The NICU: Understanding the NICU Equipment and Environment

The Neonatal Intensive Care Unit, is also called a special care nursery, newborn intensive care, or an intensive care nursery. Babies who need treatment in the NICU often arrive there within the first hours after birth. The NICU is uniquely equipped to treat problems during delivery, premature birth or health complications after birth, such as HIE.

Hospitals will have a variety of facilities, so not every location will have the same NICU tools and equipment. NICU facilities also have different care levels that indicate the type of care they can provide. 

• Level I: Provides basic resuscitation, postnatal care, and stabilize infants that need transfer to a higher level facility 
• Level II: Cares for moderately ill or premature infants, recovery after intensive care, and stabilization before transport
• Level III: Equipped with life support, very premature babies, respiratory treatments, and advanced imaging. 
• Level IV: Provides the highest level of care, including complex surgery, unique pediatric specialists, and other emergency services for critically ill infants

• Neonatologist: A pediatrician who has additional training for care of premature or sick babies.
• Neonatology fellows and medical residents: Students receiving training at different levels in neonatology.
• Medical Specialists: Doctors who treat specific health issues in different areas of the body. For example, a neurologist treats health conditions related to the nervous system.
• Head NICU Nurse: The nurse in charge of all nurses in the NICU and the quality of care provided by the NICU.
• Assistant NICU Head Nurse: Assists the Head Nurse and completes daily nursing tasks in the NICU.
• Charge Nurse: The nurse who manages the shift nurses each day.
• Assigned Nurse: The nurse whose job it is to care specifically for your baby.
• Respiratory Therapist: The professional who manages the breathing equipment and gives infants respiratory treatments.
• Occupational Therapist: The professional who consults with parents and works with infants on movement or feeding issues.
• Social Workers: Social workers offer emotional support to families and help them get the services they need.

The NICU environment is different from any other unit in the hospital. Many different medical personnel come in and out of this unit. It is a very controlled environment with special NICU equipment and machines present. Babies need to have very little stimulation in their first few days after birth. Ill and premature babies need an even more secure place to receive care.

If someone is visiting an infant in the NICU, the e staff may instruct them to speak softly and maintain a sense of calm during their visit. They may need to leave the room at times when the room is heavily populated by medical personnel who need to work with one or many of the infants. All visitors to the NICU contribute to a positive environment for the health and wellness of all of the babies present there.

Incubators: Incubators are clear plastic cribs that keep babies warm and protect them from germs and noise. These allow medical personnel access to the baby for treatment while minimizing potential environmental health risks.

Radiant Warmer: A bed for infants used instead of an incubator if the baby needs handling more often. The bed has an overhead heating source to give the baby extra warmth.

Blood Pressure Monitor: A blood pressure cuff connected to a machine. It automatically takes the baby’s blood pressure at regular intervals.

Cardiopulmonary Monitor: A machine connected to the baby by monitoring pads on his or her chest. This machine measures heart rate and breathing rate.

Transcutaneous Oxygen/Carbon Dioxide Monitor: A small circular pad attached to the baby’s skin. This monitor measures the baby’s oxygen and carbon dioxide levels. The transcutaneous monitor needs to heat the skin in order to get these measurements, so it is moved to different areas of the baby’s skin periodically. There may still be a small red mark on the skin after this monitor has been removed, but the mark will fade.

EEG Monitor: A machine which monitors brain waves and can alert staff if the baby has a seizure.

Bili Lights/ Phototherapy Lights: Bright blue lights over the baby’s incubator which are used to treat jaundice.

Intravenous Line: Tubes that deliver nutrients or medications directly into the baby’s bloodstream. In infants, these lines are inserted with an IV commonly placed in the arm, leg, or scalp.

C-PAP (Continuous Positive Airway Pressure) Machine: A method of administering air to the baby’s lungs. This breathing machine uses tubes inserted into baby’s nose or mouth and through the windpipe. The tubes are connected to a mechanical ventilator. The ventilator assists the baby with breathing rather than breathing for the baby completely.

Central Line: A small plastic tube connected to one of the baby’s large blood vessels. A central line delivers fluids and medicine and helps make blood draws easier.

Umbilical Catheter: A small tube inserted into one of the vessels in the belly button. This catheter is connected all the way to the aorta and can be used to draw blood and deliver necessary fluids, medications, blood, and nutrients to the baby.

Pulse Oximeter: A tool which uses a light sensor to check if the baby has enough oxygen in his or her blood. It is wrapped around the baby’s foot or hand and held in place with a band.

Endotracheal Tube: A tube placed through the baby’s nose or mouth and down into the windpipe to provide oxygen and warm humidified air.

Mechanical Ventilator (Respirator): This machine sends warm air and oxygen through the tube and monitors air pressure, breath quantity, and oxygen levels. This device is used to help the baby’s lungs recover by temporarily breathing for them.

Oxygen Hood: A clear plastic box which fits over the baby’s head and pumps oxygen to the baby.

Nasal Cannula or Nasal Prongs: Tubes commonly in conjunction with C-PAP machines. The tubes fit into the baby’s nostrils to deliver air.

