Bronson Children s Hospital Neonatal Intensive Care Unit · 2020-04-20 · Introduction bronsonhealth.com 4 Introduction Welcome to the Neonatal Intensive Care Unit (NICU) at Bronson

Bronson Children’s Hospital

Neonatal Intensive Care Unit

Learning, Loving, Growing Together A workbook to use during your baby’s stay in the NICU

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Frequently Asked Questions

When will my baby be discharged?

Every baby is unique. We cannot tell you exactly when your baby will be able to

come home. You can find a list of what your baby needs to be doing for

discharge on page 11.

When will my baby begin feedings?

Depending on your baby’s condition, the doctors will decide when feedings can

begin. It may take some time for your baby to eat by mouth. Many babies get their

first feedings through a tube that takes the milk to their stomach.

When can I hold my baby?

Holding your baby will depend on your baby’s condition.

We want you to hold your baby as soon as it is safe for him or her. Before that time, you

may be unable to hold your baby. Turn to page 32 to learn about hand hugging and

non-stressful touch.

Can I breastfeed my baby?

If you were planning to breastfeed, you may still do so.

Let us know right away so we can help you get started. Please see Breastfeeding in the

NICU on page 25.

How do I contact my baby’s nurse?

(269) 341-6475

(800) 757-6428

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Table of Contents

Frequently Asked Questions ......................................................................................................................... 1

When will my baby be discharged? ......................................................................................................................... 1

When will my baby begin feedings? ....................................................................................................................... 1

When can I hold my baby? ..................................................................................................................................... 1

Can I breastfeed my baby? ...................................................................................................................................... 1

How do I contact my baby’s nurse? .......................................................................................................................... 1

Introduction ............................................................................................................................................. 4

Welcome to the Neonatal Intensive

Care Unit (NICU) at Bronson

Children’s Hospital. ........................................................................................................................................... 4

Learning, Loving and Growing

Book for Parents .................................................................................................................................................. 5

It’s Not Easy Being a NICU Family .......................................................................................................................... 6

Connecting to Other Parents ......................................................................................................................... 7

Special Accommodations for Families .................................................................................................................... 9

Discharge Goals ................................................................................................................................................. 10

Moving from the NICU ............................................................................................................................... 12

Spending Time with Your Baby ............................................................................................................ 13

Seeing Your Baby for the First Time ...................................................................................................................... 14

Parenting in the NICU ......................................................................................................................................... 15

Designated Visitors............................................................................................................................................. 15

Sibling Visits ...................................................................................................................................................... 16

Condition Reports ............................................................................................................................................... 17

Telephone Calls .................................................................................................................................................. 18 NICU local number: (269)

341-6475 .................................................................................................................................................................. 18 Long Distance: (800) 757-6428

(toll-free) .................................................................................................................................................................. 18

Controlled Access Helps Keep the NICU

Safe .................................................................................................................................................................... 19

Safeguarding Against Infections ...................................................................................................................... 19

Equipment and Procedures ................................................................................................................................... 20

Breastfeeding ................................................................................................................................................... 22

Bronson Mother’s Milk Bank ............................................................................................................................... 25

Feeding Your Premature Baby .............................................................................................................................. 27

Common Questions about Feeding ....................................................................................................................... 28

Hand Hugging and Non-Stressful

Touch ................................................................................................................................................................ 29

Kangaroo Care .................................................................................................................................................... 30

Cycled Lighting .................................................................................................................................................. 32

Effects of Noise ................................................................................................................................................... 32

Fragrance Free .................................................................................................................................................... 32

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Your Baby’s Care ........................................................................................................................................ 33

Getting Involved in Your Baby’s

Care .................................................................................................................................................................. 34

Daily Care ........................................................................................................................................................ 34

Bathing Baby .................................................................................................................................................... 36

Bulb Syringe .................................................................................................................................................... 38

Swaddling ......................................................................................................................................................... 39

Positioning ....................................................................................................................................................... 39

Holding ............................................................................................................................................................. 39

Chronological Age vs. Corrected

Age ................................................................................................................................................................... 40

Challenges of Prematurity ................................................................................................................................ 41

Sepsis ............................................................................................................................................................... 43

Jaundice (Hyperbilirubinemia) ......................................................................................................................... 44

Retinopathy of Prematurity (ROP) ................................................................................................................... 44

Your Baby’s Safety ................................................................................................................................. 45

Safe Sleep for Your Baby ................................................................................................................................ 46

Smoking Around Your Baby ........................................................................................................................... 48

Shaken Baby Syndrome ................................................................................................................................... 49

Respiratory Syncytial Virus (RSV) .................................................................................................................. 51

Home Safety ..................................................................................................................................................... 52

Fire Safety ........................................................................................................................................................ 53

Baby Walkers and Child Safety ....................................................................................................................... 53

Car Seat Safety ................................................................................................................................................. 54

Things to Know Before You Go ............................................................................................................. 55

Welcome Home Baby ...................................................................................................................................... 56

Hepatitis B and Other Vaccines ....................................................................................................................... 57

At Home with Baby ......................................................................................................................................... 59

Taking Baby Out .............................................................................................................................................. 60

Promoting Development and Parent

Bonding ............................................................................................................................................................ 61

Things You Can Do to Help Your

Baby’s Development ........................................................................................................................................ 61

Home Environment .......................................................................................................................................... 62

Swaddling Baby at Home................................................................................................................................. 62

Safe Feeding ..................................................................................................................................................... 63

Enriched Formula ............................................................................................................................................. 64

Signs of Illness ................................................................................................................................................. 65

Vaccines ........................................................................................................................................................... 66

Circumcision Care ............................................................................................................................................ 66

Bronson NICU Graduates ................................................................................................................................ 67

.......................................................................................................................................................................... 67

Giving Back to Bronson ................................................................................................................................. 67

NICU Glossary ................................................................................................................................................. 68

Introduction

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Introduction

Welcome to the Neonatal Intensive Care Unit (NICU) at Bronson Children’s Hospital.

We know that we can do great things together as we…

Learn together how to best care for your special baby.

Love these precious babies. They are a gift and teach us so much.

Grow in our knowledge and expertise by helping one another.

Your Learning, Loving, Growing book is meant to help make the Bronson

NICU more familiar to you. We know you are worried. You wonder what to

expect and how you can help. This book will answer some of your questions.

We hope it will help you feel more comfortable as we work together while

your baby grows.

Every patient at Bronson is part of a unique family. We respect the importance

of your family. We encourage your involvement in the care of your baby. We

believe in partnering with you and your family to give the best care to each

baby.

Introduction

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Learning, Loving and Growing Book for Parents

This book will help you learn how to care for your baby from when you arrive

to the time your baby comes home. Growing themes will help you identify

important information. Look for these photo icons throughout the book.

Important emotional support that others have

shared as they have taken this journey

Important information that you will need to know

Information from our specialists

Topics that benefit baby and family health

What you need to know before you go

Introduction

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It’s Not Easy Being a NICU Family

Some parents say that having a baby in the NICU feels like a roller coaster ride.

When the news is good and baby is doing better your spirits begin to rise. When

something wonderful happens, you are on top of the world. Then, there may be

setbacks. Your baby may develop a new problem and your spirits drop. This is

frightening and you may find it hard to cope.

Most babies go through ups and downs in the NICU. While most recover from the

bad times and slowly grow and get strong, this time can be very hard on families. You

may have strong feelings of helplessness, frustration and anger. Watching your loved

baby struggle is painful.

You wonder if you can make it through such a stressful time. Talking with your

baby’s nurse and sharing your concerns may be helpful.

Here are some suggestions that have helped other parents.

Talking with other parents who have had babies in the NICU helps you know your

feelings are normal. It can give you hope things will get better. They may have

pictures that show how their baby has grown. The social worker, case manager or

parent liaison can help you find these parents.

Take good care of yourself. It takes a lot of energy to cope with your worries for

your baby. The trips to the hospital, nights when you can’t sleep well and keeping

yourself healthy all take energy. Drink plenty of fluids and try to eat a healthy diet.

Get rest when you can.

You may have concerns or questions about your baby’s care. Ask your baby’s

caregivers to help you understand what is happening to your baby. If anything

doesn’t make sense to you, please let us know.

Families who find prayer or spiritual reflection helpful may ask others to pray for

their baby. We have a chaplain available. Please ask your nurse if you are

interested.

You are welcome to bring pictures of your family for the baby’s crib or incubator.

Stuffed animals and baby toys may be kept in the room. You are also welcome to

bring clothes or blankets for your baby. Please wash and dry them first.

Introduction

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Connecting to Other Parents Children’s Special Health Care Services – Family Center

This is a community organization for families of children with special needs that

provides information and connects families to resources. Parent mentors are available

to share their experience and provide emotional support. The Family Phone Line is

800-359-3722.

Bronson Children’s Hospital Parent Liaison

The Parent Liaison is a former Bronson NICU parent who provides support,

information, and resources to families. She rounds frequently in the NICU. The

Parent Liaison hosts group dinners monthly. All current NICU families are invited.

A quarterly newsletter called “Footprints” for parents is also available.

Scrapbooking

The NICU offers a weekly scrapbooking session called Precious Pages. All family

members are welcome while your baby is at Bronson.

Many families find it helpful to have a way to record the beginning of your baby’s

life. You will meet other families who are going through similar experiences.

Sign-up sheets are at the front desk. Look for the Precious Pages clipboard. On the

sign-up sheet, tell us if you would like pictures taken of your baby. They will be

ready for you at the scrapbooking class.

The books and supplies are funded by a grant from the Bronson Health Foundation.

There is no cost for you.

Introduction

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NICVIEW™ NICVIEW™ is a camera system that lets you see your baby through a computer,

phone or tablet. After signing a consent form, you will get a user name and

password to log in to the system.

CaringBridge®

Create your own family web site to keep friends and out-of-town family up to date

on your baby’s progress.

www.CaringBridge.org

March of Dimes

The March of Dimes is a national non-profit organization. Their site provides up-to-

date information about pregnancy, baby care and research about high-risk babies.

They also have resources for parent support.

www.marchofdimes.org

NICU Parent Library

We have a library of materials to loan to parents and siblings. Topics include

breastfeeding, parenting multiples, sibling adjustment and the emotional journey of

NICU parenting. There are also books that you can borrow to read to your baby.

Computers with internet access are available on the 4th floor near the elevator and the

ground floor near the family kitchen.

The computers in your baby’s room are for Bronson employees only.

http://www.caringbridge.org/

http://www.marchofdimes.com/

Introduction

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Special Accommodations for Families

Parent Rooms

Two parent rooms are available on the ground floor for short-term stays. Priority is

given to parents of critically ill babies. For more information, talk to the social

worker, case manager or charge nurse.

Hospitality House — Overnight Options

Our most comfortable overnight option for family members of patients is the

Hospitality House. It is located close to Bronson and provides lodging for out-of-town

families of our patients. It is also open to visitors who are not overnight guests, but

who wish to use its shower or kitchen. Ask your nurse or the social worker for

more information. There is no charge to stay at the Hospitality House. Donations are

welcome.

