Neonatal Intensive Care Unit (NICU)

The Neonatal Intensive Care Unit (NICU) serves infants who are premature, have low birth weight, or require special needs. Family-centred care is promoted and supported by all staff. 

As a team, we believe in open, honest communication and encourage you to ask questions and participate in your baby’s care; you are the most important person for your baby.

When your baby is in the NICU you will become accustomed to some of our daily routines which include:

Daily Interdisciplinary Rounds

Each morning Monday to Friday at 10:00 a.m. the neonatologist on call along with the nursing team, social worker, pharmacy, lab, child life specialist, LC and leadership round on each baby in the NICU and discuss the baby’s plan of care. We encourage parents to be a part of NICU rounds and feel free to discuss your baby and ask any questions you may have. If you are unable to attend the 10:00 a.m. rounds you have the option to connect to the NICU staff via FaceTime or Skype through our NICU Connect program.

Daily Weights
  • The babies in the NICU are weighed once a day. 
  • This weight is recorded before the first feeding on the night nurse’s shift.
  • Most infants will lose 5-7% of their birth weight for the first 5-7 days of life.
  • After this you can expect your infant to gain 10-20g a day on average.
Blood work
  • Blood work is collected on your baby to check on their status and to determine what type of treatments may be needed. 
  • For some infants blood work may need to be collected daily.  Blood may be collected by a lab technician, by your infants nurse or even by a physician.
  • The staff in the NICU does everything possible to collect all blood at one time to reduce the number of blood draws for your baby.
Line Changes
  • Total Parenteral Nutrition (TPN)/Peripherally Inserted Central Catheter (PICC) line changes are done daily at 1600
  • Line changes are done under sterile technique and during this time parents may be asked to stand on the other side of the curtain or wait in the Ronald McDonald room
  • Line changes take about 15-20 minutes to complete
Strands of Strength
  • Total Parenteral Nutrition (TPN)/Peripherally Inserted Central Catheter (PICC) line changes are done daily at 1600
  • Line changes are done under sterile technique and during this time parents may be asked to stand on the other side of the curtain or wait in the Ronald McDonald room
  • Line changes take about 15-20 minutes to complete
Taking Care of Baby

When your baby is admitted to the NICU we ask that you provide diapers, wipes, Vaseline, diaper cream, baby clothes, comb, nail file,  or anything else from home i.e. receiving blanket, pictures of family, music, that you feel the baby would benefit from. You may want to bring comfort measures that you may need when you are here in the NICU.

Parents can provide significant care for their child in the NICU.  Once the baby’s condition allows for it, along with your nurse we encourage you to participate in the following:

  • taking the baby’s temperature
  • changing diapers
  • holding the nasogastric (NG) tube during feedings
  • performing kangaroo care (skin to skin holding)
  • hand hugging (where you cup the baby’s head and feet as this is a very soothing and comforting position for them)
  • assisting with feeds
Feeding

NG/breast/bottle feeding (feeding plans)

  • Babies who have been admitted to NICU often require acute medical treatment which delays breastfeeding. There are two alternative feeding methods in NICU: Nasograstric feeding (NG) and Bottle feeding before breast feeding is established.
  • NG/OG tube: this tube is placed through the nose (nasogastric or NG) or mouth (orogastric or OG) to the stomach and is secured with tape. It is a way to feed the baby and release built up air and gas in the stomach.
  • Bottle with expressed breast milk or formula: both bottle feeding and breast feeding require coordination of suck, swallow and breathing. This may depend on your baby’s prematurity and corrected gestation. Research indicates that premature babies start to develop effective coordination by 32 weeks but is more developed by 34 to 35 weeks.
  • Daily weight gain is a good indicator as to whether baby has an effective feeding pattern/plan.
  • Your baby’s feeding plan is constantly revised in daily rounds and is based on baby’s status.

Pumping/storing EBM (pumping times)

Breast milk has every vitamin, mineral, and other nutritional elements that your baby needs. There is no formula that completely mimics the milk your body creates. Breast milk has many immunological properties that are your baby’s first protection against the germs he or she may be exposed to. However, babies in NICU may not always be able to breastfeed. For this reason, we encourage moms to pump every 3 hours.

