parent’s guide to the neonatal intensive care units-guide-t… · page 1 university of washington...

Patient EducationNeonatal Intensive Care Unit

Parent’s Guideto the NeonatalIntensiveCare UnitInformation for families whosebabies are in our NICU

The Neonatal Intensive Care Unit (NICU) is a

special place for babies requiring intensive

nursing and medical care. Your role with your

baby and with the NICU staff is very important,

and we hope this brochure will help answer

some of your questions. Our doctors and

nurses know you can make better decisions for

your baby when you understand the care he or

she is receiving, and they want you to feel

welcome in the NICU.

University of Washington Medical Center’s Neonatal Intensive Care UnitParent’s Guide to the Neonatal Intensive Care Unit

Table of Contents

Welcome to the NICU ......................................... 1

Being With Your Baby ........................................... 2

The People Who Care for Your Baby ................... 6

Your Baby’s Special Needs ................................... 10

Leaving the NICU ................................................ 15

Glossary of NICU Terms ...................................... 17

Important People andPhone Numbers ............................. Inside Back Cover

Note: The pronouns “she/her” and “he/his” are usedalternately throughout this booklet.

Photo credits: Chris Cella (p. 16),Darrell Peterson (p. 6), Kurt Smith(p. 19), Cynthia St. Clair (pp. 1, 4, 8,10-11, 13, 15, 17-18, 20-21, 23-25),William Stickney (pp. 2, 5)

University of Washington Medical Center’s Neonatal Intensive Care Unit

Parent’s Guide to the Neonatal Intensive Care Unit

The NICU is a

special place for

babies requiring

intensive

nursing and

medical care. We

hope this brochure

will help answer

some of your

questions.

Welcome to the NICU

This booklet is for families whose babies areadmitted to University of Washington Medi-cal Center’s Neonatal Intensive Care Unit(NICU) for advanced nursing and medicalcare. We hope this information helps youbetter understand the special care your babyis receiving.

If your baby is born preterm (before 37weeks of gestation) or with a serious illnessthat requires “high tech” medical care, thedoctors may decide that he needs to be in theNICU. In this special area, the medical andnursing staff provide the sophisticated,coordinated care so vital to your child.

During this time you may wonder just whereyou, as the parent, fit in – and if your babyeven needs you. Rest assured that all babies,even those born prematurely, recognize theirparents’ voices. Your baby knows whenyou’re near. The familiar sound of your voiceseems to help your baby do better.

As caring and considerate as the staff in theNICU are, they touch your baby to providenecessary medical care. You touch your babybecause you love him, and this, like thesound of your voice, seems to reassure yourinfant. Your role with your baby and with theNICU staff is very, very important.

You are not underfoot when you are at yourbaby’s bedside. If the health care staff needsto examine your baby, they’ll tell you.Otherwise, feel welcome to be there.

The familiar sound of yourvoice and your lovingtouch seem to reassureyour baby.


When you’re not at the medical center, phoneany time to see how your baby is doing. If it’sthe middle of the night and you can’t sleepbecause you’re wondering about your baby,call and ask. Calling will often reassure youso you can get back to sleep.

Our doctors and nurses want to keep youinformed about your baby. They also recog-nize that you can make better decisions foryour infant when you understand his care.

We want you to feel welcome on our unit.

Being with Your Baby

Your baby needs to receive love along withmedical care. The NICU nurses and doctorstake care of your baby with you, not in placeof you – you have a very important role in thecare of your infant.

You can make betterdecisions for your infantwhen you understand thecare he’s receiving.



During your first few visits to the NICU, youmay not feel comfortable doing more thanlooking and listening. This is a naturalreaction. Gradually, you’ll feel more comfort-able about getting involved in your baby’scare – talking to her, touching her, andlearning to understand her needs or interprether signals. As your baby progresses, you’llbe able to hold and rock her, and becomemore involved with her physical care, such asfeeding, burping, bathing, temperature-taking,diapering, and dressing. You may want tobring a musical toy or clothes for your infant.

You may live some distance away or haveother responsibilities that make it difficult tobe with your baby frequently, but we encour-age you to visit as often as possible.