Feeding Tube: A tube placed into the mouth or nose. It is connected to the stomach to deliver breast milk or formula to babies who are unable to eat.

Peripherally Inserted Central Catheter (PICC) or Percutaneous Central Venous Catheter (PCVC): Catheters used to deliver nutrition, fluids, and medication to babies through a central, or large, vein.

Temperature Probe: A device attached to the baby’s skin with adhesive and connected to an overhead warmer.  It regulates the baby’s temperature and keeps the baby warm.

Extracorporeal Membrane Oxygenation (ECMO): ECMO involves pumping blood from the baby’s vein through an artificial lung. The artificial lung removes carbon dioxide, adds oxygen, and then returns the blood to the baby. This technique is only used in very specialized NICUs for babies with severe respiratory problems.

X-ray: X-rays use electromagnetic energy beams to create images of bones, tissues, and organs. They monitor, detect, and diagnose many different health conditions, injuries, or disorders. They may be taken in the NICU with portable x-ray machines right at the baby’s bedside.

Ultrasound: Ultrasound machines use high frequency sound waves to create images of organs, tissues, and blood vessels. This visual tool is painless for the baby and is commonly used in the NICU to examine the structures of the baby’s brain, heart, and abdomen.

Computed Tomography (CT or CAT Scan): A CT scan uses a combination of x-rays and computer technology to create horizontal or axial images of the body. CT scans are more detailed than x-rays and require less exposure to radiation. CT scans in the NICU check for brain bleeds and require the baby to be in a special room for the imaging procedure. This type of imaging may also require sedation, because the baby must not move during the scan.

Magnetic Resonance Imaging (MRI): MRIs take place in a separate room. This type of imaging uses a large magnet, radio frequencies, and a computer to create images of structures inside the body. They acquire detailed images of the spinal cord, brainstem, and soft tissues. The baby may require sedation to remain motionless during the imaging.

• For a helpful visual tour of the NICU, visit BabyCenter’s visual NICU tour.
• For useful glossaries of equipment and terms used in the NICU, visit Virtua’s NICU guide.
• March of Dimes: NICU Equipment List
• Parent’s Guide to the NICU: Equipment
• Kid’sHealth: What are NICUs For?
• Care of Preemies
• NICU Procedures and Equipment

According to Medscape, the NICU has the necessary equipment to control the infant’s temperature, oxygen, heart rate, and more. Transporting an infant in need of NICU care requires more specialized equipment for the travel. 

Infants may require therapeutic hypothermia if they have hypoxic-ischemic encephalopathy (HIE). This technique improves neurodevelopmental outcomes and survival and must be done within six hours of delivery. It is possible that this will begin in transport, though it will likely be performed at the referring institution or once the transport team has arrived.

Here are a few methods for maintaining control of neonatal homeostasis during an ambulance ride:

• Thermal (Temperature) Control: Sheets or Polyethylene bags placed over the infant help to maintain body temperature during transport.
• Effects of Changes in Altitude: Flight crew members and medical control physicians must be knowledgeable of the effects that changes in altitude can have on infants in transport. Altitude can affect the internal pressure of gasses, drug metabolism, and other aspects of physiology.
• Ventilation and Airway Control: In order to provide ventilation on transport, medical teams can use hand-bag ventilation or transport ventilators.

Although medical personnel are always present in the NICU to care for the infants, parents have a special role all their own in caring for their babies.

Infants can often recognize the voices, smells, and touch of their parents. These aspects of care will help reassure and comfort the baby. Many medical professionals encourage parents to visit their infant often, and, when possible, touch and speak to them. Parents can hold, bond with, and breastfeed their infants during their time in the NICU when it is permitted by medical personnel.

Parents will need to wash their hands and don a gown before entering the NICU. They are often required to wear gloves when touching their baby.

Other ideas for parents to stay involved in their child’s stay in the NICU:

Tape a photo of you and your family to the incubator so your baby can sense your presence even when you aren’t able to visit.
Bring bodysuits or blankets from home that the baby can wear so he or she can become familiar with your smell.
Care for yourself by eating proper meals and getting enough rest.
Cuddle with baby when permitted. Kangaroo Care, where parents hold their premature babies upright on their chests for tummy-to-tummy time, has proven benefits. It can help new babies breastfeed, help increase bonding and intimacy, calms the baby, and helps increase weight gain (which can sometimes mean a shorter NICU stay).
Use cloth diapers so you can take part in cleaning and preparing them for the baby.
Breastfeed if permitted or pump if your baby is unable to nurse (if this is possible for the mother). Both parents may be permitted to participate in feedings as well.

Note: There are specific hours in which the NICU will not allow visitors, likely when the doctors are doing their rounds and shifts are being changed.

More information about a parent’s role in the NICU:

• 7 Tips for NICU Parents

Parent Guides for More Detailed NICU Information

• A Guide to the NICU and Special Care Nursery
• Project Sweet Pea: NICU Guide
• Baby Steps to Home: Preparing NICU Parents for Going Home

More on the NICU from ABC Law Centers: Birth Injury Lawyers

• 10 Coping Tips for Parents in the NICU
• NICU Errors and Medical Malpractice
• NICU Overview: Medical Issues That Necessitate a NICU Stay