Family Kitchen/Laundry

A mini kitchen is available on the ground floor with a refrigerator, microwave, washer

and dryer. NICU staff can show you where this area is located.

Pre-Discharge Family Overnight Room

The NICU has 3 overnight rooms for families nearing discharge. This pre-discharge

opportunity can ease the transition from hospital to home.

It can be hard to talk to other parents. You want to respect their privacy and allow

them time to spend with their babies. You may also want to reach out to them. Our

private rooms can make it difficult to meet other parents. Some good opportunities to

talk with other parents would be during the scrapbooking events and the NICU Dinners.

Your personal situation may be different. You may be in your teens or in your forties.

You may be married or single. You may have supportive friends and family, or you

may feel very much alone. Despite the differences, NICU families have a lot in

common. All are concerned about their baby’s welfare. All share some

disappointment in not having the birth experience they wanted. And, at times, we are

all afraid.

You are not alone…. “I can remember sitting in the NICU nursery and thinking that I must be the only one having problems

dealing with the situation. I looked at the other mothers in the nursery and they looked so peaceful sitting there

with their babies.”

“…I was one of those other mothers in the nursery. There were times when I was peaceful, when my

baby’s oxygen needs were going down and things were going well, but there were also those difficult

times. I also remember thinking that I was the only one having problems …so when things weren’t

going well I tried to hold back my tears until I got out of the room. I didn’t want anyone else to see me

cry.”

Introduction

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Discharge Goals

The length of time your baby needs to stay at Bronson depends on diagnosis,

gestational age and complications, if any arise. Each baby’s progress determines how

long they need to stay.

Babies may need to stay in the NICU for the

entire time they are here. Some may go to the

step down nursery. Others may be transferred to

a hospital closer to home to help make visits

easier.

There are many different ways to deliver care.

You may see these different ways while you are

at Bronson or if your baby is transferred to another hospital.

It is important for you to learn how to interact with and care for your baby.

We will help you by setting goals to help you understand and meet your baby’s

needs.

Spend time with your baby as often as possible. Participate in daily care.

Your baby’s health will guide how much care you will be able to give. As your baby

grows and progresses, you will be able to hold and care for your baby more often.

The more you care for your baby, the more comfortable you will be with your baby

when he is ready to go home. It also helps your baby develop a bond with you.

Babies are ready to go home when they:

• Take all feedings from either breast or bottle

• Are able to wake on their own when hungry

• Eat enough to gain weight regularly

• Maintain a normal temperature range while in a crib

• Maintain stable breathing

There are some babies who may not meet the goals above but who may still be

able to go home with special instructions. Your baby’s doctor will talk to you about

this.

Special note: If you haven’t bought a car seat yet, please wait until

your baby is close to going home. We can suggest the best seat based

on your baby’s size and weight.

Often, but not always,

healthy premature babies

will be able to go home

close to their due dates. It

Introduction


Moving from the NICU

As your baby progresses, she may not need intensive care but is not quite ready to go

home. She may be moved to the step-down nursery (third floor) where you and baby

can prepare to go home.

We know your baby is close to moving to the step-down nursery when:

• IV nutrition is no longer needed

• Baby is growing and feeding without difficulty

If your baby is transferred to the step-down nursery, do not be surprised if you

experience some feelings of anxiety. Leaving a familiar place where you have become

comfortable can be hard.

In other cases, your baby may be moved to a hospital closer to your home. This will

occur only after the neonatologist, your local doctor and you agree that the move is

appropriate. Your baby will be moved by ambulance.


Spending Time with Your Baby

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Seeing Your Baby for the First Time

When you see your baby for the first time, you will probably feel many different

emotions: happiness, sadness, love and frustration. Your baby may seem small and

fragile to you. Everything around you is unfamiliar and scary.

The NICU staff will help you get comfortable with this new place and with your

baby. We understand that in stressful situations it is hard to remember everything you

hear. Do not be afraid to ask staff to repeat information. Do not be afraid to ask for

whatever you need. Your needs are important to us during every phase of your baby’s

care. We know that you want to be with your baby. You also need time to recover and

get used to these new and unexpected things.

Reflections from a teenage mother

“When I first walked into the NICU I was so afraid. I didn’t

understand all of the equipment, my baby was so small, and I

didn’t know anyone. I felt alone. Then nurses helped me to feel

at home. They were always there for me and explained things

to me in a clear way. If there were changes with my baby or she

got sick, they were there to tell me what had happened and

why. I felt close to them and enjoyed talking with them.”

There is something very special that you can give your baby: your love. The nurses

will help you get comfortable touching and handling your baby.

Your baby already recognizes your voice from the time she spent in your womb. Your

baby will know that your touch is one that always comforts. Most babies are soothed

by a gentle touch and a soft voice.

Talk to your nurse about the kinds of care that will be good for your baby. At first, it

may seem as if there is little you can do, but a finger to hold and the sound of your

voice can help comfort your baby.

“My baby’s nurse suggested I sleep with a small flannel blanket in

my bra and place the blanket under our babies face. This allowed

our baby to have our scent next to her.”

Dads can also sleep with the flannel blanket. Don’t wear perfumes or

colognes while sleeping with the blanket, as this may affect the baby’s

breathing.



Parenting in the NICU Families are an important part of a baby’s care. You are an essential part of the team in

helping your baby grow and get well. We want your t i m e here to be pleasant.

Parents may see their baby any time, 24 hours a day. We encourage you to call every

day, especially when you cannot come to the hospital .

Designated Visitors As parents of a NICU baby, you will be asked to name 4 people who may visit your

baby without you at the bedside. Often these are grandparents, but you may choose

any friend or family member.

The 4 visitors you choose should be the same for the entire time your baby

is with us. Think about who would be the best support to you while your baby

is with us.

A designated visitor signs an agreement that they understand and will follow the

guidelines below. Care times and kangaroo care are reserved for the parents.

Designated visitors:

• May not visit if they are ill

• Will show picture identification each time they visit

• May not bring others to visit with them

• Will not ask for or receive medical information about the baby

Before Friends and Family Come to Visit

Support from family and friends is important. Please follow these steps before you

have visitors:

• Only have two or three visitors at the bedside at one time. Your baby is

sensitive to touch and sound. Space is limited.

• You and your visitors should stay at your baby’s bedside while on the

unit. This is for the safety and privacy of all babies on the unit.

• Make sure none of your visitors have a sore throat, cough, runny nose,

fever, vomiting or diarrhea. This is for your baby’s protection.

• Please discuss your feelings about photos and social media with your

visitors.

If you think you have been exposed to an illness (chicken pox, influenza, etc.) or if you have

questions about visitors, talk with your baby’s nurse.



Sibling Visits

Siblings are an important part of your baby’s family. We encourage brothers and

sisters to visit so they can get to know the baby.

Siblings must be fully vaccinated and free from symptoms of illness in order to visit.

Be aware that there are age-based visitor restrictions during flu season.

A visit of five minutes for every year of the sibling’s age is a good

guideline.

For example, a one year old will visit for five minutes and a five year old will visit for 25

minutes. If your baby cannot handle the extra noise, your baby’s nurse may ask the

brother or sister to come back at a different time. We encourage you to bring another

adult to help with the sibling during their visit.

If you have children at home, having your baby in the

NICU may be an added worry. Some parents are torn

between being with their sick baby and being with their

children at home. If your children are little, they may

not understand why you have to be away so often. They

may cry and ask you not to go. You may find it hard to

cope with this.

Finding a place where your children can stay and be comfortable may help you and

your children feel better about the time away from you. For ideas and activities near

the hospital, talk to the social worker or parent liaison.

feel important.

Working on projects for the new baby is one way to involve brothers and sisters. It

gives them a sense of pride and participation when they may otherwise feel jealous and

neglected. A young child may make a drawing or a get-well card to decorate the isolette.

They can pick out a small toy or family picture for the bedside.



Condition Reports

Keeping patient information private is very important to us. To do this, the mother

will be asked to sign the Notice of Privacy Practices form. Mom will then receive two

PIN cards with the personal identification number of her baby. Mom may share one

of these cards with baby’s dad or another support person who she would like to

receive information about the baby. We will ask for the PIN number each time a call

is made for an update on your baby. Please do not share this number with others. We

will only share information with the two people who have received the PIN cards. We

ask that you or someone you choose share the updates with family and friends.

When you call for an update on your baby, we will ask you:

• Your name

• Your baby’s name

• Your baby’s PIN number

Another way to keep families and friends informed is with CaringBridge®. This is a

free service that allows you to create a personal web page to write journal entries or

share photos. For more information, visit the CaringBridge® link on

bronsonhealth.com under the Patient & Visitor section.

How to Answer Questions from Family and Friends

Those closest to us can sometimes be the hardest to cope with

during trying times because they want to help. Appoint someone to

spread the newest information. Also, don’t feel you have to tell

everyone everything.



Telephone Calls

When you are unable to spend time with your baby, please call us for an update. The

nurse caring for your baby will be glad to talk with you.

Please avoid calling during shift changes. These happen daily from 7 to 7:30 a.m.

and 7 to 7:30 p.m. During this time, we update the care team on your baby’s

progress.

NICU local number: (269) 341-6475

Long Distance: (800) 757-6428 (toll-free)

Guidelines for calls:

• We only accept calls from the baby’s parents or named PIN holder. Please

do not give these numbers to anyone else.

• Use the toll-free number only while your child is a patient in NICU. We

cannot transfer your call anywhere else in the hospital. If your child is

moved to another unit, or if you need to call another department or an

individual, use their direct phone number or call the hospital operator at

(269) 341-7654.

• The phone line is for all the families who have babies on the NICU. If

the line is busy, try calling again.

We want to partner with you in the care of your baby. That is why we commit to

giving information to only you, the baby’s parents. We know that your family and

friends are very interested in your baby’s progress. We must protect your

confidentiality and respect your privacy, so we cannot provide information to

them.



Controlled Access Helps Keep the NICU Safe

The NICU is a controlled access unit. The doors to the NICU are locked for added

security. Families and visitors need permission to enter the unit.

Controlled access to the NICU has benefits to our babies and families:

• Improves security

• Supports patient privacy

Safeguarding Against Infections

It is easy for babies in the NICU to get infections. One of the most important ways to

reduce the spread of infections is careful hand washing.

We require you and your baby’s visitors to wash at the sink every time you enter the

unit. Follow these hand-washing directions:

• Remove all rings, watches and bracelets.

• Place jewelry in a safe place. We suggest using the provided safety pins

to pin jewelry to your clothing.

• Push long sleeves to the elbow.

• Place hands and arms into washing unit.

• Do not put sleeves back down.

You may store your coat and personal items in your baby’s closet.

Cell phones carry a surprising amount of germs. Use the blue wipes to clean your cell

phone before entering the unit. Do not use personal cell phones while visiting in your

baby’s room. Place your phone on vibrate mode and step outside the nursery to make

calls. Be sure to wash your hands again before re-entering.

