What to Expect in the NICU: A First-Days Guide for Parents

Your first visit

The neonatal intensive care unit is where babies go when they’re born early, have a health problem, or had a difficult birth. Most are admitted within a day of being born, and a stay can last anywhere from a few hours to a few months. Babies who are sick or born early usually go straight there — sometimes after a quick moment in a parent’s arms, sometimes not.

March of Dimes says it plainly: the NICU can be an overwhelming place. Your first visit will usually include meeting some of the staff, hearing about your baby’s health and the equipment around them, and finding out when you can spend time together. If you’re still recovering and can’t get to the NICU yet, you can call the unit and ask to speak with someone on your baby’s care team.

It’s normal to feel nervous, numb, or like you don’t know where to put your hands. Your baby’s nurses can help you feel more comfortable, one visit at a time.

The bed, the wires, and the monitors

The equipment can be a lot to take in. Here’s what some of the most common pieces do, according to March of Dimes and Nemours KidsHealth. Not every baby needs all of these.

Where your baby sleeps

• Incubator. A clear plastic bed that helps keep your baby warm. You can reach in and touch your baby through the ports on the sides.
• Radiant warmer. An open bed with a heater overhead, used when a baby needs to be handled often.
• Bili lights (phototherapy). Bright lights over the bed that treat jaundice.

Monitors

• Heart and breathing monitor. Small stickers (leads) on the chest track heart rate and breathing. An alarm sounds if either goes too fast or too slow.
• Pulse oximeter. A small sensor wrapped around a hand or foot that measures the oxygen in your baby’s blood. It doesn’t hurt.
• Blood pressure. Checked with a tiny cuff on an arm or leg, or through a thin line in an artery.

You’ll hear alarms. Ask your baby’s nurse what the numbers on the screen mean for your baby and what each sound is telling them — you never have to sit and wonder.

Breathing support

• Nasal cannula. Small tubes in the nose that deliver air and oxygen.
• CPAP. Sends air and oxygen to the lungs to help a baby breathe.
• Ventilator. A breathing machine connected through a tube in the windpipe. It can give a few extra breaths or take over breathing entirely.

Feeding and fluids

• Feeding tube. A thin tube through the nose or mouth into the stomach that delivers breast milk, formula, or medicine.
• IV or central line. Thin tubes in a vein that deliver fluids, nutrition, and medicine.
• Umbilical catheter. A thin tube placed in the umbilical cord blood vessels after birth, used for fluids, medicine, and blood draws.

New words will come at you fast. Keep our NICU glossary handy.

Who’s on the care team

A NICU team is made up of doctors, nurses, and many other providers, and the people on your baby’s team may change depending on how your baby is doing, how long they stay, and how the unit schedules staff. A few of the people you’re likely to meet, as March of Dimes describes them:

• Neonatologist — a pediatrician with special training in caring for sick newborns, who may direct your baby’s care.
• NICU nurses — registered nurses with special training in caring for sick newborns. They are usually the people you’ll see most.
• Neonatal nurse practitioner or physician assistant — providers with special training to care for sick newborns.
• Respiratory therapist — cares for babies with breathing problems.
• Lactation consultant — helps moms with breastfeeding and pumping.
• Dietitian, pharmacist, and therapists — help with nutrition, medicines, feeding, and movement.
• Social worker and case manager — help your family cope with the stay, connect you to resources, and plan for discharge.
• Chaplain — offers spiritual support, if you want it.

If you’re not sure who someone is, ask. Every NICU is different, and the level of NICU your baby is in shapes which specialists are on hand.

The daily rhythm and rounds

NICU days have their own rhythm, built around your baby’s feedings, care times, and medical checks. Your baby’s nurse can tell you when feedings and care times happen so you can plan to be there for them.

Many NICUs hold rounds — a regular time when the team reviews how your baby did overnight and sets the plan for the day. Hospitals encourage parents to join, and some let a parent listen in by phone if they can’t be at the bedside. If you miss rounds, you can ask the nurse for an update or ask them to pass your questions to the doctor. Times and options vary, so ask your unit how rounds work there.

You can also ask for a family meeting (sometimes called a care conference) with the medical team. These are especially helpful when your baby’s condition changes or new specialists get involved.

One tip from UW Medicine’s NICU: write your questions down as soon as you think of them. It’s very hard to remember what you wanted to ask once you’re face to face with the team. Our printable questions to ask the NICU team is a good place to start.

How you can help care for your baby

March of Dimes puts it this way: you are your baby’s best advocate. Ask questions, share your concerns, and take part in decisions about your baby’s care. And just being there matters — your baby will come to know your smell, your voice, and your touch.

• Touch and hold. Depending on your baby’s health, you may be able to hold them even with a ventilator or IV. If not yet, you might hold a hand, rest a palm on their head, or talk and sing. Very early babies can find some touch stressful, so ask the nurse what kind of touch is right today.
• Skin-to-skin. Holding your baby in just a diaper against your bare chest is a lovely way to bond, and it can help with breastfeeding. Learn more about kangaroo care in the NICU.
• Breast milk. If you want to give your baby breast milk, it can go through a feeding tube until your baby can feed by mouth, and lactation help is available. See pumping breast milk for a NICU baby.
• Hands-on care. As your baby is ready, you can help with diaper changes, feedings, and baths, and sometimes take their temperature.
• Learn your baby’s cues. Time at the bedside helps you notice when your baby is alert, what soothes them, and the signs they’re stressed. No one knows your baby better than you will.
• Bring a little of home. Some units allow familiar items. Check with the nurses first; anything you bring should be easy to clean.

Handwashing and germs

Clean hands help protect NICU babies from serious infections. Expect to wash your hands every time you enter the unit, and to clean them again before touching your baby. Wipe down your phone before you hold your baby, and stay home if you’re sick. Visitor rules can tighten during cold and flu season, and they differ between hospitals, so ask your unit what applies right now. When it’s time to go home, read about RSV after the NICU.

Taking care of yourself

A NICU stay is stressful, and it can pull you away from the people who usually hold you up. Leaving the hospital without your baby is one of the hardest parts — Alyssa had to walk out with empty arms, too. A few things that help:

• Make small pockets of time for yourself — a shower, a walk, a meal that isn’t from a vending machine.
• Pick one friend or relative to send updates to everyone else, so you don’t have to repeat hard news.
• It’s OK to thank people for asking and say you don’t want to talk about it right now.
• Ask about parent support groups, and lean on other NICU parents who understand.
• You can call the NICU for an update when you can’t be there.

If the worry, sadness, or numbness feels like too much, you are not alone and it isn’t a weakness. Read our guide to NICU parent mental health.

If your baby is in a Boise-area NICU

The Treasure Valley NICUs we list are run by St. Luke’s and Saint Alphonsus. A few things each hospital lists on its own NICU page:

• St. Luke’s says its NICU social workers and nurses can connect you with support and advocacy groups for NICU parents, that lactation specialists and nurses are available every day, and that it runs a NICU Follow-up Clinic in Boise.
• Saint Alphonsus says families are encouraged to take part in daily care discussions, and lists family areas, sibling play areas, overnight transition rooms before going home, and certified lactation consultants.

For anything else — visiting hours, parking, how many visitors, what you can bring — ask your unit directly, since policies change. See all of our Treasure Valley NICU resources, and when the day comes, our guide to bringing your NICU baby home.

Every Mother’s Day, we bring care baskets to NICU moms in the Treasure Valley — a small way of saying you’re seen. Read Maverick’s story or help us fill a basket.