We close the NICU daily for four briefperiods – 7:00 to 7:30 a.m., 3:00 to 3:30 p.m.,7:00 to 7:30 p.m., and 11:00 to 11:30 p.m. –as nursing shifts change, while we shareinformation on each baby’s condition. Novisitors or non-urgent telephone calls areaccepted at these times.

Closing the unit to everyone except staffduring these brief times each day ensures theprivacy of every family and the timelytransfer of this important information.

Parents (or mother and designated supportperson) are welcome – and encouraged – tobe with their baby at any other time.

NICU ProceduresFor your baby’s protection, please check atthe front desk before entering the NICU andfollow a special hand-washing procedure,called scrubbing, before you touch your baby.

You are not under-

foot when you are

at your baby’s

bedside. If the

health care staff

needs to examine

your baby, they’ll

tell you. Other-

wise, feel welcome

to be there.


You and other members of your family whohandle your baby will also be asked to gown(put on a special lightweight robe) each timeyou visit your baby. These procedures aredescribed in the next section.

We ask that you visit only your own baby,and not go to other babies’ bedsides. Thishelps protect the babies against infection andguards the privacy of other families. Whenaccompanied by you, and with the consent ofthe baby’s nurse, grandparents, or the baby’sbrothers and sisters may view the baby. Yourbaby’s nurse will help the children put ongowns and masks and cover their hands.

Please have no more than two visitors, otherthan parents, at your baby’s bedside at onetime. Visits may be limited or temporarilydenied at the discretion of the nursing staff tomeet patient or NICU needs.

ScrubbingThe scrub sink and gowns are inside theNICU door and instructions are posted abovethe sink. Ask your baby’s nurse if you havequestions about the scrub procedure. If youleave the NICU, you’ll need to put on a newgown and scrub again before re-entering.After you’ve scrubbed and gowned, try not totouch anything other than your baby, includ-ing your face, hair, or equipment around yourbaby’s bed. If you do touch something, pleasewash your hands again. If you feel as ifyou’re coming down with a cold, please askfor a mask.

Your purse or coat may be securely stored inlockers in the family waiting room. Ask forthe key at the NICU front desk.

You have a very importantrole in the care of yourinfant, and we encourageyou to visit as often aspossible.



Telephone CallsWe ask that only parents telephone the NICUfor status reports on their babies. You maycall at any time, day or night, except duringshift change reports (7:00 to 7:30 a.m., 3:00to 3:30 p.m., 7:00 to 7:30 p.m., and 11:00 to11:30 p.m.). The NICU phone number is206-598-4606. Grandparents and othersshould call you to get information.

If telephone calls to the NICU are longdistance for you, let your baby’s nurse know.She or he can arrange for one of the NICUstaff to call you once a day.

There is a phone for essential outgoing callsin the NICU family waiting area.

Family Waiting AreaThe family waiting area to the right of theNICU front desk is open around the clock foryour convenience. There are toys to entertainyour baby’s sisters and brothers, a TV,telephone, lockers, and chairs. A restroom isavailable just outside the unit. We’re sorrythat that we’re unable to provide overnightaccommodations at the medical center; if youlive out of town and need information onnearby hotels, contact the NICU socialworker at 206-598-4629.

ParkingParking is available in the Triangle ParkingGarage across from the medical center andthe Surgery Pavilion Garage for UWMCpatients and visitors. Parking validation isavailable by contacting the inpatient servicerepresentative at the front desk or talking toyour baby’s nurse.

When you follow ourscrubbing procedures,you help protect yourbaby from infection.


The People Involved in YourBaby’s Care

NursesHighly skilled nurses care for the babies inthe NICU 24 hours a day. Your baby will havea team of nurses who will coordinate his care,including plans for discharge from the NICU.These nurses will try to be available to talkwith you and answer your questions wheneveryou visit or telephone.