For the safety of your baby, please eat all food outside the nursery. You are

welcome to bring covered water/drinks into your baby’s room.

Each time you enter your baby’s room, you need to

wash your hands or use alcohol gel before touching

your baby. Let the alcohol gel dry completely before

touching your baby. The scent is very strong when

wet.



Equipment and Procedures

Your Baby’s Bed

An incubator is a closed bed that can be set at a temperature to keep your baby warm.

There are portholes in the sides of the incubator for you and the NICU staff to use to

care for your baby. The incubator has a sensor that attaches to your baby’s skin to help

monitor the baby’s temperature and adjusts the heat needed for your baby.

When your baby is able to maintain her own body temperature, she will be moved to a

bassinette or an open crib. Babies need to maintain their own temperature in an open

crib or bassinet before going home.

Monitors

Monitors keep track of your baby’s vital signs (heart rate,

breathing rate, blood pressure, oxygen levels). Patches from

the monitor are gently attached to your baby’s skin for

continuous monitoring. These monitors are set to alarm if

any of the baby’s vital signs fall outside of the normal range.

Sometimes the baby’s movement or other things can cause a

false alarm.

Your baby will be switched to a memory monitor when he is 32 weeks old or ready

to go to our step down unit. This monitor records your baby’s heart rate and breathing

rate until close to discharge.

Intravenous Lines (IV)

Your baby will likely need an intravenous (IV) line. IVs are used to give fluid,

nutrition and medicine. Total parenteral nutrition (TPN) is a special IV fluid that feeds

your baby until he can tolerate full feeds. There are many different kinds of IVs.

• An umbilical catheter is a small tube put into one of the blood vessels in the

baby’s umbilicus or belly button. Blood samples may also be taken from the

tube.

• A percutaneous intravenous central catheter (PICC) is a long thin tube that

goes through the baby’s skin in an arm or leg. It passes through a blood vessel

that goes deep into the baby’s body.

• A peripheral IV is a short, thin tube placed into one of the baby’s veins.



Breathing Aids

Many premature and sick full-term babies need help with breathing. Here are the aids

that will help your baby breathe.

Ventilator: A machine that breathes for a baby who can’t breathe on his own or assists

with breathing when extra help is needed. The ventilator is attached to a plastic tube

(endotracheal or “ET tube”). This tube is put into the baby’s nose or mouth. The tube

is taped in place. It goes through the vocal cords into the baby’s windpipe. Air enters

the windpipe and travels into the baby’s lungs. The ventilator pushes air in and out of

the baby’s lungs. Since the ET tube goes between the vocal cords, you will not hear

your baby cry or make sounds. Once the tube is removed, the baby will be able to

make sounds again.

Ventilators give babies breaths at the rate they would normally breathe (40-60 times a

minute). Some babies have conditions that need a faster respiratory rate. A high

frequency ventilator or oscillator does this. It gives hundreds of short little “breaths”

every minute. The baby’s chest will look like it is shaking very fast instead of rising

and falling slowly. Some babies only need the high frequency ventilator for a few

days, others may need it longer.

Nasal CPAP (Continuous Positive Airway Pressure): Nasal CPAP is a gentle

flow of air and oxygen into the lungs. It keeps the air sacs in the lungs open just

enough to allow for easier breathing and to keep the lungs inflated.

Nasal Cannula: A thin, plastic tube with openings or prongs that go into the baby’s

nose. Air mixed with oxygen flows through the tube.

Surfactant: Surfactant is a lubricant that is produced in your child’s lungs in the

final weeks of a normal pregnancy. Babies born before 37 weeks sometimes need an

artificial surfactant. This medication is given through an endotracheal tube directly

into the lungs. It helps lubricate the air sacs in the lungs and makes them easier to

open.



Breastfeeding

Why is breast milk important?

Human breast milk is the best food for newborns, whether they are born healthy or

early with problems. Human milk provides the best nutrition, protects against disease

and enhances infant development. Not all NICU babies are able to breastfeed right

away, but they still benefit from human milk.

You can make a difference for your baby.

Breast milk can begin a lifetime of good health. Research shows that there are

advantages in feeding breast milk to preterm and sick infants:

• Breast milk is the healthiest choice for your baby’s growth and

development.

• A premature baby’s digestive system is immature. Premature babies can

more easily use the nutrients in breast milk. Breast milk helps the

baby’s digestive system mature.

• Human milk contains special cells that help protect your baby against

infections. Colostrum (the first form of milk from the breast) is rich in

these.

• The milk of preterm mothers is not the same as milk from mothers who

experience a full term pregnancy. Preterm breast milk has a higher

amount of protein and other nutrients.

• Breast milk contains special fats your baby’s brain needs to grow.

Babies fed breast milk have a ready-made source of these fats that helps

their brain develop better. These fats also help the baby to see well. No

formula has these types of fats.

• Breast milk contains endorphins (natural chemicals) that stop pain.

You may not have made a decision about how you will feed your baby. We

encourage you to pump your breast milk, even if it is just for a short period of time.

If you are unable to pump your breast milk, donor milk is available from the Bronson

Mother’s Milk Bank.

Pumping Breast Milk

Breastfeeding is a wonderful way to be part of your baby’s care. Breastfeeding helps

develop a close bond between you and your baby. It will give you a sense of warmth

and closeness. It also helps the baby’s tooth and jaw development.

If you can’t breastfeed right away, your goal is to start a milk supply for your baby.

Using an efficient breast pump is important. Rentals are available from the Bronson

Breastfeeding center. Call (269) 341-8849 for more information.



Breast Pump Directions

1. Wash your hands before you begin to pump.

2. Center the breast shields directly over your nipples. You should express milk from

both breasts at the same time.

3. Press the ON button to start pumping. Gradually turn up the dial next to the ON

button until you feel a comfortable pull.

a. When you see drops of milk, press the button to the right of the dial. This will

slow down the pumping frequency.

b.If the pressure is too tight after you press this button turn the dial down until it

is comfortable.

4. Pump for 15 to 20 minutes.

5. If your milk slows down and your breasts still feel full, stop pumping and gently

massage your breasts. Begin pumping again.

6. Wash the pump parts with soap and water each time you finish pumping.

7. Be sure to rinse them well and let them dry.

How to Make the Milk that Your Baby Needs

The first pumping will be a very small amount (less than a teaspoon). This does not

mean you cannot breastfeed. Remember, these first few times pumping contain

the important colostrum that helps to protect babies from infection.

• Pump at your baby’s bedside.

• Pump as often as your baby feeds, usually every two to three hours.

• Look at a picture of your baby or the Nic-View camera while you

pump if you are not with them.

• You can increase your milk supply by putting your baby to breast or

pumping more often.

• If you are trying to make more milk, add an extra pumping session in

the early morning.

• Anything that you are doing with breastfeeding and pumping is

important for your baby.

• Surround yourself with other moms who have the same goals. This

support will help you be more successful.



Labeling, Storing and Handling

Labeling

We will give you bottles to store your breast milk. You will place a label with your

baby’s name and hospital number on the bottle. Put the date and time of the pumping

on the label. When you bring your milk to the NICU, the nurse will scan it and send

it to the nutrition room.

Storing

Leave about one inch of space in the top of the container to allow for expansion.

Use a clean empty bottle for each pumping. Do not add new milk on top of milk

from a previous pump. You may keep milk in your freezer for three months. Put the

milk in the back of the freezer, not in the door.

You may keep milk in a deep freezer, kept at a constant 0 degrees F, for 6 months.

Talk to your baby’s nurse about how much of your milk is stored in the NICU freezer

so that you can make sure you have enough milk for your baby.

Use of Stored Milk

To prepare refrigerated or frozen breast milk for feeding, place the milk in a container

of warm tap water until it reaches room temperature. This should take about five

minutes, but not longer than 20 minutes.

Do not heat milk on the stove or in a microwave oven. This will break down the

valuable nutrients in breast milk. There may also be hot spots in the milk that could

burn the mouth or throat of your baby.

Handling

At home, put your expressed milk in the refrigerator or freezer within one hour of

pumping. Bring your milk to the hospital in a cooler with a freezer pack. In the NICU,

freshly pumped milk may be kept for up to four hours outside of the refrigerator.

Do not let milk stand at room temperature to thaw. You may thaw frozen milk

in the refrigerator. Be aware this may take up to 12 hours.

Thawed frozen milk may be kept in the refrigerator for 48 hours.



Bronson Mother’s Milk Bank

A mother’s own milk is the best food for her baby. When a mother can’t provide

breast milk, milk from healthy donor mothers is the next best thing. The Bronson

Mother’s Milk Bank collects, screens, processes, stores and distributes donated human

milk. All milk in the Milk Bank is pasteurized. Most nutrients are preserved during this

process.

How do I donate? Milk donors are healthy mothers who breastfeed their own babies.

When they make more milk than their own baby can use, they can donate their extra

milk to the Milk Bank. Mothers who would like to donate their milk can call the

Milk Bank at (269) 341-6146.

Lactation Consultants

Our lactation consultants are board certified in breastfeeding practices.

They can provide education, advice on breastfeeding practices and personal

consulting services. Contact them if:

• Breastfeeding is painful. It should not be painful.

• You plan to start a new medicine. For example, birth control pills may reduce

your milk supply.

• Your nipples or breasts are sore.

• You are concerned about your milk supply.

To contact the Breastfeeding Center call (269) 341-8849 from 8 a.m. until 7 p.m.



Non-nutritive Sucking at the Breast

Non-nutritive sucking occurs when a baby latches on to the mother’s breast soon after

she has expressed the milk from the breast. This enables the baby to learn how to

coordinate sucking, swallowing and breathing with small amounts of milk instead of

larger quantities of milk that would come from a full breast.

When babies reach 31–34 weeks gestation and are off respiratory support, they may

be ready for non-nutritive sucking or breastfeeding. Your baby may be ready for

non-nutritive sucking if they like sucking on a pacifier or fingers.

Non-nutritive sucking:

• nurtures your baby

• helps to sustain or increase your milk supply

How is this done?

Non-nutritive sucking is done at the baby’s scheduled feeding time.

• Pump before putting baby to breast.

• Position baby so the head and body are supported. The football hold

works well for premature infants and for mothers who have larger

breasts.

• Do not worry if your infant does not latch on very well the first few

times. Babies need practice.

• Do not push the baby to accept the breast if there is no sign of interest.

This can lead to frustration and over stimulation.

• We encourage you to pump a second time. Putting the baby to breast

may have stimulated a let-down reflex.

Moving from Non-Nutritive to Nutritive Breastfeeding

Nutritive sucking at the breast occurs when a baby latches on to the mother’s breast

when her breast is full of milk. Your baby may be ready to begin nutritive

breastfeeding at about 32–34 weeks gestation. Your baby’s abilities to coordinate

sucking, swallowing and breathing begin to mature around this time.

Premature infants get tired quickly when beginning to breastfeed. Limit the first

sessions to 10–15 minutes. Sessions can be longer as your baby becomes better at

breastfeeding.

How do I know my baby is successfully breastfeeding?

