NICU, SCBU & Medical Terms
NICU
The early days of arriving in a NICU (NeoNatal Intesive Care Unit) or SCBU (Special Care Baby Unit) can make you feel as though you have landed in another planet. There seem to be noises and people everywhere and when you combine that with the shock of your early delivery, everything can seem overwhelming.
It is important to remind yourself that right now your baby needs you as much as he needs all of the medical assistance that surrounds him. Ask if you can touch or hold your baby and sit with him as long and often as you need to. If you are unable to be near your baby because of hospital transfer or other reasons, then ask the staff to take a photo of him for you. If you are to be apart for some time you may like to send a recording of your voice to be played near him.
Larger hospitals have level 3 NICU’s and your baby may be in this area initially. Most infants in NICU receive support from a ventilator to help them breathe, via a tube in the nose or mouth to the lungs. Prem babies also lack body fat and this means it is difficult for them to maintain their body temperature. Due to this your baby will be in an incubator or under radiant lights.
Once your baby is stable, he can start to have milk feeds, usually via a gavage tube. (a fine tube which is placed in the nose or mouth.) Your expressed breast milk (EBM) is given to your baby this way until the sucking reflex develops. The staff will support while you learn how to express and this can be a wonderful way of keeping connected with your baby.
Breast milk can be frozen for storage and use at a later date. An excellent guide to breastfeeding and up to date storage details can be found here.
Your baby’s appearance depends on the gestation, although he will look very small and frail and his skin may seem ‘see through’. IV lines will be used to deliver medicine and fluids and monitors that measure heart rate, breathing rate, oxygen levels and blood pressure will be attatched. Try not to be too overwhelmed by everything and ask lots of questions if you are unsure of what all of the apparatus is there for. The NICU staff encourage your questions and phone calls at any time of the day or night, you will be shown how to wash and disinfect your hands prior to entering the NICU.
In these first few days, you will meet many people and it can be a good idea to keep a notepad handy to write any names or questions you may have for different staff. Having a journal near the baby is helpful to as it gives you and staff an opportunity to leave messages for each other.
Having a baby in NICU is extremely stressful and you may feel a range of emotions, including anger, fear, confusion and vulnerability. You may also experience grief at the loss of your pregnancy and sadness or depression. The NICU staff are experienced with dealing with parents and can be a great help to you at this time. Many hospitals have a support worker or counsellor to assist you and your family. Practical support and information such as car parking and accomodation options can also be provided by this worker.
Whether you have had a C section or vaginal birth it is important to care for yourself and get lots of rest. Take up all of those offers of meals, cleaning, ironing or childcare as this is a wonderful way for friends to feel involved in supporting you.
Take lots of photos, even if you feel you will never want to look at them. Try and include something like a toy or wedding ring in the shots as you will be amazed at how quickly your baby will grow. You can use the same toy to take photos every few weeks, months or years.
Special Care
When your baby is no longer requiring intensive care, he will be moved to a special care cot/nursery.
In this area you will have a greater opportunity to care for your baby and as he grows so will your confidence in doing things like changing nappies or bathing.
Cuddles and kangaroo care are really important for you and your baby. Ask staff to let you know when you can hold your baby. It is really special to be able to hold him when he is being gavage fed and most nurseries will try and accommodate this. You may be able to put your baby to the breast for an introduction and cuddle time. He will not have the energy to suck yet but it will do wonders for your milk production and a great start to feeding for you both. By around 34 weeks are learning to suck and this is the time they will start to breast, cup or bottle feed.
Kangaroo care is skin to skin contact with the baby being placed on a parent’s bare chest. It has been proven to have wonderful benefits including improved weight gain, decreased need for oxygen and earlier breastfeeding. See: http://www.prematurity.org/baby/kangaroo.html
If your baby was transferred to a NICU Hospital, and no longer requires intensive care, you may be able to transfer to a hospital closer to home. You will be advised when your baby can travel and when there is an available SCBU/SCN bed in your local hospital. As your baby still requires special care a team called NETS will transfer him. NETS is the Newborn Emergency Transport Service and operates from the RWH in Melbourne. See: http://www.rwh.org.au/nets
When you arrive at your local hospital, it is a good idea to get familiar with the routines of the staff and nursery. You may be one of a small number or the only family in the nursery which will be very different from a large busy, city hospital. Moving can be unsettling for you and frustrating as you may have formed close bonds with the staff who have cared for your baby until now. Give yourself time to get to know the new staff as they are an important link to your baby. Remind yourself that each step you take in this journey is one closer to bringing your baby home.