Nurse PractitionersNeonatal Nurse Practitioners (NNPs) areadvanced practice nurses who specialize inand devote their entire practice to intensivecare of the newborn. The NNPs are membersof the Medical Staff of the hospital andprovide support to the entire NICU team.Your baby may be managed by the NursePractitioner Team under the supervision of theAttending Neonatologist. The NNPs do notrotate regularly and so are able to provide acontinuous presence in the NICU.

PhysiciansA team of pediatricians cares for your infantunder the supervision of an attending pediatri-cian or neonatologist (pediatrician specializ-ing in the care of newborns), who serves atwo-week shift in the NICU. The attendingphysician, a faculty member of University ofWashington School of Medicine, supervisesall aspects of your baby’s medical care andorders tests, medications, and treatments.

Under the supervision of the attendingphysician, a team of fellows, residents andinterns are available around the clock in theNICU to care for your baby. Residents andinterns serve month-long shifts in the NICU.

Your baby will have one ormore primary nurses whowill be responsible forcoordinating her care.



Detailed information about your baby’sprogress is shared daily by these physiciansduring “rounds.”

Social WorkerAll parents with babies in the NICU can callon a social worker with special training andexperience with parents of premature or sickinfants.

The social worker can help you and otherfamily members cope with the normalstresses of having a premature or sick baby,such as worry about the baby’s health,confusion about how the medical centerworks, disappointment over having deliveredearly, sadness at having to leave without thebaby, frustration over being unable to visit asoften as you would like, and financialconcerns.

In addition, the social worker can provideinformation on community resources suchas parent support groups, housing, andparenting classes.

If you haven’t been contacted by a socialworker and would like to discuss some ofthese concerns, call 206-598-4629.

Respiratory TherapistsThese highly skilled individuals have specialtraining in the treatment of breathing prob-lems, including oxygen delivery systems anduse of mechanical ventilators. There is arespiratory therapist specially trained to carefor infants available around the clock forNICU patients.

The social worker

can help you and

other family

members cope

with the stresses

of having a

premature or sick

baby.


Physical TherapistA pediatric physical therapist will evaluateyour baby’s motor and behavioral develop-ment. When your baby is ready, the physicaltherapist will show you ways to hold and playwith him to promote optimal growth anddevelopment.

Inpatient Service Representative (IPSR)These front desk staff members perform andcoordinate clerical and receptionist duties forthe NICU.

Breast-feeding SupportCertified lactation counsultants are availableto answer questions about breast-feedingyour premature baby, breast pumps, storingyour milk, and related concerns. You cancontact the lactation program by calling206-598-4628.

When you are at UWMC, you may use oneof our electric breast pumps in a privateroom or at your baby’s bedside. To rent anelectric breast pump to use at home, call425-462-0577 or 1-800-578-2260 (PacificMedical Systems). This company will delivera pump to our medical center or to yourhome, if you live in the Seattle/King Countyarea. To get a list of other breast pump rentalcompanies, call UWMC’s Lactation Servicesat 206-598-4628.

Some insurance companies pay for breastpump rental; prescription forms are availableif needed. Ask your baby’s nurse or thelactation specialist if you have questions.

Our physical therapisthas had special trainingin activities that enhanceyour baby’s motor andbehavioral development.



Neonatal NutritionistThis specialized dietitian is trained in thenutritional needs of newborn babies, includ-ing premature infants. She provides ongoingassessments of your baby’s growth andnutritional status and information to theNICU staff.

Neonatal PharmacistsThese pharmacists have specific knowledgeabout the medications used to treat conditionsaffecting newborn and premature babies.They monitor medication therapy and provideother NICU team members with informationto help in selecting the appropriate medica-tions and dosages your baby may require.

If your baby needs medications for a timeafter discharge from the NICU, the neonatalpharmacists will help you understand whatthe medications are for, their possible sideeffects, how they are given, and what to doabout medication storage and prescriptionrefills.


Your Baby’s Special Needs

A full-term pregnancy usually lasts 40 weeks.When a baby is born before 37 weeks ofgestation, he is called premature or preterm.

Don’t assume that your baby was bornprematurely because of something you did ordidn’t do while carrying your baby. If yourpregnancy was “high risk,” your doctor maybe able to explain how it was related to anearly delivery. However, premature deliveriesoften occur for reasons that are unknown.