You will know that your baby is successfully breastfeeding when he is having six to

eight wet diapers and at least two to three yellow-seedy stools a day, is eating well, and is

content.



Feeding Your Premature Baby

When can my baby begin to breastfeed or take a bottle?

Non-nutritive Sucking

• Non-nutritive sucking will prepare your baby for feeding from breast

and bottle.

• Non-nutritive sucking can be done with the pacifier or by putting baby

to breast after mom has pumped.

• It is important to start your baby on non-nutritive sucking as soon as

they show interest in sucking and are stable.

• Some babies start sucking on a pacifier as early as 28–29 weeks.

• Some babies start non-nutritive sucking at the breast as early as 31

weeks.

Breastfeeding/Bottle Feeding

• If your baby is stable and shows interest in eating, you may try

breastfeeding as early as 32 weeks.

• Your nurse and the lactation consultant can help you with

breastfeeding.

• If your baby has breathing problems, they may not be ready to start

feeding until they are older and more stable.

• The nurses will help you look for signs that your baby is ready to bottle

or breastfeed. Baby:

- Wakes on their own before care time.

- Is able to stay awake during care time

- Is able to suck on a pacifier for 5-10 minutes.

- Shows they are hungry by bringing hands to face and opening their mouth

for the pacifier.

- Has a respiratory rate less than 70 breaths per minute.



Common Questions about Feeding

How long will it take for my baby to eat well enough to go home?

• A baby born early needs a lot of time to learn how to suck, swallow

and breathe.

• Every baby is different. Some babies take several weeks and may be

close to term before they eat well enough to be able to go home.

• Some babies with breathing or stomach problems take longer to learn

how to eat.

Why is it so hard for my baby to eat?

• Your baby’s muscles are weaker. Your baby needs extra sleep and

may tire quickly.

• Your baby needs time to learn to coordinate swallowing and

breathing. Your baby needs a lot of energy to eat.

Why isn’t my baby eating as well as yesterday?

• Your baby may not have enough energy to eat well every day.

Infection or illness can affect how much your baby is able to eat.

• A busy day with visitors or procedures makes your baby tired. Being

out of the incubator takes more energy and may affect eating.

Why don’t we try to feed my baby at every feeding time?

• Some babies don’t have enough energy to eat every feeding in the

beginning.

• Your baby may need more rest breaks if they have breathing problems.

How can I help my baby learn to eat?

• Your baby can use the pacifier to practice sucking. They can do this

even before they are old enough to start eating from the breast or

bottle.

• Your baby can use the pacifier while getting tube feedings.

• Ask your baby’s nurse to show you the signs that your baby is ready

to eat.

• Your baby should suck for no more than 20–25 minutes at a feeding.

Your baby needs to save energy for the next feeding.



Hand Hugging and Non-Stressful Touch

Gentle touch is needed for your baby’s growth and development. It can take many

forms. Hand hugging and kangaroo care are two ways of touching your baby in a

kind and caring way.

The smallest of infants will benefit from contact with parents. The nursery can be

scary for you and your baby. Take some time to sit by your baby’s bedside. Lean your

head on the incubator and focus on your baby.

When you are ready, talk with your nurse about the best time to start gentle touch.

Hand Hugging

We want you to greet your baby with a hug. Research shows that hand hugging is

good for the health and well-being of you and your baby.

1. It is important that you wash your hands with soap and water or with alcohol

foam before your hug. If you use the alcohol foam, let your hands dry and the

odor go away before starting your hug.

2. Open the portholes of the incubator and talk softly. Your

baby knows your voice. This will help prepare your baby

for the next step.

3. Reach into the portholes and place one hand near your baby’s

head and the other hand near their feet. Cup your hands and

gently touch your baby’s head and support their feet close to

their body. When you first touch your baby, they may move

or be startled.

4. Keep your hands st i l l . Your baby will quickly realize

that it is you and that this is a joyful experience. Please do

not rub or pat your baby.

5. Use a very soft voice as you talk to your baby. Your baby will show they are

enjoying your hand hug by keeping a stable heart rate, oxygen saturation and

blood pressure. If you find that hugging and speaking softly bothers your

baby, simply stop speaking. Just hugging might be enough.

6. When you are ready to end your hug, you will have to move slowly.

7. Gently lessen the pressure you are using to hug. Remove your hands slowly.

First remove your hand that is holding the feet.

8. Give your baby time to get used to that hand being removed. Next remove

your hand holding the head. This will take time.

The hand hug is a comfort touch. It should not stimulate your baby. If your baby is

very sick, you may need to put your hands near, but not on your baby.

Your baby’s nurse will help you and can answer any questions.



Kangaroo Care

Kangaroo care is the practice of either parent holding their diapered baby on their

bare chest, with a blanket draped over the baby’s back. This skin-to-skin contact

benefits both you and your baby.

Kangaroo care is safe and beneficial for babies who are in stable condition. A very

small baby or a baby with tubes in place can benefit from skin-to-skin contact. The

positive effects of touching and cuddling promote nurturing and growth.

You may be nervous about trying kangaroo care because you are afraid you will hurt

your baby. You won’t. Your baby knows your scent, touch, voice and breathing.

They will enjoy feeling close with you.

Kangaroo care can help your baby:

• Maintain body warmth.

• Regulate heart and breathing rates. This helps save energy.

• Gain weight.

• Spend more time in deep sleep. This encourages growth.

• Spend more time quiet and alert. There is more parent-infant contact and

less time crying.

• Have a better chance of successful breastfeeding. Kangaroo care can

improve the mother’s milk production.

• Have fewer episodes of apnea (pauses in breathing) and better oxygen

levels.

When will my baby be ready for kangaroo care?

• Each time you visit, your baby’s nurse can help you decide if your baby

is stable and ready for kangaroo care.

• Kangaroo care helps even very premature babies on ventilators, nasal

CPAP or other types of support.



How is kangaroo care done in the NICU?

• You can give your baby kangaroo care at the bedside. Please plan to spend at least

an hour kangarooing your baby. You will want to use the bathroom and have a drink

before you begin.

• Sit in a comfortable chair and have a curtain for privacy.

• Wear a loose fitting, front opening shirt. For moms, not wearing a bra helps maintain

your baby’s temperature. This lets your baby’s skin come into contact with your skin.

• Your baby will wear only a diaper. Your shirt or a blanket is placed over him. Your

nurse will check on your baby to be sure he is warm and not in any distress.

During one time period when I was

unable to visit because of illness and unable to do kangaroo care, she started to have pulse drops

again. Once again these stopped when I was able to do kangaroo care regularly. My baby was

calmer and seemed happier after kangaroo care. It felt so good to me to have her so close to me. I

can’t describe the feeling that I had inside when she had her tiny hands on me and moved them

slowly back and forth. It made me feel so good inside.



Cycled Lighting

We use several levels of lighting in the NICU. Your baby will have different levels used during his

stay. We change the light levels to help your baby’s development. You can help your baby by

asking the nurse what light level your baby should have and keep the lights at that level when you

visit.

When babies are less than 32 weeks, they should have their beds covered all the time to protect their

eyes. This gives your baby a lot of rest time for growing. If you are holding your baby, the lights in

the room should be dimmed.

When your baby is getting an exam or is having a bad day, the lights may be on or the bed uncovered

even if he is less than 32 weeks. We try to keep these periods as short as possible.

After 32 weeks, we begin day and night patterns. During the day, the baby’s bed is uncovered and

the lights are on in his room. During the night, the covers are on the beds and the lights are off. This

helps the babies get used to the day and night pattern they need for sleep and growing. This will

also help you when you take the baby home.

Effects of Noise A premature baby is born during an important period of their development. They are cared for in an

environment very different from their mother’s womb. When your baby was in the womb, they heard

muted sounds. The noise that your infant hears in the NICU is much louder.

Too much noise may have harmful effects on their long-term development. Your baby may respond to

noise by startling, stopping breathing, pulse drops and color changes.

Loud noise in the NICU is created by a variety of sources, which include equipment alarms, talking,

telephones and movement of equipment.

You can help to lessen the sound levels in your baby’s room by:

• Talking softly and reminding others to talk softly.

• Opening and closing incubator doors gently.

• Not tapping on top of incubator.

• Turning cell phones to vibrate.

• Leaving your baby’s room to talk on your cell phone.

Fragrance Free

For the health of your baby, our NICU is an odor-free area. Please do not wear scented body and

laundry products on the days that you come to the hospital. If you smoke tobacco or marijuana

(cannabis) in any form, do not smoke or vape before coming to the hospital. You may be asked to keep a

clean, odor free set of clothing at the bedside to change into before holding your infant.



Your Baby’s Care

Your B

aby’s C

are

Your Baby’s Care


Getting Involved in Your Baby’s Care

When your baby first arrives in NICU, nurses will give most of your baby’s care. There are

things you can do to help right from the start. As time goes on, this list will grow so that by the

time your baby goes home, you will be giving all care. Below are some ideas of things you can

do now with your baby. Once your baby is stable, you will be able to do much more.

Daily Care

Your baby’s care is done together at one time. This is called clustered care. We cluster

the care so that the baby has more time to sleep, heal and grow. These care times will

occur when your baby is awake. We will be watching your baby and making sure they

are okay in between care times.

We measure your baby’s weight every day. We measure your baby once a week. Your

baby’s growth is graphed on a growth chart. Watching your baby’s growth lets us know

that your baby is getting the right nutrition.

Diapering

Diaper changes are done during care times, so your baby can have long rest periods. Your

baby’s nurse will help you until you are comfortable changing the diaper alone.

• Place a clean diaper under the soiled one for easy diapering once the

soiled diaper is removed.

• Clean the diaper area with one of our special baby wipes located near the

diapers at your baby’s bedside. You will need to wet the wipe with warm

water from the sink.

Boys

• When washing baby boys, be sure to lift the scrotum to remove any stool.

Even small amounts of stool can cause irritation.

Girls

• The outside area of a baby girl’s genitalia (called the vulva) may be

swollen. There may be a white mucus discharge from the vagina for

several days after birth.

• Gently washing the vulva and skin folds to remove all stool is all that is

necessary.

• Always wipe baby from the front to the back.

A NICU Dad said: “Learn everything you can about your baby’s care. It

was quite awkward the first time my big hand got into the isolette to get

our baby out, but practice makes perfect.

Your Baby’s Care


Umbilical Cord Care

Keep this area clean and dry until it heals. If the cord is soiled with urine or stool, use a

mild soap and water. The cord comes off seven to ten days after birth. The base usually

heals about one week later.

Keep the diaper folded below the umbilical cord until healing is complete.

Temperature Taking

Your baby’s nurse will show you how to use the digital thermometer to take your baby’s

temperature under their arm. It should be between 97.6 and 99 degrees F. The

temperature of a baby’s hands or feet is not reliable. If you get a temperature that is out of

the normal range, tell your baby’s nurse.

Taking an axillary (under the arm) temperature:

1. Place tip of the thermometer high up in the armpit next to the skin. The area

should be dry. Make sure the end of the thermometer is completely covered

between your baby’s arm and side.