If you have other children, you may find that they are very demanding of your time now that you are home. You may feel torn between being with your baby and being at home. Everyone seems to need you and you may feel as though you are stretched to the limit. This is the time to say yes to all of those offers of help!
Make a list of what needs to be done for when family or friends ask what they can do to help.
Some ideas for helping are shopping, making a meal, babysitting or housework.
At this stage your baby may still require medications, oxygen therapy and heart or breathing monitoring. This is the time however that your baby will begin to take more breast, bottle or cup feeds and learn to maintain his body temperature. All of this requires a lot of energy from your baby and he may need to alternate breast/bottle/cups feeds with gavaging until he is stronger. Sleepiness and weight loss may also occur as your baby is using more energy to feed and maintain body temperature. Staff will monitor this and can assist with warming your baby using heaters near the open cot or sometimes bubble wrap between blankets.
As the time approaches for your baby to come home you will need to organise to have your baby car seat fitted. You may be confident to do this yourself although the RACV recommends you have it professionally fitted. The correct positioning of the straps and belts is imperative to your child’s safety.
If you haven’t done so yet, get your baby’s room or area ready for him. He will need a safe hammock, cot or bassinet to sleep in. It is okay to use second hand equipment but be sure it has an Australian Safety Standard rating. Check the http://www.sidsandkids.org/safe_sleeping.html site for the latest on safe sleeping.
By the time your baby is ready to go home, he may have been in hospital for weeks or even months. He may be ready to go home before or soon after his due date. This has been a long and exhausting journey for you and feelings of excitement and anxiety at finally having your baby coming home are normal. Even if you have had other prem babies this is always a frightening time. Remind yourself how strong you have been to get through the journey so far and know that the staff would not let your baby go home unless he was ready. Most hospitals will advise that you room in with your baby for a night and perform all his care.
Congratulate yourself – You have made it through what will probably be one of the most stressful times in your parenting! Enjoy your precious baby and remember to take care of yourself. Having a newborn baby (for this is the corrected stage your baby is at) is exhausting. Night feeds and lack of sleep are hard work, take care of your own health and try and curl up on the couch for a snooze whenever you can.
Medical Abbreviations
| |
| BF - |
Breast Feed |
| BM - |
Breast Milk |
| B/M- |
Bowel Motion |
| BP - |
Blood Pressure |
| BPD - |
Bronchopulmonary Dysplasia |
| CP- |
Cerebral Palsy |
| CPAP- |
Continuous Positive Airways Pressure |
| CVI- |
Cortical Vision Impairment |
| CVL- |
Central Venous Line |
| EBM |
Expressed Breast Milk |
| ECG- |
Electrocardiogram- records heart activity |
| EEG- |
Electroencephalagram- measures brainwaves |
| ELBW- |
Extremely Low birthweight- less than 800grams |
| FT- |
Full term – over 37 weeks gestation |
| GA- |
Gestational age
|
| G-tube- |
Gastro intestinal tube |
| HELLP- |
Haemolysis, elevated liver |
| HMD- |
Hyaline Membrane Disease |
| HMF- |
Human Milk Fortifier |
| IUGR- |
Intrauterine Growth Retardation- result is SGA |
| IVH- |
Intraventricular Haemorrhage- brain bleed |
| LBW- |
Low Birth Weight –under 2500grams |
| NEC- |
Necrotising EnteroColitis- inflammatory bowel disease |
| NG Tube- |
Naso Gastric Tube |
| NICU- |
NeoNatal Intensive Care Unit |
| OT- |
Occupational Therapy/ist |
| OG Tube- |
OraGastric Tube |
| PT- |
Physical Therapy/ist |
| PTL- |
PreTerm Labour |
| PROM- |
Premature Rupture of Membranes |
| RAD- |
Reactive Airways Disease |
| RDS- |
Respiratory Airways Syndrome |
| ROP- |
Retinopathy of Prematurity – an eye disease found in prems. |
| RSV- |
Respiratory Syncytial Virus |
| SCBU- |
Special Care Baby Unit |
| ST- |
Speech Therapy/ist |
| TTTS- |
Twin to twin transfusion syndrome |
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