The Neonatal Intensive Care Nursery isspecially designed to care for premature andsick babies. When your baby is admitted tothe NICU, the nurses and doctors watch himclosely for changes in skin color, breathing,heart rate, temperature, and blood chemistryvalues. Your baby may have a variety ofproblems that influence how long he needs tostay in the NICU.

NutritionUntil your baby can eat by sucking from yourbreast or a bottle, we feed her a nutrient-richformula and other fluids intravenously (viaan IV line) or by gavage (via a soft, flexibletube passed through the nose or mouth intothe stomach for each feeding).

If you want to breastfeed your baby later,start pumping your breasts on a regular basisas soon as possible after the baby is born.This will ensure that you’ll have an adequatemilk supply when the baby is able to nurse.We can teach you to pump your breastssuccessfully and store your milk for futureuse, as well as answer your questions aboutnursing your premature baby.

Many premature babiesare fed by gavage untilthey are able to feed frombreast or bottle.

Our nurses and doctorswatch your baby closelyfor changes in skin color,breathing, heart rate,temperature, and bloodchemistry values.



When premature babies reach the gestationalage of about 34 to 36 weeks, most can beginfeeding from breast or bottle. A commonmisconception is that if a baby can suck wellon a pacifier, then she should be able to startbreastfeeding or feeding from a bottle. Theability to suck on a pacifier comes muchearlier than the ability to feed from a nipple.Reflex sucking is seen before 28 weeks, buta coordinated “suck-swallow-breathe”pattern usually does not occur until 34 to 36weeks of gestational age.

WarmthPremature babies have very little body fatand thinner skin than full-term babies, sothey can easily become chilled. We use twopieces of special equipment to make sureyour baby stays warm.

The radiant warmer is a flat, open bed withheat lamps enclosed in the hood. This bedallows NICU staff to work closely with yourbaby while keeping him warm.

The incubator is a plastic, enclosed bed withwarmed and/or moist air. The temperatureinside can be regulated to meet each baby’sindividual needs.

When your baby is able to be out of theincubator for a while, we can teach youhow to dress him to stay warm while inyour arms.

Most premature babiesare able to feed frombreast or bottle at about34 to 36 weeks ofgestational age.


Respiratory Distress SyndromeSome babies have respiratory distress syn-drome (RDS), also referred to as hyalinemembrane disease (HMD). Respiratorydistress syndrome is a condition in whichthe baby’s immature lungs do not produceenough of a needed chemical calledsurfactant.

Surfactant keeps the air sacs of the lungsopen during expiration (breathing out). If theair sacs are not open, exchange of oxygen(O

2) and carbon dioxide (CO

2) are decreased,

and it becomes hard for your baby to breathe.Consequently, she begins to “grunt,” a soundresulting from her efforts to keep the air sacsopen. She also begins to breathe faster,because many air sacs have already col-lapsed, so the remaining open air sacs have totake over the extra work. This rapid breathingis called tachypnea (tak-ip´-ne-ah).

Because of the lack of surfactant, the lungsare “stiff” (difficult to expand). When therespiratory muscles, such as the diaphragm,contract as the baby breathes in (inspiration),they produce negative pressure inside thechest cavity. This helps expand the lungs andpulls in the flexible chest wall, causingindentations to appear in the baby’s chest(retractions).

Despite your baby’s efforts to meet herbody’s demands for more O

2 and to eliminate

CO2 through tachypnea and grunting, she will

need help. She may require additional oxy-gen, which can be provided through a clearplastic “oxy hood” placed over her head, orby nasal prongs. If the RDS is more severe, aventilator – a machine used to assist orbreathe for the baby – may be required.

Babies who need extraoxygen often wear nasalprongs – slender, flexibletubes in the nostrils thatare connected to anoxygen tank.



Some babies require extra oxygen or ventila-tor support while their lungs heal and producesurfactant. The physicians and NICU staff willmonitor your infant’s progress and providesupport as long as necessary.