2. Hold baby’s arm tightly against the side of the chest.

3. The temperature is ready to read when the thermometer beeps or the readout

stops flashing.

Skin Care

It is easy to focus on the heart, lungs and stomach when you have a preterm infant.

Sometimes we forget about another important organ, their skin. A complete sponge bath

may be postponed until your baby is medically stable and then given as needed. Until

then, washing your baby’s hands and face and cleansing the diaper area with warm water

is enough.

You may help with your baby’s care by giving mouth care and cleansing the diaper area.

As you are more comfortable and confident, you will be able to clean your baby with

little help from the nurse.

Your Baby’s Care


Bathing Baby

Let your nurse know when you would like to bathe your baby. Before feedings is usually

a good time. Most babies fall asleep shortly after eating. You will work with your baby’s

nurse to give your child a bath. Together, you can decide when would be a good time for

a bath.

We use a method of bathing called swaddle bathing. This method has made bath time less

stressful for our patients. During swaddle bathing your baby is swaddled in a blanket or

towel.

Swaddling helps maintain their temperature and keeps them calmer during the bath.

During a swaddle bath, your baby uses less oxygen and has fewer changes in heart rate.

This helps to conserve energy to be able to take oral feedings after their bath. There are

two ways to bathe your baby: sponge bath and tub bath.

• Work quickly and keep the room warm so your baby does not become

cool.

• You do not need to bathe your baby every day as long as the diaper area

and skin folds (armpits, groin creases, neck creases, and thigh rolls) are

kept clean.

• Babies often cry and act startled when placed in water for their bath.

• Sponge baths are usually given until the umbilical cord falls.

Bath Supplies

Before you begin, gather all the bath supplies you will need before, during and after the

bath:

• Washcloths (1 or 2)

• Large towel to swaddle baby

• Towel for drying

• Mild soap and shampoo

• Clothes and diaper

• Basin or tub

Sponge bathing with your baby swaddled

• Wash your baby’s face and scalp with a washcloth and clear warm water.

• Lightly soap the rest of your baby where needed with the washcloth or

your hand.

• Wipe the soap off by going over the body several times with the rinsed

washcloth, paying attention to creases.

• Wash the baby’s head last to keep her from getting cold. The scalp and

hair can be washed with baby shampoo or baby wash once or twice a

week.

• Use towel to pat dry.

Your Baby’s Care


Tub Bathing/Swaddle Bathing

• Fill the tub with water that is approximately up to the baby’s shoulders.

The tub should be filled before you put the baby in it.

• Water should be comfortably warm, not to hot or cold. Test the water with

your elbow, wrist or use a bath thermometer. The water should be about

100°.

• Using a baby bath seat may help keep the baby upright. Swaddle the baby

in a fleece blanket before placing in the tub.

• Hold your baby so her head is up. Reaching behind the baby’s head and

back, you can support the baby on your wrist. Use the same hand to hold

on to the baby’s opposite arm during the bath.

• Before placing the baby in the tub, use a washcloth wrapped around your

finger to wipe your baby’s eyes gently from inner corner to outer corner.

Use clean warm water if you need to repeat.

• Wash your baby’s face in the same manner. Clean the outer part of the ear,

the entrance to the ear, and behind it — not inside.

• Place the baby in the water. Apply soap to a washcloth then slowly and

carefully take out each arm, gently clean it, and then rewrap it. Repeat

this with each leg.

• Clean baby’s entire body except the genital area. Rinse.

• The back can be cleaned with adding soap to the blanket and gently

rubbing to wash and rinse the back.

• The head is done last to keep them from getting cold. Wash the scalp

using a small amount of baby shampoo or baby wash. Rinse the scalp with

a damp washcloth several times. Take care not to get soap in your baby’s

eyes.

• Wash genitals front to back and rinse.

• After the baby is dried, your baby would be placed skin to skin for

kangaroo care time.

Your Baby’s Care


Bulb Syringe

A bulb syringe is used to remove formula or mucus from your baby’s nose and mouth.

When to Use the Bulb Syringe: Use a bulb syringe when your baby spits up, has a stuffy nose or sneezes. It is a good idea

to keep a bulb syringe close to your baby, especially during feedings.

Use the bulb syringe only when congestion makes it hard for your baby to breathe or eat.

Each baby should have their own bulb syringe.

Do not use the bulb syringe unless necessary. Overuse of the bulb syringe can make

your baby’s stuffiness worse.

Using the Bulb Syringe:

1. To use, first squeeze the bulb until it collapses.

2. Gently place the tip along the cheek inside the mouth first then in each

nostril. Quickly release the bulb. This will bring the formula or mucus into

the bulb.

3. Remove the bulb syringe from the mouth or nose. Quickly squeeze the

bulb into a tissue to get rid of this material.

Cleaning the Bulb Syringe:

1. Wash the bulb syringe with hot soapy water and dry.

2. Wash and rinse the inside of the bulb syringe with hot water.

3. Squeeze the bulb to empty as much water as you can.

After baby has had an infection or cold, throw the bulb away and buy a new one.

Your Baby’s Care


Swaddling

Swaddling helps your baby to:

• stay warm

• stay calm

• feel more secure, as if being held

• stay in a proper position so his muscles gain strength

Your baby may not be swaddled if they:

• have a fragile IV line (most likely at the belly button) or a chest tube

• need to be under phototherapy lights

• have fragile skin.

Positioning In the NICU, we work hard to ensure proper

positioning of your baby to help avoid problems

such as:

• Flat spot on baby’s head

• Poor shape of baby’s head

• Weak muscles

• Increased arching of back and

shoulders

Your baby will rotate through six positions at each care time. The nurse will help you to

position your baby. When your baby is taking more than half of feedings by bottle or

breastfeeding, they no longer need the special positions. They should only be put on their

back to sleep. Your baby should always sleep on their back at home.

Holding

Babies grow emotionally and physically just by being held. Often the best time to hold

your baby is after care time. We encourage you to hold your baby as long as they are

stable.

Your Baby’s Care


Chronological Age vs. Corrected Age

Correcting for Prematurity

When a baby is born early, they have not completed the normal stages of development in

the womb.

It is important to adjust your baby’s age to correct for the number of weeks they were

born early. This will help you identify the accurate development stage for your baby. The

actual age is the age since birth. Corrected age is the age your baby would be if they were

born on your due date.

You can subtract the number of weeks or months that your baby was born prematurely

from your baby’s actual age to find their corrected age. For example, if a baby’s actual

age is six months and they were born two months premature, the corrected age would be

four months old.

Corrected age applies to both growth and development. Your baby’s head, weight and

length should be compared to corrected age percentiles. You should correct for your

baby’s age until they are two years old. Make sure your baby’s doctor accounts for their

prematurity when measuring growth and development.

Remember, your baby’s development will follow

his or her corrected age.

Your Baby’s Care


Challenges of Prematurity

Younger babies have more challenges of prematurity. These may be problems with their eyes, the

nervous system, infections, digestion, feeding and breathing.

We know you worry about your baby. The NICU team

can help you understand these issues. We will tell you

what is happening and how you can help.

Your Baby’s Brain

To evaluate your baby’s brain, a painless, head ultrasound may be done. Your baby’s doctor will

talk to you about the need for the test and the test results.

Your Baby’s Heart

Preterm babies are at risk for heart problems. Your baby’s doctor or pediatric cardiologist

(children’s heart doctor) will follow them carefully. The doctor may order an echocardiogram to

see your baby’s heart more clearly. It is similar to an ultrasound. The pediatric cardiologist or

your baby’s doctor will talk to you about the results.

Patent Ductus Arteriosus (PDA) is a condition that occurs in some babies. The Ductus Arteriosus

is a blood vessel that connects the two major blood vessels in the heart. In most full-term babies

soon after birth, the vessel closes as part of normal circulation. In preterm babies, it may remain

open and require medicine or surgery to close it.

Murmurs are common and can be normal in babies. Your doctor will talk to you if treatment is

needed.

“Your baby was born at 28 weeks. Right now, she is on a ventilator but stable. She has

some evidence of RDS but she was given surfactant in the delivery room. She will be at

risk for ROP, PDA and IVH. We will screen for those as needed. We will let you know if

her condition changes.” “Huh?”

Quote from a parent of a 28-week premature baby

Your Baby’s Care


Your Baby’s Lungs

Some premature babies have respiratory distress syndrome (RDS) because their lungs are not

fully developed. Their lungs don’t produce surfactant, a substance that helps keep the tiny air

sacs (alveoli) in the lungs open. This can make it hard to breathe.

Extremely premature babies may not be able to breathe on their own and may need a breathing

machine (ventilator). Even after they no longer needs a ventilator, a baby may need extra oxygen

or breathing support for a while. They may breathe faster than normal and need extra calories

because they are working hard to breathe.

Most babies born before 35 weeks gestation have a breathing condition called apnea. Apnea

occurs because the part of the brain that controls breathing is not fully developed. Periodic

breathing gaps are normal. With apnea, a baby will pause for more than 20 seconds between

breaths.

Apnea is often linked to bradycardia or a low heart rate. This happens when a baby stops

breathing. The oxygen level decreases causing their heart to beat slower. This is why most babies

are on monitors to alert nurses to changes in their condition. Your baby will have medicine if

apnea happens a lot.

Your Baby’s Care


Sepsis

Sepsis is an infection in the bloodstream. Tiny organisms, bacteria, viruses and fungi (yeast)

cause infections. These are often grouped together as germs. Infections caused by bacteria are the

most common.

During pregnancy and childbirth, a baby can be exposed to germs. After birth, all babies are

exposed to germs in the air, on hands, and on objects that touch the baby. If a germ enters the

baby’s system, it may cause an infection. The infection may get into the bloodstream and spread

through the body.

Sometimes it is hard to tell whether a baby has an infection. The baby may be fussy or very

sleepy. Their temperature can be too high or too low. They may breathe faster or need more

oxygen. Apnea and bradycardia may also be signs of infection.

A baby showing any signs of infection has a series of tests called a septic workup:

• A blood test that checks for germs (blood culture). This test shows if there is an infection.

It can take up to three days to get the test results.

• A complete blood count (CBC) checks for the number and types of cells in the blood. A

change in certain cells happens when the body is fighting an infection.

• CRP (C-reactive protein) checks for inflammation that may be caused by an infection.

• Lumbar puncture (LP) is done to get a sample of spinal fluid to see if there are germs in

the nervous system.

Treatment of Sepsis

Your baby’s doctors will start giving your baby medicine as soon as signs of infection are

present. They will start with a combination of antibiotics that work against the most common

germs. Once the culture results are known, the antibiotics may be changed if others will work

better against a certain germ.

Antibiotics are given for different lengths of time depending on the kind of infection. The typical

length of time is three days to two weeks. An IV will be used to give the antibiotics several times

a day. During this time, your baby may not be given feedings. Instead, the IV fluid will provide

nutrition and calories.

