• The Hamot Women's Hospital
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• Neonatal Intensive Care Unit (NICU)
• Pediatrics
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Neonatal Intensive Care Unit (NICU)

Babies admitted to the neonatal intensive care unit (NICU) need special care. The need for this type of care and the technology can be hard to understand and accept. We help parents and other family members to understand treatment and plan of care for baby. Our NICU staff is ready to answer questions and support families who are dealing with the natural emotions of having their precious loved one in a special care area. Even though your baby can't go home just yet, your baby's birth is still a very special event to be shared with people who love and welcome him or her into the world, and into your family.

The NICU team is made up of many health care professionals with special training and skills. Most of them have continuous contact with your baby. Others come to the NICU only when asked to examine or treat the baby and consult with the doctors about special problems. These professionals work as a team, discussing your baby's needs and progress. Some of the team members include:

Neonatologist- Leader of the NICU team; a pediatrician with special training and skills in the care of premature and sick newborn babies (neonates).

Pediatrician - A physician who specializes in the care of infants and children.

Neonatal nurse practitioner - A RN who has completed an advanced educational program in neonatology and works under the direction of the neonatologist.

Visiting NICU

After entering into the main lobby of Hamot Medical Center, take the elevators in the North Complex to the third floor. Enter the large doors across from the elevators and walk past the regular nursery. Enter the door to the NICU and introduce yourself to the person at the desk. You will be shown where to leave your coat and wash your hands. Please keep purses with you. You will be responsible for any personal belongings.

Bonding with your baby is an important step on the road to going home! Visit as much as you can. We encourage parents to hold, touch and care for baby as his or her medical condition permits. Parents are allowed to visit anytime. Other friends and relatives may visit or view your baby if the medical condition and time permit. Parents will need to be present when others visit. If you are ill, please postpone your visit to the NICU. Masks can be provided if a parent has a cough, but if you have a fever, we encourage you to wait until your temperature is normal to visit. Cameras and camcorders are permitted. Many parents bring disposable cameras to leave at their baby's bedside.

Careful hand washing is required before entering the NICU and before and after infant care (such as diapering). This is the best way to prevent infection. We try very hard to provide a clean and germ-free environment for our patients.

We encourage you to leave siblings under two at home. If you must bring them with you, make arrangements to have someone accompany you that will be responsible for watching them. We want the time you spend with your baby to be entirely on your own.

Like a lot of NICU parents, your feelings may be jumbled, confused and not very pleasant at times. Some parents feel guilty, even though they are not to blame. Most feel anger too at some point. You may be shocked, or at least surprised, at how small and helpless your baby seems. You may feel a very strong need to protect him and you may want to cry. Cry if you want to anytime, any place, it's a necessary release. It may also help to bring a good friend or loved one the first time you visit the NICU.

You may feel as though the NICU nurses are doing your job. But really, it only seems that way. While the NICU nurses give life saving care, they rely on you to spend time holding your baby, talking to him or her and just making him feel loved. Your love is one of the most important things you can give your baby at this time. Your baby is learning to know your voice and touch, and you are an important part of your baby's recovery.

Make sure you know what to do when your baby is ready to go home. Before you take your baby home, our staff will teach you about caring for you baby and tell you about any follow up care your baby will need. They will talk about daily care, diet and any medicines you will need to give. Our staff is very supportive and will answer any questions if you do not understand.

Your Care

You can't control your feelings. In fact, you shouldn't try to. They help you work through the tough times that are part of life. They key is to use them in a positive way and not let them keep your from doing what's best for you and your baby. It is common to feel tension, anxiety and sadness after delivery. The sudden hormone changes are thought to be a cause of postpartum depression and could be adding to your feelings. It affects some women in different ways. Be patient with yourself and realize that what you are experiencing is normal. Talk with your doctor if you cannot seem to get over these feelings.

Resting and eating well can help you strike a balance between home and the NICU. That in turn will make you a better parent for your baby. Keep your rest and sleep schedules as close to normal as you can. At this time your body is stressed; too little sleep will only make it harder to regain the strength you need to take care of yourself and your baby. Feeling tired and being quick to anger could be signs that you need more rest. Accept help from friends and family. Take others up on their offers to care for your other children, clean your house, shop, etc. Save your energy for visiting your baby.

Keep a journal of your baby's progress and write down your feelings. Putting your thoughts on paper may make it easier to deal with them. Look at your baby's picture. Taking pictures of your baby will help you feel closer even when you cannot be with him. It will also help you to recognize his progress! Talk to family, NICU staff and friends; keep communication open with people who can give you comfort and strength.