SepsisThe term “sepsis” means infection. Allnewborn infants, especially those who arepremature, are susceptible to infection be-cause their immune systems, which provide anatural defense against infection, are notmature at birth. As a result, an infection canenter the body and spread.

An infant can be infected in the uterus, duringdelivery, or in the nursery. In the nursery,infection is usually spread by skin contact.The NICU visiting procedures, such asscrubbing and gowning, are essential todecreasing the risk of infection.

Apnea, Bradycardia, Cyanosis (ABC)While still inside the womb, a baby receivesall his oxygen through the umbilical cord. Atbirth, he has to start breathing for himself.Because his brain is still maturing, he some-times “forgets” to breathe. If this period of notbreathing is 15 seconds or longer, it is calledapnea (ap´-nee-ah) and the baby is describedas apneic.

When a baby is apneic, his heart often beginsto slow down. This slow heartbeat is calledbradycardia if the baby’s heart rate dropsbelow l00 beats per minute for 15 seconds ormore.

Sometimes the baby’s skin takes on a bluishtinge, especially around the eyes and mouth.This is referred to as cyanosis.


Because premature infants tend to have theseapneic and cyanotic episodes, all babiesadmitted to the NICU are monitored forbreathing and heart rate. The baby’s monitoralarm will sound if the apnea lasts 30 secondsor more or his heart rate drops below l00beats per minute. A nurse will always come tothe baby immediately and stimulate him tobreathe. This returns his heart rate to normal.There is a sheet posted at your baby’s bedsidewhere all episodes of apnea (A), bradycardia(B), and cyanosis (C) are recorded. Each timean episode occurs, a nurse checks A, B, and/orC on the chart. The nurse also writes downthe time, the lowest heart rate, and how muchstimulation was required to get the babybreathing again.

A “spontaneous” apnea or bradycardia meansyour baby began breathing or increased hisheart rate on his own. “Mild” means heneeded gentle stroking, his nose or mouthsuctioned, or a position change. “Moderate”means the baby required a more vigorousstimulation. “Severe” refers to the nursegiving him breaths and breathing for him withan oxygen bag and oxygen. Ask your baby’snurse to show you the ABC sheet and anoxygen bag the next time you visit.

As your baby’s brain matures, he outgrowsthe apnea. He’ll have fewer episodes the olderhe gets, until one day he won’t be at risk foreven a spontaneous episode of apnea, brady-cardia, or cyanosis.

If you have any questions about apnea,bradycardia, or cyanosis, ask your baby’snurse or doctor.

Many babies need the fullrange of sophisticatedtechnology in the NICU,but their parents’ loveand support is also veryimportant.



Leaving the NICU

It’s an exciting day for your family – and forthe NICU staff – when your baby leaves. Somebabies are transferred to a hospital nursery inyour community. Other babies go home. Thereis no strict rule about how much your babymust weigh before she can be discharged.

When your baby is ready to go home, she willno longer require any special care. For thebaby, this means feeding well, gaining weight,maintaining body temperature in a crib, andbeing free of breathing problems.

As your baby approaches this big transition,we’ll help you learn how to care for her soyou’ll feel comfortable about taking her home.

Medical Care After DischargeIf you already have a pediatrician to care foryour baby once she leaves the NICU, pleaseinform our staff. We’ll provide your doctorwith progress updates while your baby is inthe NICU and send a summary of the hospitalcourse after discharge.

Your baby will need regular checkups by yourpediatrician after leaving the NICU. If you needa physician, we’ll be glad to help you find one.

High-Risk Infant Follow-Up ClinicThe services of this special clinic at UW’sCenter on Human Development and Disability(CHDD) are available for any infant whosedevelopment may be influenced by prematurebirth or other risk factors.

Infants are seen at the corrected age (seeGlossary) of 4 months and then yearly untilschool age, unless additional visits are needed.

By the time your baby isready to leave the NICU,you’ll feel comfortableabout taking over all hiscare.


The High-Risk Infant Follow-Up Clinic staffincludes pediatricians specializing in childdevelopment, physical and occupationaltherapists, audiologists (hearing specialists),psychologists, and a nutritionist.

