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When having a baby, parents don’t like to imagine their child needing to stay in the neonatal intensive care unit (NICU). But, as Pankaj Nagaraj, MD, UnityPoint Health, explains, there are several reasons why preterm and term babies are admitted to the NICU.
1. Prematurity. Babies born early (less than 37 completed weeks) is the most common reason for a NICU admission. Premature babies aren’t quite physically and developmentally developed and are unable to transition to the outside environment as well as full-term babies. They can’t control their body temperature and often have excessive weight loss and unstable vital signs, which all affect long-term neurological outcome. These babies need to remain in a controlled, enclosed environment known as an isolette or incubator, which provides heat to keep a constant body temperature and mimics the uterine environment. Higher caloric food is given to these delicate patients, along with IV hydration and other evidence-based therapies.
2. Respiratory Distress Syndrome (RDS). RDS is the most common respiratory problem in infants because of immature lungs. Mild cases can be treated by using a machine that pushes oxygen to the baby through a mask. Severe cases are treated with a breathing tube, as well as placing the baby on a ventilator.
3. Sepsis or infection. Sepsis or infection is the most common reason for neonatal death and poor outcomes. Infections are more common in premature infants when compared to full-term infants. The earlier a baby is delivered, the more likely the baby is to have an infection, as the immune system can’t fight it off. Antibiotics may be used for a set period of time, based on signs of infection and laboratory values.
4. Hypoglycemia. Hypoglycemia, or low blood sugar, is usually seen in premature infants, infants born to a mom with gestational diabetes or infants who have an infection.
5. Perinatal depression. Traumatic delivery, or problems during delivery, can lead to decreased blood flow and oxygen to the baby. Doctors treat babies born with perinatal depression with whole body cooling, a new method of decreasing brain injury to the infant, due to the decreased blood flow.
6. Maternal chorioamnionitis. One reason a baby might be sent to the NICU actually involves the mom’s health. Maternal chorioamnionitis is an infection and inflammation of the placenta, and/or the umbilical cord, before or during labor, and this puts the baby at a very high risk for an infection. The mother usually has a fever, with increase in heart rate and uterine tenderness. Baby is immediately admitted to the NICU after birth and started on antibiotics for at least 48 hours before being discharged to home.
After birth, Dr. Nagaraj says care teams assess infants to make sure their temperature, heart rate, breathing and color are within normal limits. In babies born to moms who have risk factors in pregnancy, like diabetes, high blood pressure or history of drug use, additional testing is required.
“It’s hard to predict the average length of NICU stay, as it depends upon a multitude of factors,” Dr. Nagaraj says. “The general rule is if a baby has been stable – not needing oxygen, eating all feeds orally and otherwise stable – for 48 hours, they are discharged home with close follow up.”
Dr. Nagaraj also says even if labor and delivery go well, there are circumstances where babies can be admitted to the NICU shortly after leaving the hospital.
“Babies born without complications usually go home in 48-72 hours. Usually, the most common reasons for readmission after going home are late onset infection/sepsis, jaundice and poor weight gain. There are certain cardiac conditions that also present after three days of life, which need admission to the NICU,” Dr. Nagaraj says.
If you find yourself in the NICU with your little one, Dr. Nagaraj wants you to know you’re not alone.
“Having a child in the NICU is very stressful for the parents due to the uncertainty, worry and stress about the well-being of the child. Our NICU team members try their best to ease fears and make the parents’ journey as smooth as possible. Ask your NICU staff for recommendations on ways to cope with the challenges faced in the NICU, such as books or support groups,” Dr. Nagaraj says.
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