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Neonatal Intensive Care Unit (NICU)

About the NICU

Women & Infants operates one of the nation’s largest single-family room Neonatal Intensive Care Units (NICU), where the latest technology and highly skilled specialists care for babies born prematurely or sick.

The NICU provides comprehensive care through the coordinated efforts of social workers, occupational therapists, nutritionists, respiratory therapists, neonatal nurses, neonatal nurse practitioners, neonatal-perinatal fellows, and attending neonatologists and pediatricians. Practitioners skilled in the care and stabilization of sick newborns are available in-house 24 hours a day. The single-family room model also encourages families to be actively involved in their baby’s care.

 

 

What to Expect

Having a new baby who requires the care of a newborn intensive care unit (NICU) can be overwhelming. The providers and staff in Women & Infants’ Carter Family NICU, as well as the March of Dimes NICU Family Support, welcome new families and offer information about what to expect in the NICU and what resources are available. This journey begins with all of us working together to take care of your baby.

 
Why Choose Us

Each room has a special couch that converts to a bed so parents can spend the night with their baby. On the two-story unit, there is also plenty of space dedicated to families for rest, eating lunch, or making phone calls with status updates. A beautiful family lounge stretches from the first floor to the second in the NICU, featuring a full kitchen, showers for parents, computers, a play area for older siblings, and a mesmerizing saltwater fish tank.

Families also find support in the unit’s full-time parent advocate, sponsored by a grant from the Rhode Island Parent Information Network, and a March of Dimes’ parent advocate.

The Women & Infants NICU is a special place. Nearly 25 percent of babies born here are to high-risk mothers, and 11 percent are premature. Our survival rates for very low birth weight infants are well above national averages.

Newborn Nurseries

The newborn nursery service is led by Dr. Adam Czynski. This service includes a team of pediatricians, pediatric and family practice residents, and medical students from The Warren Alpert Medical School of Brown University. This team of physicians works in concert with the mother-baby nurses, lactation consultants, and other sub-specialty consultants to meet the specific needs of the family and to ensure continuity of care.

Over the last year, the newborn nursery service has expanded to include community physicians with a specialized interest in the care of the newborns and the supervision of residents to provide pediatric attendings seven days a week. This caring environment is enhanced with the involvement of our dedicated community and voluntary medical staff who partner with us to provide individualized care to our families.

 

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NICU Parents Handbook

Who's Who in the NICU
  • Assistant nurse manager - Nurse who coordinates the daily functions of the NICU and SCN
  • Case manager - A registered nurse who organizes the plan of care for your baby’s discharge
  • Laboratory technician - Specialist trained in drawing and analyzing babies’ blood samples
  • Neonatal nurse - Nurse with special education in the care of sick and/or premature infants
  • Neonatal pharmacist - Expert in the use of medications to care for the needs of sick and/or premature infants
  • Neonatologist - Pediatrician with advanced training in the care of sick and/or premature infants
  • Neonatology fellow - Doctor doing a three-year sub-specialty training program in the care of sick or premature infants. He or she coordinates medical care for your baby in the NICU or SCN with the neonatologist
  • Nurse manager - Nurse administrator who directs the overall nursing care and operations of the NICU and SCN
  • Nurse practitioner – Nurse with a master’s degree and national certification. Nurse practitioners in the NICU have specialized training in the care of sick and/or premature infants.
  • Nutritionist – Registered dietitian specializing in the growth and nutritional needs of sick and/or premature infants
  • Occupational/physical therapist - Specialists who help babies with physical development and provide developmental assessments
  • Pediatric resident - Doctor taking specialized pediatric training. Our residents come through Brown Medical School.
  • Private pediatrician/family practitioner - Doctor who will care for your child after discharge from the hospital. If the doctor is on staff here, he or she will be notified that your baby has been admitted to the NICU. Once your baby is medically stable, the doctor may join the team in managing his or her care.
  • Radiology technician - Specialist trained in taking x-rays and/or ultrasounds
  • Respiratory therapist - Specialist trained in the use of ventilators, respiratory support, and oxygen therapy
  • Social worker - Professional who provides support and counseling to families
Visiting the NICU

We encourage you to visit your baby as soon and as often as you wish. We ask, however, that you follow the guidelines below:

  • We will only give the parents information about the baby.
  • We ask that visitors with colds or another communicable disease not visit the nursery.
  • We ask that visitors respect the privacy of other parents.
  • One of the banded parents must be in the room with any visitors.
  • We ask that no more than four people are in the room at any one time.