Before your baby leaves the NICU, you’ll geta letter explaining this clinic in more detail.The High-Risk Infant Follow-Up Clinicphone number is 206-685-1255.

Training in Infant CPR and First Aidfor ChokingCardiopulmonary resuscitation (CPR)techniques have saved 80,000 to 105,000lives each year since the early 1960s. Thesetechniques improve every year throughresearch and the efforts of the AmericanHeart Association and the American Red Cross.

Countless people know the basics of CPR;others are certified as basic life rescuers orteachers. Through public awareness and educ-ation, CPR is becoming universally known.

You have the opportunity to learn infant CPRand first aid for choking in infants. Prematurebabies do not have a greater need for CPRthan full-term infants; the NICU staff teachinfant CPR solely to stress the need to protectand preserve all childrens’ lives.

CPR instruction is offered. The instructiondoes not officially certify you, but it does giveyou the basic techniques. If you’d like tolearn, please ask your baby’s nurse to set atime for instruction. If you wish to becomecertified in adult and infant CPR, contact theAmerican Heart Association or the AmericanRed Cross.

Taking baby home is anexciting day for the wholefamily.



Glossary of NICU Terms

ABCApnea, bradycardia, and cyanosis (seeseparate entries).

ABG (arterial blood gas)A sample of the blood from an artery that ischecked for acid/base balance, oxygen, andcarbon dioxide levels.

ApneaA pause in breathing, often due to an imma-ture breathing system. Apnea is common inprematures, and generally begins during thefirst week of life. When this occurs, thebaby’s monitor sounds an alarm so the nursecan remind him to breathe.

BaggingExtra breaths of oxygen given to the babyby placing a mask attached to an inflatablerubber bag over his nose and mouth. Thismay also be done through an ET tube if thebaby is on a ventilator.

Bili lights (phototherapy)A bright light placed over the baby’s incuba-tor, used to treat jaundice. When under bililights, the baby’s eyes are protected with softcotton patches (“bili mask”).

Bilirubin (“bili”)A normal byproduct of the breakdown of redblood cells. If bilirubin accumulates in theblood and skin, the skin takes on a yellowishtinge (see Jaundice). “Bili” also refers to theblood test done to determine the level of thissubstance.

Page 17University of Washington Medical Center’s Neonatal Intensive Care Unit


Bagging

Bili mask (see Bili lights)


BPD (bronchopulmonary dysplasia)This is a form of chronic lung disease ofvarying severity in infants, thought to becaused by the mechanical ventilation andoxygen therapy needed by some newborns. Itis primarily a problem related to the severeimmaturity of the lungs. The healing of lungsaffected by BPD is slowed if the infant hasrequired mechanical ventilation or oxygen formore than a few days. The repair of the lungtissue can take time, and it is common forinfants to require supplemental oxygen duringthis period of healing.

Bradycardia (“brady”)A temporary slowing of the heart rate, oftenoccurring in association with apnea. As withapnea, the baby’s monitor will sound analarm, and the nurse will gently stimulate himto increase his heart rate.

CBG (capillary blood gas)A sample of the baby’s blood, taken from theheel, to be checked for acid/base balance,oxygen, and carbon dioxide levels.

Chest tubeA small plastic tube inserted through the skininto the space between the baby’s lung andchest wall, used to remove excessive air and/or fluid. A chest tube is placed in response toan air leak from the lungs (pneumothorax),and frequently remains in place for severaldays.

Corrected ageA baby’s age figured from his or her due date,rather than birth date. For example, if a babywas born 3 months early and is now 7 monthsold, his corrected age is 4 months.

Page 18University of Washington Medical Center’s Neonatal Intensive Care UnitParent’s Guide to the Neonatal Intensive Care Unit



CPAP (continuous positive airway pressure)A method of providing oxygen and keepingthe baby’s lungs expanded by applyingpressure to the airway via a tube leading fromthe baby’s mouth or nose into her lungs.