Breastfeeding is a wonderful process that you and your baby will learn together. When you and your baby are ready to start breastfeeding, please know that it is a learning process for both of you and it may take a while to get the hang of it. The mechanics of breastfeeding are important, too. Your nurses are here to help with your breastfeeding questions. A Lactation Consultant is available to you; please check with your nurse regarding the schedule.

In the NICU, we provide a temperature controlled (2-5C) breast milk refrigerator at your baby’s bedside to store your expressed breast milk (EBM). We can accommodate up to 24 hours of milk supply.

Factors that influence your milk supply and successful breastfeeding

Although many medications and herbal products are safe while breastfeeding, some are not. It is always best to ensure that a prescription medication, over the counter drug or herbal remedy including teas is compatible with breastfeeding.

Breast pumps 

A breast milk pump is free to use while in the hospital, and Medela multiuse breast milk pump kits are available for purchase and rental:

Double breast pump kit $55

Freestyle double pump $499.99

Single swing pump $299.99

15% off coupon available with the purchase of an MSH Blue Book

Rental prices:

2 weeks $55

4 weeks $85

*For rentals, additional weeks are $30 per week or can opt for an additional 2 week rental at $55.  Prices do not include HST

Pumping Tips & Tricks

Don’t worry if it takes a few days of pumping before you see much milk. Once you move from hand expression to using the pump, you may see production stall. That’s normal. It can take five or six days for your milk to come in. Keep pumping regularly, record how much you’re getting, and if you have concerns contact the lactation consultant.  If you’d like to bump up milk production, try pumping more frequently. For example, pump every 2 hours during the day rather than every 3. It’s better to pump more frequently rather than for longer sessions. "Prime" the pump. Always drink a glass or two of water before pumping. Make a hands-free pumping bra by cutting holes in an old sports bra.

 

Formula

For mothers who do not have enough breast milk supply yet, NICU has formula available for babies while in hospital

Avoid wearing underwire bras; the pressure can encourage blockages. Encourage milk flow by massaging before you pump, which can stimulate the "let down" of the milk. Warm compresses can help ease blockages and get milk moving. Hot water in a diaper can be effective; some moms use a sock filled with rice that they heat in a microwave. You can pump either at your baby’s bedside or in the Care by Parent room if you are staying there. The most important tip is if you have any questions or concerns, talk to your nurse or Lactation Consultant. And remember... pumping can be challenging, but the rewards are great.

Total parenteral nutrition (TPN)

  • TPN is an IV solution that contains nutrients to help your baby grow when your baby is not able, or just starting to feed.
  • TPN contains water, mineral, carbohydrate, fat, protein, vitamins and trace minerals to meet your baby’s daily caloric requirements.
  • TPN can be given via peripheral intravenous, umbilical venous catheter (UVC) or peripheral inserted central catheter (PICC).
  • When you baby is on TPN, she/he will require blood work few times a week to make sure the correct amount was given.
Developmental Care/Environment
  • When babies are first admitted to the NICU, they are frequently placed on open beds with overhead warmers, which help maintain their body temperature. These beds also allow easy access to provide various medical procedures and/or treatments that your baby may need. Once your baby needs less assistance, he/she may be placed in an isolette (incubator). These beds provide warmth and allow for close observation for your baby.

    All babies admitted to the NICU are placed on a cardiac and/or SpO2 (saturation) monitor and this monitors your baby’s heart rate, respiration rate and oxygen saturation. The monitor is only one component of your baby’s overall assessment. Your nurse will be happy to show this monitor to you and explain how it works.

    All of the NICU monitors are connected to each other and are centralized to a main computer at the nursing desk. If a monitor is alarming for a baby in another part of the unit the alarm will show up on every screen, so the nurses know which alarms are ringing no matter where they are. In the same way, a nurse can look at any monitor screen to see if your baby is okay and take any action your baby needs.

    Every baby develops at his or her own pace and a baby’s development is delicately timed by nature. The following is a brief overview of baby’s senses and corresponding activities that are appropriate for premature babies:

    Vision
    As babies mature they begin to open their eyes, focus on faces and objects and stay awake for longer periods of time to protect your baby’s developing eyes from bright lights, we suggest gradually removing the incubator cover and keeping the lights dim. FACT: visual acuity is 20/400 t birth.