Your First Visit

You may be anxious about your first visit to the NICU, but it’s important to bond with your baby, despite his or her hospitalization. When you come to the nursery, stop at the reception desk and sign in. You may be asked to show identification or a hospital wristband. The secretary will hand you a scrub brush and then you may go to your baby's room. There are instructions on proper scrubbing in your baby's room or you may ask your nurse for help.

Sibling Visits

Siblings can visit any time. However, we request vaccination records, which include flu shots, for all children under age 13.

Pictures and Videotaping

You can take as many pictures of your baby as you wish. To protect the privacy of other families, please photograph your child only.

Neonatal Follow-Up Program

Once discharged from the hospital, babies from the neonatal intensive care unit (NICU) and SCN are directed to the Women & Infants Neonatal Follow-Up Program for supplemental care. The staff, which includes developmental pediatricians, neonatologists, a nurse practitioner, a psychologist, a psychometrist, and a nutritionist provide services for infants who were born weighing less than 1250 grams, discharged on oxygen or a monitor, or who had other special problems as a newborn.

Assessment

We will evaluate your baby’s physical condition, growth parameters, and tests of reflexes, vision, hearing, development, language, and motor assessment. We share these results with you and your private physician.

Management of Cardiorespiratory Monitors for Reflux or Apnea

We monitor:

  • Alarms
  • Complete physical and neurological exams
  • Help you understand “normal alarms” at home
  • Review medications
  • Monitor pulse oximetry
  • Observe feedings
  • Order tests to assess ongoing events or alarms at home
  • review memory monitor downloads

Management of Bronchopulmonary Dysplasia

We monitor;

  • Respiratory status
  • Complete physical and neurological exams
  • Monitor medications
  • Monitor oxygenation and pulse oximetry
  • Monitor growth
  • Conduct nutrition assessments

Management of Reflux

We review the baby’s history of;

  • Reflux and alarms
  • Conduct physical and neurological exams
  • Review downloads and order any necessary pneumograms
  • Monitor growth
  • Conduct nutrition assessments

Management of Slow Growth

We conduct;

  • Nutrition assessments
  • Assess growth velocity and weight-length ratio
  • Monitor the baby’s growth between visits
  • Observe a feeding
In addition to your visits with the Neonatal Follow-Up Clinic, it is important to maintain regular appointments with your baby's doctor, as well-baby care and immunizations are not part of the program.

For additional information read our latest issue of Neonatal Follow-Up Clinic News.

The Neonatal Follow-Up Clinic is handicap-accessible and is located at:
134 Thurbers Ave., Providence, RI
Phone (401) 453-7750, during clinic hours (401) 274-1122, extension 1227, during off-hours
Our hours of operation are:
Tuesdays 9 a.m. to 12 p.m.
Wednesdays 9 a.m. to 4:30 p.m.
Third Thursday of each month 9 a.m. to 12 p.m.

Going Home

Before you take your baby home, we will help you:

  • Register with a pediatrician or clinic for well-baby care and follow-up. Search for a pediatrician.
  • Sign a circumcision consent form, available from the secretary, if you wish to have your son circumcised.
  • Actively participate in your baby’s care and demonstrate the skills necessary to meet his or her needs.
  • Register with the secretary for discharge and CPR classes.

If your baby was born at less than 35 weeks, we will also monitor him or her in the car seat before discharge.

Homecoming Day

Bring clothes, a blanket, and the car seat on the day of discharge. Discharge is between 1:15 and 2 p.m.

Adjusting to Home

Taking your baby home is a very exciting time, but we know you may have questions. We provide telephone support during the first few days at home.

In addition, Women & Infants offers the following services:

  • A nurse is available between 9 a.m. and 5 p.m., at (401) 785-615
  • The Warm Line - a telephone service for new parents. Registered nurses respond to all calls, Monday to Friday from 9 a.m. to 9 p.m., and Saturday and Sunday from 9 a.m. to 5 p.m. This number is 1-800-711-7011. Please call your pediatrician if you are concerned that your baby may require medical attention.
Feeding Your Baby

Many infants in the NICU or SCN may have difficulty sucking, swallowing, and breathing, which might make nipple feeding impossible. These babies must be fed initially through a special tube. After your baby gets stronger and grows, he or she will be fed by mouth. By the time of discharge, your baby will be taking all food by either breast or bottle.