Your Baby’s Care


Jaundice (Hyperbilirubinemia)

Jaundice is a common condition in newborn babies. Premature babies and full term babies with

bruising are more likely to get jaundice and may need treatment.

Jaundice happens when bilirubin levels are high. Bilirubin is released when red blood cells

break down after birth. Your liver filters the bilirubin out of your body. Because a baby’s liver

is not mature, they have difficulty breaking down the bilirubin. As a result, some babies need a

few days under special lights. The lights help them to break down the bilirubin.

Retinopathy of Prematurity (ROP)

ROP is an eye condition that occurs when part of the eye (called the retina) has not fully

developed. Most cases of ROP are mild and will not need treatment. Some cases of ROP can

result in vision problems.

An eye doctor (ophthalmologist) screens babies for ROP. The doctor will talk to you about the

results of your baby’s eye exam.


Your Baby’s Safety

Your B

aby’s S

afe

ty



Safe Sleep for Your Baby

Babies need a safe place to sleep. The following are important to keep your baby safe.

• Always place your baby on their back to sleep, even when they can roll over. Once

baby can roll from stomach to back and back to stomach, baby can remain in the sleep

position that he or she assumes. Parents should always start baby on the back.

• Place your baby on a firm sleep surface, such as crib, bassinet or play yard with a safety

approved crib mattress covered by a fitted sheet.

• Keep soft objects out of your baby’s sleep area.

• Toys

• Pillows

• Crib bumpers, including mesh bumpers

• Blankets, comforters or sheepskins

Sudden Infant Death Syndrome (SIDS) and other Sleep-Related Infant Death

SIDS is the sudden death of an infant under one year of age of

unknown cause. One of the best ways to reduce the risk of SIDS

and other sleep-related infant death is to place babies on their back

when sleeping or napping. Do not let your baby overheat during

sleep. Dress the baby in as much or as little clothing as you are

wearing.

Keep your baby’s sleep area close to, but separate from, where you

and others sleep. Your baby should sleep alone. They should not

sleep with adults or other children in a bed, on a couch or on an

armchair. If you bring your baby into bed with you to breastfeed,

put them in a separate sleep area when finished. Your baby needs

their own bassinet, crib, cradle or play yard (such as a pack-n-play).

Watch “Safe Sleep” DVD.

Call your

baby’s healthcare

provider right away

if your baby:

• develops fast

breathing or breathing

problems

• wheezes (makes a

whistling sound

when exhaling)

• develops a

worsening cough

• looks blue around

the mouth or

fingertips

• has trouble sucking

and swallowing

• less interested in food

• develops a fever



Crib Safety Guidelines

Based on a study by the Center for Injury Research and Policy, crib standards were

updated in June of 2011. In the study, they found an average of 9,500 injuries and 100

deaths per year in the United States were related to crib, playpen and bassinet accidents.

The new federal safety standards prohibit the manufacture and sale of drop-side rail cribs.

The new standards require:

• Stronger slats and mattress supports.

• Better quality hardware.

• More vigorous testing of new cribs.

The American Academy of Pediatrics recommends the following:

• Get a new crib that meets safety standards.

• If you have an older crib that was made before the 2011 safety standards, check

the Consumers Product Safety Commission crib recall list (www.cpsc.gov) to

make sure that your crib has not been recalled. Also, check with the

manufacturer to see if they provide hardware to prevent the drop-side from

moving. Check the crib frequently to make sure that the hardware is tight and

that there are not broken parts.

• Slats, spindles, corner posts and rods must be less than 2 3/8 inches apart at all

points. There should be no loose slats so that your baby cannot slide through

and get stuck.

• All joints and parts should fit tightly.

• Wood surfaces should be free of cracks and splinters and have lead-free paint.

• There should be no cutouts in the headboard and footboard. Your baby’s arms,

legs, or head could be trapped.

• Corner posts should be flush with the end panels or be taller. It should not be at

a height that your child’s clothing could get caught by the corner posts.

• The mattress should be firm and tight fitting. It should be the same size as the

crib so there are no gaps for arms and legs. You should not use the crib and

mattress combination if you can place more than two fingers between the

mattress and the crib side.

Resource:

Back to Sleep Campaign

31 Center Drive, Room 2A32 Phone: (800) 505-2742

Bethesda, MD 20892 Fax: (301) 496-7101



Smoking Around Your Baby

Smoking is harmful to smokers and non-smokers. Your baby’s lungs can be hurt by

smoke.

Babies who breathe in smoke may develop respiratory infections. Smoke contributes to

nearly 300,000 respiratory infections in babies. Many of these lead to hospitalization.

Smoking also:

• Stunts lung growth.

• Causes permanent lung and breathing problems.

• Causes a higher rate of throat infections.

• Causes thousands of new asthma cases every year.

• Makes childhood asthma worse.

• Causes a permanent decrease in lung function.

• Leads to a higher rate of repeat ear infections.

• Increases the risk of Sudden Infant Death Syndrome (SIDS).

If you smoke, quit. Don’t smoke anywhere in your home. Don’t let anyone else smoke

in your home. Smoking should only be done outside of the house. Babies can still breathe

in the smoke even if you smoke in a different room.

• People who have been smoking should change their shirt before handling your

baby.

• No one should hold your baby and smoke at the same time.

• Never smoke when the baby is in the car with you.

Second hand smoke is dangerous for your baby. If you or someone in your home

smokes, now is a good time to stop. Ask your doctor or your baby’s doctor for help.

Smoking, Childcare and the Law

There are many things to consider when you choose a childcare provider. One concern is

whether your child will be exposed to smoke.

Smoking is not allowed in regulated, licensed childcare centers or registered family and

group daycare homes. If your baby is cared for in an unregulated home, make sure

there is no smoking in the home. Always place your baby in a smoke-free environment.



Shaken Baby Syndrome

When Your Baby Cries

Taking care of a baby can be a rewarding and exciting experience. It can also be

challenging when a baby cries, especially when the end to the crying seems to be

nowhere in sight. While crying can be irritating and frustrating, it is a baby’s only way to

tell you what they need.

Babies cry because they are:

• Hungry.

• Need to suck.

• In pain or are feeling ill, such as with an ear ache.

• Teething.

• Wet or have a soiled diaper.

• Too warm or too cold.

• Over tired.

• Over stimulated.

• Reacting to stress.

• Colicky.

Each baby is unique and speaks a language all their own. You’ll understand your baby’s

language in time.

What can you do when your baby cries? Here are a few things you can try: • Check for sickness. (See signs of illness on p. 65)

• Check to see if your baby needs a diaper change.

• Feed your baby slowly.

• Burp your baby often.

• Offer your baby a pacifier.

• Hold your baby against your chest and walk.

• Rock your baby gently.

• Take your baby for a car or stroller ride.

• Sing to your baby or play soft, soothing music.

• If you are breastfeeding, don’t eat onions or beans or drink caffeine (coffee, cola,

or tea). If these foods affect you, they will affect your baby.

If you have tried to calm your crying baby but nothing seems to work, it is important to

stay in control of your temper.

It is never okay to shake, throw or hit your baby. Never toss a baby into the air.

Support your baby’s head and neck when you hold them.



If you feel as though you could lose control:

• Take a deep breath and count to 10!

• Put your baby in a safe place. Take time out and let your baby cry alone.

• Call someone close to you for emotional support.

• Call your baby’s doctor. There may be a medical reason why your baby is crying.

My son was born 10 years ago. I still remember the immense joy I had when I

held him for the first time and looked into his eyes. I was in love. My husband

was supportive of me and in caring for our son. Our families lived out of state

so we were pretty much on our own. I had a C-section and was uncomfortable

for the first few weeks. When my sweet boy was three months old, he finally slept

through the night. Exhaustion was my middle name. One afternoon after a very long

night with my son, he was crying and crying. I could not figure out what to do. Nothing

worked. My husband was at work, and I felt too embarrassed to call anyone else. After

all, as a NICU nurse and a “seasoned mom” of three months I should know exactly what

to do and be in complete control. I approached the line of losing control and potentially

hurting my son. It was a very scary place to be. I used the last shred of control I had and

placed my screaming baby in his crib where he could be safe and then shut the door to his

room. I vacuumed the house for about 15 minutes using the noise from the vacuum

cleaner to drown out his cries and mine. When I felt calmer, I went back to his room

where he was safe in his crib. We were both exhausted from crying so hard. I picked him

up, held him tight and we snuggled together for a long while. After that, I never came that

close to the line again. I realized that despite being a NICU nurse and a “seasoned mom,”

I was human, I had limits, and I needed to be aware of them and respect them. My advice

to every new mom: you are human, know your limits, ask for help if you feel yourself

approaching the line; crossing that line is a different story.

Peace and blessings to you and your family.

When Your Baby Cries, Take A Break — Don’t Shake!

Spread the Word

If other people help take care of your baby, make sure they know about the dangers of

shaken baby syndrome. Tell your childcare providers, siblings, grandparents and

neighbors. Tell anyone who cares for your baby. Make sure they know it is never okay

to shake a baby.

Watch “Never Shake a Baby” DVD.



Respiratory Syncytial Virus (RSV)

RSV is respiratory syncytial (sin-SISH-all) virus. RSV spreads from person to person.

The virus causes a cold in adults and older children. RSV causes a stuffy or runny nose,

cough, fever and sometimes ear infections.

Babies with RSV can develop serious respiratory infections, such as bronchiolitis or

pneumonia. Bronchiolitis is an infection of the small breathing tubes in the lungs. These

infections are dangerous to babies who are born prematurely, have lung or heart

problems, or have other chronic illnesses. Most babies with RSV do not get very sick. A

few become very sick and need to be admitted to the hospital.

Ways you can help protect your baby from RSV:

• Keep them away from people who are sneezing or coughing.

• Make sure everyone who touches the baby washes his or her hands frequently.

• Keep your baby away from young children. Keep your baby away from crowds.

• Do not allow anyone to smoke near your baby.



Home Safety

Preventing Poisoning

• Store poisonous products and medicine out of the sight and reach of children. A locked

cupboard is the best choice.

• Keep products in their original containers with the original label.

• Do not use food containers to store cleaners or chemicals.

• Use child-resistant packages. Nothing is childproof.

• Never call medicine or vitamins candy.

• Be extra careful during the holidays, when away from home or while moving.

Have the numbers of your child’s doctor and the poison control center near your

telephone.

Treating Poisoning

If your child has eaten a poison or medicine, check your child’s mouth and remove any

you can see. Pediatricians no longer recommend Ipecac.

Call the National Poison Control Center (800) 222-1222. Don’t wait to see if the

child will be all right. Call for help. Poison control will ask your baby’s age, weight,

what was ingested and how much. Have the poison container with you when you call.

Other Safety Tips

• Never leave your baby alone with young children or animals.

• Do not leave your baby unprotected in the sun.

• Never leave your baby alone in a car. A baby left unattended may get too hot in summer

or too cold in winter.

• Never put plastic bags on your baby’s mattress. Keep plastic bags in a place that your

baby cannot reach.

• Do not pour or carry hot liquids when your baby is close by.

