Neonatologist; orogastric tube; pulse oximeter; continuous positive airway pressure; necrotizing enterocolitis; patent ductus arteriosus. The neonatal intensive care unit is a busy place with a language of its own that’s often difficult for outsiders to decipher, even with context. When parents of a newborn find themselves in the NICU, the amount of new terminology that has suddenly become critically important can be overwhelming. If you are a new parent with an infant in the NICU, the best thing you can do is talk to the nurses and doctors. Be involved in your baby’s care and don’t be afraid to ask questions. Hospital staff can explain your individual situation and help you learn the terminology relevant to your child.
For family and friends of preemies, it’s helpful to learn some basic NICU terminology so that when you ask, “How’s the baby doing?” you’ll have a better understanding of the answer. The same goes for anyone expecting a baby, even with a low-risk pregnancy. Birth can be unpredictable, and even a passing familiarity with the world of neonatal intensive care will be a benefit in the event your baby needs to spend some time there. Here are some basic terms, conditions, and treatments used in hospitals to care for premature and sick infants. This list is an introduction to the NICU; for more comprehensive information, have a look at the resource links at the bottom.
Care Team Members
Neonatal Nurses provide most of the day-to-day care in the NICU. They are instrumental in almost every aspect of a baby’s care, including feedings and changings, monitoring the preemie or newborn baby’s vital signs, implementing a care plan, advising and carrying out a doctor’s orders, and supporting and educating families. They offer a wealth of information, experience, and support for families.
Neonatologists are doctors who specialize in treating newborns with medical conditions stemming either from premature birth or other complications in a full-term baby. The neonatologist is usually the attending physician who will manage the medical care of a baby, including making diagnoses, ordering treatments, and coordinating specialists on the medical team.
Pulmonologists are the doctors in a NICU who specialize in diagnosing and treating lung and breathing conditions. Because important lung development happens in the final weeks of a full-term pregnancy, preemies often require help to breath effectively. A pulmonologist will identify what is causing a baby's breathing trouble and recommend treatment.
Gastroenterologists are doctors who specialize in conditions of the stomach and intestines. Premature babies are sometimes born with conditions that cause complications in their digestive systems, making feedings difficult and increasing the risk of serious illness. Gastroenterologists diagnose and treat problems that arise involving a baby’s digestion.
Medical Conditions Treated In the NICU
Respiratory Distress Syndrome (RDS) is a lung condition that commonly affects preterm babies, especially those born before 35 weeks. Because a preemie’s chest and lungs aren’t fully developed, the baby may have difficulty breathing and take in an insufficient amount of oxygen. As a result, breathing is less effective and results in lower oxygen levels in the blood. Doctors and nurses pay close attention to the quality of a baby’s breathing and take steps as needed to make sure the baby is getting enough oxygen.
Patent Ductus Arteriosus (PDA) is a condition related to an artery that connects two large blood vessels that leave the heart. In a healthy newborn, this artery, the ductus arteriosus, narrows and closes naturally within a few days. If it does not close and remains large, it can cause too much blood to flow to the lungs, resulting in breathing and heart problems. Doctors and nurses in the NICU monitor babies carefully to make sure that the ductus arteriosus closes and take the necessary steps if it causes the baby distress.
Necrotizing Enterocolitis (NEC) is a serious condition of the digestive system in which cells in the lining of the intestines become infected and damaged. The risk is that the contents of the digestive system will spill out of the damaged intestinal wall into the baby’s abdomen, causing a potentially devastating infection. NEC is not completely understood, but babies who receive breast milk rather than formula have a significantly lower risk of developing it. Preventing NEC is one of the reasons that so much effort is made to provide preemies with human milk.
Common NICU Treatments and Equipment
Radiant Warmers and Incubators are the special equipment used in the NICU to maintain a baby’s temperature and, in incubators, a proper humidity level. They may be controlled by a sensor on the baby that monitors his temperature and adjusts accordingly.
Cardiorespiratory Monitor This is a device that monitors a baby’s heart rate and breathing and displays the numbers on a screen. If the heart rate or breathing rate fall outside of the normal range, the monitor with alert the NICU staff, who will check on the baby and make sure that everything stabilizes.
Pulse Oximeter This is another device that is connected to a baby to measure the amount of oxygen in the blood. It is usually wrapped around the baby’s wrist, hand or foot and shines a red light through the skin. The pulse oximeter measures the oxygen saturation of the blood and displays it, along with the baby’s heart rate, for monitoring.
Continuous Positive Airway Pressure (CPAP) is a treatment for babies who have difficulty breathing because of RDS or other breathing complications. A tube is secured over the baby’s nose and a continuous flow of low-pressure air, with or without additional oxygen, is pumped into the baby’s lungs. This keeps the airways open and makes it easier for the baby to breathe naturally.
Intravenous Line (IV) An IV is placed in a vein to provide a baby with fluids, nutrients, or medication as needed. Because the baby squirms, the IV may be jostled loose and its location might be changed frequently between the baby’s hand, arm, foot, leg, or scalp.
Orogastric and Nasogastric Tubes A small, flexible tube may be placed through a baby’s mouth (orogastric) or nose (nasogastric) and down the food pipe into the stomach. It is used to release gas or fluids that accumulate in the stomach, or to give feedings to a baby who is unable to take milk by mouth.
The range of experiences in the NICU is vast. A family may be there for a couple of days for observation, or for weeks or months to treat a seriously ill baby. It’s a trying time for families in most cases. Learning about the baby’s challenges and treatment is an important way for parents to stay involved in his or her care. Extended family and friends can also benefit from learning about the NICU in order to understand what a family is facing and offer support. If you want to learn more or find out about a specific topic, many local hospital websites offer NICU information. Here are some other comprehensive resources:
From the American Academy of Pediatrics: https://www.healthychildren.org/English/ages-stages/baby/preemie/Pages/default.aspx
From the March of Dimes: http://www.marchofdimes.org/complications/the-nicu.aspx
From Graham’s Foundation: http://grahamsfoundation.org/wp-content/uploads/2015/02/NICU-glossary-b1a.pdf
The source I used for this article, which I highly recommend, is the book Understanding the NICU: What Parents of Preemies and Other Hospitalized Newborns Need to Know. Edited by Jeanette Zaichkin, Gary Weiner, and David Loren. Published by the American Academy of Pediatrics, 2017. It’s extremely helpful, informative, and encouraging.