NICU Formula Mixing Recipe Book

FAQs

Visiting my baby is difficult because I live far away. What can I do?

Your social worker may be able to help. Once your baby’s condition is stable, he or she may be able to transfer to a SCN closer to home.

I don’t have insurance. How is the NICU covered?

Contact one of our financial counselors at (401) 274-1122, ext. 41419, or speak with your social worker. We routinely help families apply for such programs as WIC or medical assistance.

How can I participate in my baby’s care?

Let us know when you are coming to visit so we can coordinate the care of your baby to involve you. Discuss this with your baby’s nurse and let your needs be known.

Can we bring gifts into the nursery?

Small toys or stuffed animals, family photos, socks, and clothing are all great ideas. Do not bring anything of great value, plants, or balloons.

What if my baby needs blood?

Infants who need a transfusion receive blood products that are rigorously screened by the Rhode Island Blood Center and distributed through Women & Infants’ Blood Bank. You can discuss participating in our Direct Donor program with your baby’s physician

Classes

Our Health Education Department offers a wide range of programs for new parents, including:

  • CPR for Family and Friends.
  • Caring For You and Your Infant.
  • Intro to Breastfeeding Classes.

For more information, please contact the Health Education Department at extension 6-7030 or direct dial at (401) 276-7800, or view our classes. Women & Infants Warm Line (1-800-711-7011) is available to answer any questions parents may have concerning newborn care and breastfeeding.

Breast Feeding

Breastfeeding Tips

We encourage any mother who wishes to breastfeed to do so.

If your baby is too sick or small to nurse, you can pump your breasts as soon as possible after delivery to assure a good milk supply. Your nurse can provide a pump kit and help you begin. Electric pumps are also available in the family rooms, just attach your kit to it. Sterile containers are available in the nursery. Ask your baby’s nurse for a supply. Mark each container with the date and time the breast milk was expressed.

Freeze all breast milk until your baby begins to eat. Do not allow the milk to thaw en route to the hospital because thawed breast milk can only be used for 24 hours. Frozen breast milk lasts up to six months. Fresh milk is good for 48 hours when refrigerated and one hour at room temperature.

Our weekly Mothers Milk Club – which meets Wednesdays at 3 p.m. - offers you a chance to learn from a certified lactation consultant and share experiences with other mothers.

Primary Nursing

We may assign a primary nurse to your baby if he or she is expected to be in the NICU for a while. This nurse will care for your baby as often as possible and will be familiar with you and your baby, which provides important continuity for the baby. The primary nurse can help you keep in touch with the medical team.

Some babies may have more than one primary nurse, on alternating schedules or shifts, or none at all. Please do not be concerned. All of our nurses are skilled in neonatal nursing, and your baby will receive the same level of expert care.

Research
A Brown Medical School teaching hospital, Women & Infants is involved in a variety of important research programs, all of which are reviewed by an internal committee that considers the rights and safety of participants. You may be asked to join a research activity and you have the right to refuse permission for yourself or your baby. If you decide not to participate, your baby’s care will not be affected in any way.
Glossary of Medical Terms
Abdominal distension

Fullness or swelling of the abdomen (stomach), causing it to look bigger than normal.

Abdominal girth

Measurement of the abdomen (stomach) just above the umbilicus (belly button).

Ambu bag

Ambag is attached to a mask or endotracheal tube and is used to give oxygen to the baby.

Angiocath (angio)

 A small, plastic tube is used to give intravenous fluids; commonly called an IV.

Antibiotics

Medications are used to fight infection.

Bilirubin

A yellow pigment can be seen in the skin of most newborn infants.

Catheters

Plastic tubing is inserted into the body, including those catheters used for feeding, suctioning, delivering IV fluids, and removing urine for specimens.

Cc

Cubic centimeter; a metric measurement used to measure fluid; one cc is the same as one ml (milliliter); 5 cc = 1 teaspoon, 15 cc = 1/2 ounce, 30 cc = 1 ounce, 60 cc = 2 ounces.

Chest physiotherapy (CPT)

Tapping or vibrating the chest to loosen mucus from the lungs before suctioning.