• Plug or cover all unused electrical outlets.

• Place safety latches on cabinet doors.

• Consider installing a carbon monoxide detector.



Fire Safety

Never leave your baby at home alone — not even for a minute.

Keep rope ladders on upper floors to help you escape in case of fire.

Locate several escape routes from each level of your home, including your baby’s room.

Agree on a meeting place outside for your family members.

Call the fire department for advice on smoke detectors and fire extinguishers for

your home.

Baby Walkers and Child Safety

Baby walkers are dangerous. Many babies are badly injured each year using a walker.

Most of these babies are between 7 and 10 months old. Most of the injuries happen at

home. Protecting a baby from danger becomes even harder when the baby uses a walker.

A stationary activity center is a better option for your baby for short periods of time.

Long periods of use may lead to delays in your baby’s development. If you don’t own a

baby walker, don’t buy one.

A playpen, stationary activity center or highchair are safer choices. To reduce the chance

that flat spots will develop on your baby’s head, provide supervised “tummy time” when

your baby is awake. Tummy time helps your baby’s head, neck and shoulder muscles get

stronger. Avoid too much time in car seats, carriers and bouncers.



Car Seat Safety

Choosing a seat for your baby:

• The best seat is the one that fits your baby, fits your car, fits your budget and that you

will use correctly every time.

• Know the seat’s age, crash history and model number to verify that the seat is not under

recall. Be sure all parts and pieces are present.

• We will check your car seat before you go home to make sure it is safe and approved for

use.

Car seat checks are held throughout the community. Ask your nurse for details.

• Your baby may need car seat testing before you take your baby home. This is an

American Academy of Pediatrics policy on safe transportation of premature low birth

weight babies.

• We’ll ask you to bring in your baby’s car seat to evaluate your baby for breathing

problems while in the car seat.

• This test will tell if your baby is safe to travel in a car seat or if they need a special car

seat.

• Review the handouts on car seat safety for your

baby.

• Read and follow the instruction manuals for both

the vehicle and the car seat.

Most crashes occur close to home and on roads with low speed. When used

correctly, car seats can prevent injury and save lives. Correctly buckle the car

seat into the vehicle and get the right fit. The back seat is the safest location

for baby. NEVER use a seat that has been involved in a crash.

Watch Car Seat Safety DVD.


Things to Know Before You Go

Th

ing

s to K

no

w B

efo

re Y

ou

Go



Welcome Home Baby

Life After the NICU

This is the day when you get to bring your baby home from the hospital! This event may

be filled with both happiness and fear. You may be scared about taking a fragile baby

home. These are normal feelings. The knowledge and skills you have learned while your

baby has been in the NICU will help you care for your baby at home. You will become

more comfortable and confident each day.

Besides having the nursery ready, you have a doctor for your baby. A summary of the

hospital stay from birth to discharge will be sent to the doctor. A summary will also be

sent to any specialists your baby may see for follow-up.

Feeding: Babies usually start taking all of their feedings by nipple as they get close to

going home. Sometimes parents worry about how much their baby should eat after they

go home. Our dietitian will talk with you about:

• How much weight your baby should gain during the first few weeks at home.

• How much your baby is likely to eat during this time.

• Where to find special formula your baby needs.

If you are enrolling your baby in the Women, Infants and Children (WIC) Program, we

will give you a prescription if your baby needs special formula.



Hepatitis B and Other Vaccines

Your baby’s Hepatitis B vaccine will be given before discharge. It is the first in a series

of three vaccines. We will give you a form that will help you keep track of your baby’s

vaccines and when the next are due.

Medicines

• If your baby will be going home on medicine, you will receive information about

each medicine.

• We will teach you how much medicine to give your baby and how to give it. You

will give your baby the medicine before you go home.

We can answer any questions you have. For example:

• Why is my baby taking this medicine?

• What do I do if my baby spits up the medicine?

• Will I hurt my baby if I give too much medicine?

• What should I do if this happens?

Here are some good rules to follow:

• Give all the medicines as directed by your baby’s doctor.

• Keep all medicines in a place children cannot reach.

• Use a standard medicine measuring spoon, cup, dropper or syringe to give

medicine. Do not use regular silverware or household measuring spoons to

estimate a dose. This could harm your baby.

• Do not give your baby over-the-counter or herbal medicines unless your baby’s

doctor says it is okay.

• Do not use old prescription medicines or another child’s prescription medicine.

• Store medicine properly. Some medicine may need to be kept in the refrigerator.

• Do not give medicine in the dark. Be sure you have enough light to read the label,

measure the dose and see that your baby gets the medicine.



Baby’s success at feeding and sleeping is important.

In the first one to two months at home, expect your premature baby to sleep a lot, but

for shorter periods. All babies, including premature ones, should be put to bed alone,

on their back and in a crib to reduce the risk of sudden infant death syndrome.

Most babies need eight to ten feedings with no more than four hours between

feedings. You may need to feed your baby during the night until your doctor tells you

they can sleep through the night. If you wait any longer, your baby may become

dehydrated. Six to eight wet diapers a day show that the baby is getting enough breast

milk or formula.



At Home with Baby

Expect to stay home with your baby at first. Because their immune system is still

developing, they are at risk for infection. For the first several weeks, visits outside the

home should be limited to the doctor’s office. This is especially important if your

baby leaves the hospital during the winter.

A doctor’s office usually has kids with viral infections in the waiting room. Try

scheduling your appointment at the first of the day or ask to wait in an examining

room. Talk with your doctor about limiting your baby’s contact with other children

and adults during these first weeks. Limit your baby’s public outings for the first one

to two months.

When Family and Friends Come to Visit

Friends and family will want to visit you when your baby comes home. They will

want to hold your baby and shower them with love and affection. They are well

meaning, but it may be too much for you and your baby.

• Do not let visitors disturb the baby’s sleeping or feeding schedule. Be firm.

• Only you and immediate family (or close friends) should handle your baby the

first few weeks at home.

• You can say something like “Dr. ________ said only a few people should

handle the baby the first month. This is to keep my baby from getting sick.”

This will help you not look over-protective or feel badly about having your

wishes carried out.

• No one who is sick should visit.

• Do not allow anyone to smoke in your home.

• Everyone needs to wash their hands or use sanitizer gel before they touch your

baby.

• You may want to request that anyone who visits have a flu shot and pertussis

vaccine.

Some visits may need to wait until your baby’s immune system grows stronger. Talk

to your doctor.



Taking Baby Out

Fall and winter months are bad for respiratory and flu viruses that could put your baby

back in the hospital. If you do take your baby out, avoid crowded places like shopping

malls, grocery stores, restaurants and religious services. Crowds increase your baby’s risk

of catching an infection.

Putting baby in a sling or front carrier will decrease your baby’s exposure to others. It

can be hard to control well-meaning people who want to touch your baby. This type of

contact will increase your baby’s risk of catching an infection.

Dress your baby according to the weather. If the weather is

cool, put a hat on your baby. Babies lose a lot of heat through

their uncovered heads. Dress your baby in about the same type

of clothing that you are wearing. Be careful not to overdress

your baby. On days when the temperature is above 80o F, a

blanket is usually not needed.

Babies can get sunburned easily. Avoid direct sunlight. Babies

should be moved under a tree, umbrella or stroller canopy. Talk

to your doctor before using a sunscreen on your baby if they are

less than six months old.

Take Care of Yourself

You will spend a lot of time caring for your premature

baby during the first few months at home. It is important

to be good to yourself. Having your baby earlier than

expected and in the NICU is very stressful. Accept offers

of help from family and friends to baby-sit your other

children, run errands or clean the house. This gives you

time to care for the baby and rest.

Treat yourself well by getting enough rest, eating well and

exercising moderately. Ask for support and

encouragement from doctors, nurses, veteran parents,

support groups or online communities. If you are

overwhelmed or depressed, get professional help for

yourself so you can fully enjoy your new baby.



Promoting Development and Parent Bonding

Babies need to adjust to their home and the new noises and sights. Premature babies may

respond less to you and their surroundings when awake. Premature babies may also spend

less time awake and are often fussier when awake.

During your baby’s hospital stay, you learned a lot about what works to comfort your

baby when they are crying or showing signs of stress. Your baby is unique.

Things You Can Do to Help Your Baby’s Development

One of the most important things that you can do to help your baby’s development is to

read to your baby every day. Babies who are read to every day do better in brain,

language and social development.

Talking, singing and playing music to your baby also helps brain development. The best

time to talk, read or sing to your baby is when they are quietly awake.

Often parents may hold their baby, talk on the phone, watch TV and

listen to the radio at the same time. All of this normal activity for

parents will create a stressful overload for your premature baby. Allow

yourself to unplug. Turn it all off and simply enjoy having your baby

all to yourself.

Thoughts from an NICU mom: Try very hard not to compare your baby with

term babies born around the same time. One of my cousins had a baby 2

weeks before Tyler was born. Sometimes it makes me very sad to see her

development and compare her to Tyler. I have to remember what Tyler went

through. They shouldn’t be the same age at all. There should be 4 months

between them — even if he had been born at term, they wouldn’t be at the

same place developmentally.

All children develop at different rates anyway. Give your baby some time to

catch up.



Home Environment

Keep the room where your baby sleeps at a comfortable temperature. Do not place your

baby under fans or near drafts. Signs that the house may be too cool or that your baby is

underdressed are your baby:

• Feels cool to touch.

• Looks pale.

• Is mottled or blue on their hands and feet.

Swaddling Baby at Home

Your premature baby will benefit from being swaddled at home for four to six weeks.

Follow these guidelines for safe sleep:

• Always place your baby on their back.

• Swaddle your baby in ONE thin blanket. A receiving blanket works well for this. Do not

use soft, fuzzy blankets.

• Dress your baby in a light sleeper or onesie. If the weather is warm or your house is very

warm, put your baby in a diaper only. Then swaddle her with a thin blanket. Your baby

should never be warm enough to sweat.

• The blanket should come no higher than your baby’s shoulders when you finish

swaddling.

• There should be enough room to fit two fingers between your babies’ chest and the

blanket. This will let your baby breathe comfortably.

• Do not put loose blankets, stuffed animals,

bumper pads or pillows in the crib with your

baby.

• Your baby should have a firm mattress with a

well-fitted crib sheet. Do not lay your baby on

soft, fuzzy blankets or on thick comforters. Do

not use pillow-top mattress covers.

• When your baby begins to wiggle out of the

swaddle or when your baby shows any signs of

attempting to roll, stop swaddling your baby.



Safe Feeding

Follow these guidelines when preparing your baby’s feedings.

• Wash and dry your hands.

• Clean the prep area thoroughly.

• Wash the bottles and nipples in hot, soapy water. Rinse well in hot water. Allow

to air dry.

• Bottles may be washed in a dishwasher. Follow the instructions on the bottles.

• Follow label instructions carefully.

• Make sure the formula container is not damaged and check the appearance of the

formula.

• Check the “use by” date.

• Warm the bottle in a bowl of warm water.