Care in the NICU

To provide the special care your baby needs, NICU staff members are trained to watch his vital signs including blood pressure, temperature, breathing and heart rate. Most of the equipment you see around your baby is there to help the NICU staff keep an eye on his vital signs. If alarms or buzzers sound don't panic, the NICU nurses are trained to respond quickly. Much of the time, alarms are simply telling the staff to respond in order to avoid a problem.

Heart Monitor - A heart monitor is the machine used to monitor your baby's respirations. Small adhesive monitoring pads, referred to as "electrodes" or "patches" are placed on a baby's skin to detect chest movements as he breathes and to pick up the impulses of his heartbeat. Wires attached to the pads transmit this information to the heart monitor machine next to the baby's bed. If the baby's vital signs become abnormal, an alarm will sound which alerts the NICU staff.

Pulse Oximeter - A pulse oximeter is non-invasively monitor. It determines a baby's arterial blood oxygen saturation and pulse, and measures changes in the absorption of oxygen within the blood stream by using infrared light that passes through vascular tissue.

From the time of conception, your baby was nurtured inside the warmth of your body. At birth, he emerged wet into a cold world where he suddenly needed to regulate his own body temperature. A chubby, full-term baby who gains a pound of fat a week during the last weeks before birth is relatively well insulated. A premature baby, however, is very vulnerable to chilling.

A premature baby, especially a baby with breathing problems, is poorly supplied with calories and oxygen, the fuels he need to heat his body. Because of the potential dangers, a main objective of your NICU staff is to keep your baby warm but not too warm. Your baby's temperature must be carefully controlled in an incubator or warmer. A tiny device that acts as a thermometer is taped to your baby's stomach. It constantly senses your baby's temperature and regulates the temperature of the environment. It will increase the warmth when your baby gets too cool and decrease it when he's too warm.

A RH is a bed designed to keep your baby at the right temperature. Warmth is provided to your baby from a heat source above the bed.

Incubator - An incubator is a heated plastic box that you can see through. It provides a controlled temperature environment which helps to keep your baby warm and his body at the correct temperature. As your body varies in temperature, heat is increased or decreased appropriately.

By the time your baby is ready to go home, he will be sleeping in an open crib. He has matured enough that now he can maintain a normal temperature when dressed and covered with blankets.

Helping Babies Breathe

In the NICU, there are many methods and devices used to help support your baby's breathing, your baby's own special condition will determine which of these methods will be the most helpful for him.

Repiratory distress (RDS) - RDS is also know as hyaline membrane disease. This condition is common among premature whose lungs are not fully developed. Immature lungs do not produce enough surfactant, a soapy substance that lines the small air sacs in the lungs and allows them to open and close. If these sacs do not expand easily, the lungs cannot take in air and get the necessary oxygen to the bloodstream. Many premature babies are administered a surfactant drug directly into their lungs shortly after birth. This supplements the baby's own natural surfactant and can help relieve the symptoms of RDS.

Apnea - Often, a tiny baby breathes irregularly. For example, he may take several short breaths, stop breathing for a few seconds and then start breathing again at a normal rate. If a pause in breathing lasts longer than 15 to 20 seconds, it is called apnea. An apneic event is usually remedied with gentle rubbing or tapping on the arm or the leg to "remind" the baby to breathe. If a baby has repeated spells of apnea, he may be given extra oxygen.

A baby having frequent spells of apnea, or is too weak to breathe well on his own, may have to be intubated.

Endotracheal (ET) Intubation - An air tube placed to threaded through the mouth, down the throat and into the trachea to allow for the direct exchange of air and oxygen into and out of the baby's lungs. The endotracheal tube is connected to a respirator. This machine regulates the flow of air, oxygen and air pressure as it goes in and out of the lungs. The baby's breathing rate, flow of oxygen and pressure are controlled with settings adjusted by the doctors and respiratory therapists. Some of the tiniest babies may benefit from high frequency ventilation. Instead of delivering a normal rate of breaths per minute, this ventilator vibrates a baby's chest with up to 900 tiny puffs of air per minute. The lungs remain constantly inflated.

Nasal Prongs - Nasal prongs are used to help your baby breathe in a treatment called continuous positive airway pressure (CPAP). Through this procedure, pressurized air is delivered to your baby's lungs through small tubes placed inside your baby's mouth. This method uses a tube placed in the baby's nostrils. A constant flow of forced air through the tube into the lungs provides extra oxygen and mild pressure to keep airway passages open. The oxygen may also be delivered through a face mask or an endotracheal tube if necessary.

Oxygen Hood - An oxygen hood is used for babies who can breathe on their own, but still need extra oxygen. If high or precisely measured doses of oxygen are required a plastic box or dome, called an oxygen hood, is placed over the baby's head. Warm, moist, oxygenated air flows into the hood. An oxygen analyzer, placed beside the baby's head, double checks the amount of oxygen he is receiving.