Chest tube

 A tube placed in the chest, just outside of the lungs, creates a negative pressure (like a vacuum) to keep the lungs open.

Circumcision

Removal of the penis foreskin.

Corrected age

Age of baby in weeks after conception.

Dextrostick (D-stick, glucose screen)

Measurement of blood glucose (sugar) level.

Electrolytes (lytes)

Sodium (salt), potassium, and chloride, essential body elements that may be checked in the blood or urine or may be added to the IV fluid.

Endotracheal tube (ET tube)

A tube in the trachea (windpipe) to help breathing.

Extubation

Removal of the tube from the trachea (windpipe).

Gavage feeding

Giving formula or breast milk through a gavage tube.

Gavage tube

 A small, plastic tube placed from the nose to stomach (called a nasogastric or NG tube) or from the mouth to stomach (called an orogastric or OG tube) through which the baby receives formula, breast milk or medications; also may be used to allow air to escape when baby is on NCPAP.

Gestational age

Age of the baby from the time of conception to birth (full-term = 40 weeks).

Gram

Metric measurement of weight (454 grams = 1 pound).

Grunting

Deep, short noises are heard when a baby is having trouble breathing.

Heat probe

A small, silver or gold probe, usually placed on the stomach or back, to monitor body temperature and regulate the warming table or incubator temperature.

Heatshield

A small, plastic shield placed over any baby less than 1500 grams creates additional protection against drafts.

Hematocrit (crit)

Concentration of red blood cells in the blood; red blood cells carry oxygen throughout the body.

Heplock

Insertion of a small amount of heparin (a medication that keeps the blood from clotting) into an IV so it can be clamped off temporarily and used again at a later time for medications.

HOB

Head of the infant’s bed.

Hood (oxyhood)

A small, Plexiglas hood is placed over the infant’s head through which oxygen is given.

Humidified mist

Warm mist is placed over the premature baby within the first days to help prevent water loss and keep his/her skin from drying and cracking.

Hyperal solution (HAL)

IV solution containing sugars, proteins, and essential vitamins and minerals.

Infiltrate

Temporary bruising, redness, or swelling around an IV site caused by leakage of IV fluid out of a vein and under the skin.

Intake and output (I & O)

Record of all fluid an infant receives (both IV and by mouth), as well as the amount of urine the infant makes.

Intralipid

IV fat preparation is given for nourishment and growth.

Intravenous (IV)

Fluid is given directly into a vein.

Intubate

Placing a tube in the trachea (windpipe) so the baby’s breathing can be assisted by a ventilator.

Isolette

An enclosed bed that is heated to keep the infant warm.

IV pump

 A machine that controls the rate and amount of IV fluid given.

Jaundice

Yellow coloring of the skin or eyes is caused by a build-up of bilirubin in the bloodstream.

KUB

An x-ray of the infant’s abdomen (stomach and intestines).

Lanugo

Fine, downy hair (the amount of which can vary) is seen mostly on premature infants; though it usually covers the entire body, it is most noticeable on the baby’s shoulders and back.

Leads (electrodes)

Three probes are attached to the infant; white is placed on the right, black is placed on the left, and green is placed on the leg with the cables leading to a monitor to obtain a recording of the infant’s heart and respiratory rates.

Lumbar puncture (LP)

Removal of a small amount of spinal fluid to check for the presence of blood or infection.

Meconium

Baby’s first bowel movements, usually dark green and of a pasty consistency.

Meconium aspiration

Condition when the baby inhales meconium during or before his/her birth and which may cause pneumonia.

Milia

Small white or yellow, “pimple-like” bumps on the infant’s skin, usually on the nose or chin, which will go away without treatment as the baby gets older.

Mongolian spots

Bluish spots over the lower back or buttocks that may be present at birth, usually found on dark-skinned infants.

Nasal cannula

Small, clear prongs are inserted into the nose to give oxygen.

Nasal flaring

An indication of trouble breathing; the nostrils open widely with breaths.

NCPAP (nasal CPAP)

Continuous positive airway pressure; nasal prongs (short or long) provide a small amount of air, oxygen, and pressure into the lungs to help the baby breathe on his/her own by keeping the lungs from collapsing.

Necrotizing enterocolitis (NEC)

Infection of the intestines is caused by bacteria and/or decreased blood flow to the intestine.