• Test the feeding before giving it to your baby. Let a few drops of formula fall on

the inner side of your wrist. The formula should feel cool or warm, but not hot.

• Do not warm the formula in the microwave. You could burn your baby’s mouth.

Feeding Your Baby

One of the benefits your baby receives from feeding is being close to you. This is a great

opportunity for parents to bond with their babies. When feeding your baby from the

bottle or breast, hold them so they can see your face with their head slightly above their

body. Adjust the amount of talking and stroking you do during feeding based on how

baby responds to it. Never prop a bottle to feed your baby.

Burping

Hold your baby upright over your shoulder

and gently pat him on the back until the extra

air comes up.



Enriched Formula

What is enriched formula?

Enriched formula is made for premature babies. Enriched formula has more calories,

protein, vitamins and minerals than standard formula.

How often should my baby eat?

At home, you and your baby will develop your own schedule for eating. Follow your

instincts. Find out what works best for you both. Babies usually tell us they are hungry by

starting to make sucking movements with their mouths and searching for something to

suck on. They fuss or cry. Feed your baby when they are alert and hungry before they

fuss and cry. It may be only two or three hours between feedings, or it may be four to

four and a half hours. If your baby goes four and a half hours or longer between feedings

more than once a day or eats less than six times in a 24-hour period, baby may not be

eating enough. You know your baby is getting enough to eat if they gain at least five

ounces each week.

During the first few months after leaving the hospital, premature

babies often grow much faster than they did in the hospital.

Studies show that this “catch-up” growth is more likely to happen

when babies take enriched formula. Bones tend to be stronger.

Head growth is better, showing better brain growth.



Signs of Illness

You may be wondering how you will know if your baby is sick after going home

from the NICU. You are the best observer of your baby’s health. Signs of illness

may include:

• Baby’s breathing becomes harder.

• Baby’s color is pale or blue.

• Baby is too quiet or too fussy (not acting right).

• Baby cannot be calmed easily by your usual means.

• Baby is floppy, limp or not as active as usual.

• Baby is sleeping much more than usual or is hard to wake up.

• Baby eats poorly two feedings in a row.

• Baby throws up more than usual.

• Baby has many watery stools or diarrhea.

• Baby does not have as many wet diapers as usual.

• Baby has an under-arm temperature above 100 degrees F.

Call your baby’s doctor if your baby shows any of these signs of illness. It is best to have

your baby checked or to get the advice of your doctor.

Information you need to tell the doctor:

• Your baby’s name and age. Your last appointment date and any concerns noted at

that time.

• Why you think your baby is ill.

• Baby’s temperature and how you measured it.

• Current medicines your baby is taking. This includes prescriptions and over the

counter.

• Recent immunizations.

• The name and phone number of your pharmacy.

• Remind the office that your baby was in the NICU.

Have a paper and pen ready when you call the doctor. You can write down appointment

information and instructions.



Vaccines Vaccines help your child fight diseases. Vaccines are given by injections (shots) into a

muscle, typically the thigh. There may be mild reactions like a fever or soreness at the

injection site.

The American Academy of Pediatrics suggests premature babies receive vaccines on the

same schedule as full-term babies. Your baby’s doctor will decide with you the best

schedule for your baby.

For information about recommended childhood vaccines, visit

www.healthychildren.org/immunizations.

Circumcision Care Circumcision is the surgical removal of the foreskin (the skin covering the tip of the

penis) so that the head of the penis is exposed.

For the first 24 hours after circumcision, the penis will be red and swollen. Healing takes

about one week.

To clean the circumcision, squeeze warm water from a washcloth over the penis and pat

dry. Do not use packaged baby wipes to clean the circumcision. They contain alcohol that

would cause baby pain. Do not rub the area or use any soap. This could also cause pain

for baby.

For the traditional circumcision, use petroleum jelly on a piece of gauze. Place this on the

tip of the penis with each diaper change. Do this for the first few days.

If your baby has a Plastibel™

device, do not use petroleum jelly. The head of the penis

may show signs of irritation. It will look white or yellow in places or look purple-red and

slightly swollen as it heals. This is the normal healing process.

When to Call the Doctor

Watch for signs of infection. Call your baby’s doctor if you notice yellow, pus-like

drainage, swelling, or bleeding. If your baby cannot pee, call the doctor immediately.

Care of the Uncircumcised Baby

Care of the uncircumcised boy is quite easy. “Leave it alone” is good advice. Wash and

rinse your baby’s penis every day. Do not pull back the foreskin if it does not slide back

easily. Forcing the foreskin back may harm the penis. It could cause pain, bleeding and

scar tissue. The natural separation of the foreskin from the tip of the penis may take

several years.

http://www.healthychildren.org/immunizations.



Bronson NICU Graduates

Our staff would like very much to see you and

your baby if you are at Bronson. We invite you

to bring your baby back to visit us. We would

also like to have a picture of your baby after

they have been discharged. If you send us one,

we will put it in our staff lounge. Our mailing

address is:

Bronson Methodist Hospital Attn: NICU

601 John Street, Box 43

Kalamazoo, Michigan 49007

Giving Back to Bronson

After families have experienced Bronson’s

NICU, they often want to assist other

families. There are many ways to support

NICU families:

• participation on our Bronson Children’s

Hospital advisory council

• participation on our Patient and Family

Advisory Council

• volunteering for various NICU projects such

as the parent mentor program, NICU

reunion, or making blankets and hats

We also welcome contributions from donors

interested in helping support our work.

Contributions can be made through the

Bronson Health Foundation, c/o NICU,

301 John Street, Box C, Kalamazoo, MI

49007.

NICU Glossary


NICU Glossary

Antibiotics: medicine to fight infection.

Anemia: a low number of the red blood cells that carry oxygen.

Apnea: a long pause or temporary stopping of breathing that lasts longer than 20 seconds. Apnea is

common in premature or ill babies.

Bilirubin: by-product of red blood cell breakdown that causes jaundice. It may be harmful to babies

if there are large amounts in your baby’s blood. High levels of bilirubin will turn the skin a

yellowish color (jaundice).

Blood Gases: a test done on a small amount of blood. It lets the doctor know how well the lungs put

oxygen into the blood and remove carbon dioxide from it.

Bradycardia: a heart rate that is 80 beats per minute or lower.

Cyanosis: bluish color of the lips and skin due to a low level of oxygen.

Desaturation: term for decreased oxygen in the blood.

Edema: a collection of extra fluids in the body, especially in the skin.

Electrode or leads: a small pad placed on the skin and attached to a monitor to measure breathing

and heart rate.

Encircled bed holding: a special way of holding when the baby must stay in bed. The baby is

moved close to the edge of the bed and the parent sits next to the bed and encircles the baby with

their arms/hands placing their face as close to the baby as possible.

ET Tube (endotracheal tube): a breathing tube passed through the mouth into the trachea and

connected to the ventilator.

Extubate: to remove the breathing tube from the trachea.

Fontanel: the soft spot on a baby’s head.

NICU Glossary


NICU Glossary (continued)

Gavage Tube (also called OG or NG): a thin, plastic tube that is passed through the nose or mouth

into the stomach. It is used to give formula or breast milk, give medicine or to take out stomach air

or contents.

Gavage Feeding: feeding the baby through a gavage tube.

Gestational Age: the number of weeks your pregnancy lasted.

Glucose: a sugar that gives energy to your baby.

Gram: a metric unit of weight; 1000grams = 1 kilogram= 2.2 pounds.

Hand hugs: placing hands firmly around and over the baby to help them feel safe and secure.

Heel Stick: a method of getting a blood sample by pricking the baby’s heel.

Hematocrit (also called CRIT): the measure of the number of red blood cells in the blood.

Hemoglobin: a protein carried by red blood cells. It picks up oxygen in the lungs and delivers it to

the body’s tissues.

Hep-lock: a device to give medicine or IV fluids.

Incubator: a closed bed that can be set at a temperature and humidity to keep

your baby warm.

Intubation: putting a breathing tube through the mouth into the windpipe to help the baby breathe.

This tube is connected to a ventilator.

Intravenous (IV): a special plastic tube or needle put through your baby’s skin into a vein. Most

IVs are put into the hand, arm, foot, leg or head. They are held in place with tape. IVs are used to

give fluid or medicine.

Jaundice: yellow coloring of the skin and eyes due to bilirubin in the blood.

Kangaroo care: a method of caring for babies in which the infant is held skin to skin with a parent

for as many hours as possible.

Lumbar Puncture (LP): the process of inserting a needle into the lower spinal canal to remove

fluid for analysis. This fluid helps to diagnose illness.

Meconium: dark green or black stool. It is the first stool the baby passes.

NICU Glossary



Memory Monitor: a special monitor that records any alarms (apnea and bradycardia) to be

evaluated by a doctor.

Monitor: a machine that measures the baby’s heart rate, respiratory rate, and sometimes blood

pressure and oxygen levels.

Mucus: secretions in the lungs, mouth, or nose.

Nasal Cannula: small plastic prongs in the nostrils that carry oxygen through the baby’s nose.

Nasal CPAP (Continuous Positive Airway Pressure): air or oxygen given under pressure through

the nose to help keep the lungs from collapsing when baby breathes out.

Newborn Screen: a group of tests required by law for every baby. It uses a small blood sample to

find medical problems.

Non-nutritive breast-feeding: the baby suckles at the empty breast for practice but does not take

breast milk into their mouth.

NPO: term meaning that no feedings are given by mouth or tube.

Nutritive breast-feeding: the baby suckles at the full breast in attempt to drink breast milk.

Oxygen: the part of the air our body uses. The normal air we all breathe has about 21 percent

oxygen. Up to 100 percent of oxygen can be given.

Phototherapy (Bili Light or Bili Blanket): special light to help breakdown bilirubin so it can leave

the body in the stool or urine.

Pulse Oximeter: a sensor wrapped around a hand or foot to tell us blood oxygen levels.

Retractions: a sinking in of the skin between a baby’s ribs as they breathe. This means the baby is

working harder to breathe.

Safe Sleep: program to encourage parents to have their baby sleep alone, on their

back on a flat, firm surface in their own crib or bassinet.

Sepsis: an infection of the blood or other tissues.

Spell: term that often refers to apnea or bradycardia.

Swaddling: to wrap a baby in a cloth that supports the baby in the fetal position. This position offers

the baby comfort and support.

NICU Glossary



Tachycardia: heart rate faster than the normal.

Tachypnea: respiratory rate faster than the normal.

Thermoregulation: keeping the body temperature stable.

Transient Tachypnea of Newborn (TTNB): condition resulting in fast breathing because of fluid

in the lungs.

Umbilical Artery or Vein Catheter: a tiny tube inserted into the blood vessels in the baby’s belly

button (umbilicus) to give the baby fluids or get blood samples.

Ventilator: a machine that is used to help the baby breathe.

Revised March 2020

Documents

Bronson Children s Hospital Neonatal Intensive Care Unit · 2020-04-20 · Introduction bronsonhealth.com 4 Introduction Welcome to the Neonatal Intensive Care Unit (NICU) at Bronson