CultureA laboratory test used to determine whetherthe baby has an infection. Samples of thebaby’s blood, urine, and sometimes spinalfluid are sent to the lab and watched forseveral days to see if any bacteria grow. Ifbacteria grow, the baby is said to have apositive culture. If no bacteria grow, theculture is negative.

CyanosisA bluish color temporarily seen in the skin,due to inadequate oxygenation of the blood.Cyanosis is often seen with apnea and brady-cardia, and is sometimes due to poor circula-tion.

ET tube (endotracheal tube)A small, flexible tube placed into the wind-pipe through either the nose or the mouth andconnected to a ventilator to assist the babywith breathing. The ET tube is periodicallysuctioned to remove mucus from the baby’slungs.

GavageA method of feeding used for babies who arenot yet strong enough to feed from bottle orbreast. A soft plastic tube is placed throughthe mouth or nose into the stomach; fluidspoured into the tube flow into the stomachby gravity.

Gavage

ET tube




Hematocrit (“crit”)A measurement that estimates the numberof red blood cells in the baby’s blood. Thebaby’s hematocrit often changes daily andmay drop as a result of removing blood fortests. If necessary, the baby will be given asmall transfusion (see Transfusion) to replacethis blood.

IncubatorAn enclosed infant bed with clear wallsthrough which the baby is carefullyobserved. The temperature inside the incuba-tor can be adjusted to meet the baby’s needs.Air is constantly circulated through a filter inthe incubator.

IV (intravenous)A slender tube placed in one of the baby’sveins through which fluids and medicines aregiven. IVs are frequently placed in the hand,foot, or scalp veins.

JaundiceA condition in which bilirubin accumulates inblood and skin, giving a yellowish appear-ance to the skin (see Bilirubin). This is acommon condition in newborn infants.

MonitorEquipment used to record pulse (heart rate)and respirations. Several small sticky paperdiscs called leads pick up these signals.They are placed on the baby’s chest andconnected by wires to the monitor. (Nothingenters the baby’s skin.)

MurmurA soft “whoosh” sound heard when listeningto the heart with a stethoscope. This is verycommon in premies. (See also PDA.)


Monitor lead (see Monitor)



Nasal prongsA method of delivering oxygen throughslender, flexible tubing placed in the nostrils.

NIDCAP (Neonatal Individualized Develop-mental Care and Assessment Program)NIDCAP is a system used by the NICU stafffor closely observing an infant’s behavior todetermine how much activity, handling,noise, and light he or she can tolerate withouthaving a decreased oxygen level or becomingupset. Once this is known, caregiving can bedesigned to meet the baby’s individual needs.Observations at intervals show the baby’sincreasing ability to tolerate and interact withthe environment.

NPOThe baby is not receiving anything by mouthor gavage. An IV is started to provide nutri-ents and water.

OximetryContinuous, non-invasive monitoring of theoxygen saturation of the blood.

Oxy hoodA clear plastic hood or tent placed overthe baby’s head to deliver oxygen and/orhumid air.

OxygenBabies having difficulty breathing mayreceive up to 100% oxygen (room air is 21%oxygen). The amount of oxygen required isdetermined by the ABG (see ABG). A con-stant supply of oxygen is delivered throughan oxyhood or a ventilator (see Oxy hood,Ventilator).




Parenteral nutritionIV fluid containing vitamins, minerals, andsugar necessary for nutrition. Parenteralnutrition is started when the baby is unableto eat for a prolonged period.

PDA (patent ductus arteriosus)A heart murmur common in premature babies,caused by the connection between the pulmo-nary artery and the aorta not closing afterbirth or re-opening. The defect usuallycorrects itself as the baby matures.

Periodic breathingA pattern of breathing in which the baby maytake a few short breaths, a long breath, and ashort pause. This pause is much shorter thanthe pause seen in apnea.

RDS/HMD (respiratory distress syndrome/hyaline membrane disease)A condition affecting many premature babies,due to the lungs not being fully mature.Babies with RDS have difficulty exchangingoxygen and carbon dioxide, and frequentlyrequire extra oxygen and/or assisted ventila-tion.