NPO

Nothing by mouth.

Oxygen

Gas, essential for life which is carried by the blood from the lungs to the tissues; concentrated oxygen may be given through an Ambu bag, ventilator, hood, nasal CPAP, or prongs.

Patent ductus arteriosus (PDA, duct, open duct)

Blood vessel opening near the heart which did not close after birth.

Phototherapy

Fluorescent lights are placed over the infant to treat jaundice.

Plastic wrap

Sometimes placed over the warmer; used to help keep the baby warm.

Pneumothorax

Air leaks from the lungs to the space between the lung and ribcage.

PO

By mouth.

Premature infant

An infant born before 37 weeks gestation.

Pulse oximeter

A probe with a red light is used to detect how much oxygen is in the blood.

Retractions

Sign of difficulty breathing, noted by inward pulling (retracting) of the chest muscles, causing an indentation of the middle of the chest and between the ribs.

Room air

The air around us contains 21 percent oxygen.

Rounds

Times each day when the medical, nursing, and social work staff discuss each baby’s progress and make decisions regarding his/her care.

SaO2 (sats)

The measure of oxygen in the blood; in most cases, a reading on a pulse oximeter of 82 or higher can be expected.

Seizure

Abnormal, increased electrical impulses in the brain which may cause jerking movements, rolling back of the eyes, sucking motions, and stiffening of the arms and legs.

Septic workup

Group of tests used to determine if an infection exists; consists primarily of a lumbar puncture, blood counts, blood culture, and urine culture.

Suctioning

Removal of the mucus in the trachea (windpipe), nose, mouth, or stomach with a catheter.

Surfactant

Medication that helps the lungs expand (open) more easily.

Tachycardia

Heart rate more than 170 beats per minute while resting.

Tachypnea

Sign of respiratory difficulty noted by a rapid rate of breathing, usually more than 60 to 70 breaths per minute.

Transcutaneous monitor (TCM, combi unit)

Measures oxygen and carbon dioxide in the blood instantly and continuously by the use of a skin probe.

Umbilicus

Belly button.

Umbilical catheter

Very thin, plastic tube placed in a blood vessel in the umbilicus to give fluids, obtain blood samples and monitor blood pressure.

Umbilical arterial catheter (UAC)

Thin, plastic tubing placed in an artery of the umbilicus; used to give fluids, obtain blood samples and monitor blood pressure.

Umbilical venous catheter (UVC)

Thin, plastic tubing is inserted into the vein in the umbilicus to give fluid and monitor pressure.

Vein

Blood vessel that carries unoxygenated blood to the heart.

Ventilator (respirator)

Machine used to breathe or assist breathing.

Vital signs (vitals)

Pulse (heart rate), respirations (breathing rate), temperature, and blood pressure.

Warmer (radiant warmer)

Open bed that uses radiant heat to keep the infant warm; warmer temperature is automatically regulated by a heat probe placed on the infant.

X-rays

Pictures of the inside of the body used to assist in diagnosis.

NICU Discharge Instructions

Congratulations

We have enjoyed caring for your baby and are pleased he or she can finally go home. Please view our newborn care section for helpful information that you can use once you and your baby are home.

Remember, you can also call the Warm Line nurses at 1-800-711-7011. This free service answers questions about postpartum recovery, breastfeeding, newborn care, and other women's health issues. Call weekdays, 9 a.m. - 9 p.m., or 9 a.m. - 5 p.m. on weekends. Leave a message and a nurse will return your call within an hour.

Going Home Checklist

Discharge time is scheduled from 1 to 2 p.m., please be prepared to leave with your baby during this time. We understand that there may be circumstances that do not allow you to leave during that time. If so, please contact the nurse manager or assistant nurse manager through the secretary on your floor to discuss options.

  • Find a pediatrician and schedule the baby's first appointment
  • If your baby was born less than 35 weeks, bring in the car seat so we can observe him/her in it
  • Take a CPR class (see secretaries for times)
  • Take a discharge class (see secretaries for times)
  • Sign the Hepatitis B vaccine consent
  • Sign the circumcision consent, if desired
  • Sign the RSV immunization consent if discharged between October and April
  • Complete the hearing screen
  • Set up an appointment for Neonatal Follow-Up Program, if needed
  • Bring discharge outfit