Nasal Cannula - This is a plastic tube hooked to a device that can supply a controlled amount of extra oxygen. The tube goes under the baby's nose, it has two prongs inserted in his nostrils, and through the tube air with extra oxygen flows into his airway. Once your baby's respiratory distress has been successfully treated, he will be breathing room air. He will no longer need the assistance of machines or extra oxygen.

Going Home from the NICU

All Hamot NICU babies are checked in their car seat before discharge. Some babies also require a car seat test. This is done to ensure every baby is in a car seat appropriate for their size and weight and that they will be able to tolerate being in an upright position for the ride home.

Babies born prematurely or who have had other problems requiring a NICU stay may have breathing problems when they sit semi-reclined in a car seat. For this reason, your baby's doctor may order a car seat test one to two days before your baby goes home to make sure your baby can safely travel in a car seat.

The car seat will be placed in a crib and your baby will be positioned in the car seat with side and crotch rolls if necessary. The car seat test must be done in the unit so your baby can remain on the monitor. During the test, we ask you to not wake or play with your baby since this can alter the results. The car seat test will begin one hour after your baby has finished his or her feeding. Your baby will be in the car seat for a minimum of one hour. If it takes you longer than one hour to get home, the doctor may recommend a longer test period.

The test will monitor your baby for apnea, slow heart rate and decreases in oxygen saturation. If there are no problems during the testing, your baby has passed his or her car seat test. The nurse will report any problems your baby may have had to the doctor.

Please remember unless we have the proper car seat, we cannot do the testing. If you do not bring your car seat in before the day of discharge, your discharge may be delayed by several hours. You should bring the car seat and the base when your baby is in an open crib. Make sure you read and understand the directions for installation and use of the car seat. Make sure the car seat is clean and undamaged. If you have a used car seat, you need to make sure that you have the instruction manual, ensure all parts are intact and in working order and that the car seat has never been in an accident or recalled.

If you are not sure how to install the car seat in your car, you can take it to one of the checkpoints listed below. Nurses are not permitted to assist in securing the car seat or base in your car.

Northwest Regional Highway Safety Network (at Erie County Health Department)
606 West 2nd Street (by appointment only)
Call (814) 451-6717

Millcreek Police Department (for Millcreek residents, by appointment only)
Millcreek Township Building
Call (814) 838-9515

Pennsylvania State Police Barracks (first come first served)
Lawrence Park second Wednesday of the month 9 a.m. to 1 p.m.
Girard Station first Wednesday of the month 10 a.m. to 1 p.m.
Corry Station fourth Wednesday of the month 10 a.m. to 1 p.m.
Meadville Station fourth Wednesday of the month 4 p.m. to 7 p.m.
Franklin Station second Monday of the month 9 a.m. to Noon
Mercer Station third Wednesday of the month Noon to 3 p.m.
Forest Station first Wednesday of the month 10 a.m. to 2 p.m.

Buying a Seat

Take a tape measure to the store and remember to keep the receipt so the car seat may be returned or exchanged should there be a problem. You want to look for the following:

• The car seat should be an infant only car seat with a three or five point harness system.
  
• The distance between the shoulder strap and the seat bottom should be no longer than 10 inches. If your baby is premature, look for a seat that has a shoulder length of seven to eight inches.
  
• The crotch length from the back of the seat to the crotch buckle should be five inches or less.

A car seat is too big if either the shoulder straps are too high, even when they are inserted at the lowest point, and/or the space between the crotch buckle and the baby is too long. Your baby must properly fit in the car seat to provide the safety needed in case of a crash, to prevent your baby from sliding down in the seat and to prevent excessive side to side movement of their head and body

We cannot let your baby go home in a car seat that does not fit properly. If your baby requires a car seat test it can only be conducted with the correct car seat, this may mean you will have to purchase a different car seat. We have provided you with a list of car seats that most babies are able to use because they have smaller measurements.

To keep your baby from sliding down, the crotch buckle must fit securely between the baby's legs. A small rolled diaper may be used to take up some of the space but nothing larger can be used. One or two receiving blankets rolled lengthwise may be placed on each side of the baby to prevent the head from rolling. The insert for the shoulder straps have to be at the baby's shoulder level and fit securely over the baby's chest with the harness across the baby's upper chest.

Car Seat Options
Graco Snug Ride (birth to 20 pounds) - 5" crotch 7" shoulder
Century Avanta (birth to 20 pounds) - 6" crotch 7" shoulder
Evenflo Portabout (birth to 20 pounds) - 4" crotch 5" to 9" shoulder