Retinopathy of prematurity (ROP)An overgrowth of the blood vessels of theretina, the membrane lining the inside of theeye that receives the image produced by thelens. Most babies with ROP usually do notexperience vision damage, although a fewbabies may lose all or some of their vision inone or both eyes.

RetractionsIndentations seen in the baby’s chest wallwhen she is working hard to breathe.




Room airThe air around us, containing 21% oxygen.

ROP checkA special eye exam to detect retinopathy ofprematurity (see Retinopathy of prematurity),performed on infants weighing less than1500 grams (3 pounds, 5 ounces) at birthwho have received oxygen.

SepsisAn infection in the baby requiring treatmentwith antibiotics.

SGA (small for gestational age)An infant who is smaller in size and weighsless than average for an infant the same age.

SuctionRemoving mucus from the baby’s mouth,nose, or lungs through a soft flexible tube.Premature babies do not cough very well andneed help in removing this mucus.

Transcutaneous monitor (trans Q)A monitor used to estimate the amount ofoxygen or carbon dioxide in the baby’sblood. A round electrode is placed on theskin, warming it and thus bringing bloodcloser to the surface so that the oxygen orcarbon dioxide can be measured. The elec-trode is moved every 3 hours. A red mark istemporarily left on the skin; it will disappearin about 24 hours.

TransfusionA small amount of blood given to the babythrough an IV (see IV) to treat anemia (a lowhematocrit – see Hematocrit).

Transcutaneous monitor(foreground)




UltrasoundA diagnostic imaging procedure in whichpictures are taken of the baby’s internalorgans. Ultrasound uses high-frequencysound waves, rather than radiation, as isused in X-rays.

Umbilical artery line (IA or UAC)A slender tube placed in the umbilical arterythrough which solutions are infused andblood samples drawn.

VentilatorA machine used to assist or breathe for thebaby, delivering a certain number of breathsper minute, pressure to expand the lungs, anda concentration of oxygen. The settings forthe ventilator are determined by the physicianfrom the ABG (see ABG).

Vital signsVital signs include temperature, pulse,respiratory rate, and sometimes blood pres-sure. The baby’s vital signs are frequentlychecked by her nurse.

Umbilical artery line



Important People and Phone Numbers

NICU and Intermediate Nursery ........ 206-598-4606Lactation specialist ............................. 206-598-4628Social worker ...................................... 206-598-4629UW parking information .................... 206-685-1553Metro bus information ........................ 206-553-3000

Toll-free Calling

You can now place a toll-free call to the medicalcenter’s NICU by using our UW AutomatedAttendant. Just follow these four easy steps:

1. Select the number below that corresponds to thecity you live in and dial.

2. When the system answers, dial the NICU at206-598-4606.

3. Press the pound key (#).4. Wait until the call is connected. (If the call does

not connect on the first attempt, please try again.)

Aberdeen/Grayland/Westport ..............360-612-5500Bellingham/Everson ............................360-543-5500Black Diamond/Enumclaw..................360-615-5500Bermerton/Kitsap ................................360-525-5500Chehalis/Centralia ...............................360-557-5500Coupeville/Oak Harbor .......................360-544-5500East King County ................................425-519-5500Everett/Monroe/Marysville .................425-262-5500Hoodsport/Union .................................360-614-5500Mt. Vernon ...........................................360-542-5800Olympia ...............................................360-252-5500Port Angeles/Sequim/Gardner .............360-504-5500Port Townsend .....................................360-554-5500Seattle ..................................................206-685-5500Tacoma ................................................253-552-5500

If your city is not listed here, call 1-866-522-5589from your home and they will provide you with anumber to use. Or, go to www.washington.edu/admin/comtech/calluw.

Neonatal IntensiveCare UnitBox 356077

1959 N.E. Pacific St.Seattle, WA 98195

206-598-4606

© University of Washington Medical Center12/1997 Rev. 05/2005

Reprints: Health Online

Questions ?

Neonatal IntensiveCare Unit206-598-4606

Your questions areimportant. Call yourdoctor or health careprovider if you havequestions or concerns.The UWMC NICU staffare also available tohelp at any time.


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