer your question about treatment and your baby’s progress. Doctors and Health professionals from other areas of expertise /disciplines may be involved, E.g. opthalmologist, etc

• Therapists. Specialist therapists may be involved along the way depending on your baby’s needs, including physiotherapists, occupational therapists and speech and language therapists.

• Nursery nurses. A nursery nurse typically helps support the nurses and neonatal team within a special care unit and cares for low-dependency babies, and sometimes helps in transitional care.

• Dieticians. They will work with the team to support you and your baby in providing bespoke nutrition.

• Counsellors. Through your journey, talk to the nurse helping you care for your baby and they will signpost you to the best resource for you and your family.

On top of that list, other important faces and roles within the neonatal care unit include the porters and cleaners, clerical staff and the chaplaincy team. Remember, the neonatal care team are always there to support you and answer any questions or concerns you may have.

What Equipment is Used in a Neonatal Care Unit?

We have listed some of the equipment you may see around the neonatal unit. Some of it is used to keep babies warm, help them breathe or monitor their vital signs, etc. For a more in-depth look at the equipment in a neonatal care unit, read our article all about NICU equipment.

• Incubators

• Ventilators: CPAP and other breathing support equipment

• Vital signs monitors

• Oxygen saturation monitors

• Intravenous drips (IV)

• Feeding tubes

• Phototherapy lamps or light blankets.

Tests and Procedures for Preterm Babies

The number of procedures and check-ups a baby may go through in a day depends on their needs. The neonatal team will work with you to decide on the best care for your baby and should always ask for consent before tests and procedures whenever possible. You may also be encouraged to be with your baby during any test.

Depending on your baby’s needs, here are some of the tests they may need:

• Blood tests

• Vision and hearing tests

• Ultrasound scans

• Magnetic resonance imaging (MRI)

• X-rays

• Screening tests.

The neonatal team will explain any tests and procedures in detail to you.

A Safe And Peaceful Environment

Premature or sick babies need a calm, peaceful and safe environment in which to rest and recover. They will spend 90 percent of their time sleeping, compared to 75 percent in the average full-term newborn – this sleep helps their development and recovery. Here are a few ways in which a safe and peaceful environment is promoted in the neonatal unit:

• To help keep vulnerable babies safe from infections, there are guidelines in place regarding handwashing and hygiene.

• Skin-to-skin with the parent is important in providing your baby with the optimal nurturing environment to help their development and recovery.

• To avoid disrupting too much of your preemie’s healthy sleep, skin-to-skin can be done even when they’re sleeping, and care episodes, such as nappy changes, can be done during your baby’s waking hours and according to each individual baby.

• You can also increase intervals between nappy changes by using high-quality preemie nappies, such as Pampers Preemie Protection nappies which you can now order online for free home delivery via www.pampers.co.uk/preemies-ordering-platform.

• Parents are encouraged to be with their babies 24 hours a day in the neonatal unit, if possible. Each unit has its own access policy, so you should check this policy if other family members want to visit your baby.

Forming Close and Loving Relationships With Your Preterm Baby

It’s natural to feel apprehensive when your baby is in the neonatal care unit and many parents want to know what they can do to help so they can form a close and loving relationship with their baby. And it’s not just parents that feel the strain, siblings of your preterm baby may also feel excluded or confused, and will benefit from being part of their sibling’s journey from the start and throughout. From feeding to nappy changes, here are a few ways you can help build that special relationship:

1. Skin-to-Skin Contact

We often underestimate the power of touch; but when your baby is in the neonatal unit, you will start to see the benefits of touch. Also called ‘Kangaroo care’, skin-to-skin involves holding your baby on your bare chest so both your skin is touching. These special moments can help form that loving relationship, and can also help to calm your baby.

The neonatal staff will support you with skin-to-skin as soon as possible. In many units, delivery room cuddles are being offered now. You can find out more information on this special bonding method in our article, Every Touch is Huge.

2. Feeding

Whether you choose to breastfeed or use formula in the neonatal unit, you will be supported throughout. The neonatal staff will help you to express your milk and feed your baby, or you may wish to use donor milk or formula. Skin-to-skin contact may also help to support feeding.

3. Changing And Skin Care

As you are the primary caregiver and the best possible person to care for your baby, the neonatal staff will inform, support and work with you to ensure you feel confident and have the skills in all aspects of caring for your baby, including, bathing your baby and changing nappies.

Order your Pampers Preemie Protection Nappies online for free home delivery via www.pampers.co.uk/preemies-ordering-platform.

For more information and tips on changing and bathing your little one, read our article on How to Care for Your Preterm’s Skin.

4. Just Being There

Just being there, next to your baby makes a world of difference – even if you can’t physically touch them yet. Your baby will be able to recognise your voice and scent, and you will be encouraged to sing, read or simply talk to them. These simple things can reassure both you and your baby and help to form that special relationship you may be longing for.

Some Emotions You May Feel

It may be difficult to fully prepare yourself for the emotions you may feel during this period. Many parents and siblings experience a range of emotions and responses during this journey.

Here are some more things that you (and your partner or close family members) can try to help you cope with the arrival of your preemie and life in the NICU:

• Talk about your feelings with your partner, neonatal staff, friends or family members and reach out for help if you need it.

• Talk to other parents who have been through the same thing – there are a lot of peer support resources available

• Discuss financial worries with your neonatal unit, social worker or family support workers. They can tell you what support is available for you and provide information on the upcoming Neonatal Care (Leave and Pay) Bill.

• Try to get plenty of sleep – skin-to-skin with your baby in a reclining chair is the best possible way to relax and build a close and loving nurturing relationship.

• Take some time out if you choose. Perhaps get some fresh air and exercise by going for a walk.

• Do things you love, like reading, listening to music, etc.

• Eat well and stay hydrated.

• Try relaxation methods, such as meditation or breathing exercises.

• Non-birthing partners will also be encouraged and supported in the neonatal journey by helping out with daily routines or trying skin-to-skin contact.

Remember, you may feel a rollercoaster of emotions – you’re not alone! And your neonatal care team are there for you every step of the way.

Next Step of the Journey

You may be waiting for that joyful yet nerve-wracking day when you’re able to take your baby home or transition to the next part of your journey.

When your baby leaves the hospital with you depends on their individual situation and medical needs. Sometimes a preterm baby will be moved to a different level of care within the neonatal unit or repatriated nearer home. For a preterm baby to go home, they need to be able to regulate their own body temperature, their feeding and weight will be on track, and the parents will be supported to continue their care at home.

From the start, the neonatal care team will work with you to build your skills, prepare you for going home and ensure you are confident in all aspects of your baby’s care.

You can learn all about taking care of a premature baby at home in our informative article – because we know that preterm care goes beyond the hospital.

_{How We Wrote This Article The information in this article is based on the expert advice found in trusted medical and government sources, such as the National Health Service (NHS) and is written in collaboration with Claire Campbell, Neonatal Care Coordinator, NHS Northern Neonatal Network. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.}