    Hearing
    Babies prefer low, soft sounds and all babies are calmed by their parents’ voices as your baby matures they will be ready for soft rhythmic sounds like soft music or quiet singing.

    Touch
    Infants respond to tactile stimulation in different ways. Infants who are medically unstable require as gentle handling as possible. Parents are often the most appropriate caregivers to provide touch interventions such as supportive holding and when ready skin to skin/kangaroo care. We do not advise light strokes or feather touching but rather place a firm, cupped hand on his/her head or legs then remain still with a firm, constant pressure.

    Smell
    Even young babies have well-developed senses of smell and will be comforted by their parents’ unique scents holding your baby close is one way for him/her to get to know your scent. You can also keep your scent near your baby by wearing a soft cloth next to your skin then keeping it in your baby’s bed close to their face.

    Sleep

    Sleep is very important for all babies but especially premature babies. They need a lot of sleep to promote growth and development. Even babies born near their due dates sleep 16-20 hours a day. The team will minimize handling and therefore combine their care giving tasks during wakeful times to maximize sleep for your baby.

Respiratory Syncytial Virus
  • Respiratory Syncytial Virus (RSV) is a virus that infects the lungs and airways (breathing passages).  RSV can affect anyone of any age, but it is most common in infancy and early childhood. Almost all children will have been infected with RSV by the age of 2 to 3 years. RSV infections tend to occur from fall to spring in Canada, but the season may vary.

    RSV is usually a mild disease that goes away on its own.  In premature babies and in children less than 2 years old with certain lung conditions or congenital heart disease, RSV can lead to serious infections of the lungs, like pneumonia or bronchiolitis (as swelling of the bronchioles – the smallest passages of the lungs). When this happens, babies can become very sick and may require hospitalization.

    The Ontario government offers a series of monthly injections with a vaccine-like medication called palivizumab (Synagis®) to protect babies who are most at risk for developing complications from a RSV infection,however, not all babies are eligible.

    If your baby is less than 33 weeks gestation, he/she will most likely qualify to receive Synagis® during RSV season either in hospital, your pediatrician’s office or in the RSV clinic at Markham Stouffville Hospital. If your baby is born between 33 and 36 weeks gestation, a questionnaire will be completed by your nurse to determine whether or not your baby is eligible.

    Even if your baby is not eligible to receive Synagis®, there are other ways to help reduce your baby’s risk of developing an infection from this highly contagious virus:

  • Wash hands with warm water and soap or alcohol hand rinse before touching your baby and ask anyone who touches your baby to do so as well
  • If you have a cold or fever, gently hug instead of kissing your baby and practice frequent hand washing
  • Keep anyone with cold symptoms or fever away from your baby
  • Try to keep your baby away from crowded places (such as daycare, malls, large family gatherings, etc.)
  • Do not allow your baby to be around smoke and keep your home smoke-free
  • For more information about RSV, please visit and/or ask a member of your baby’s multidisciplinary team.

Care Providers
  • Registered Nurse – Your baby will be cared for by a registered nurse who has specialized knowledge in caring for babies who are in the NICU.  During your baby’s stay in the NICU, you will have the most contact with the RN’s caring for your baby and will be able to answer the questions you have and provide you with an update on the progress of your baby.

    Lactation Consultant (LC) – The Lactation Consultant (LC) is a registered nurse with specialized training in breastfeeding.  The LC’s are able to provide information and answer your questions on pumping and breastfeeding your baby.

    Registered Respiratory Therapist (RRT) – A registered respiratory therapist has specialized knowledge and training in all areas of respiratory care.  If your baby requires additional respiratory support, an RRT will help the team choose the best method in providing support for your baby.

    Social Workers– Our Social Workers are part of the interprofessional NICU team.  They can help you and your child with personal, social, emotional and financial needs you may be experiencing following your baby’s admission to the NICU.

    Pediatrician – A doctor who specializes in pediatrics help to assess your babies’ needs and requirements on a daily basis with the consultation of the registered nurse that is caring for your baby.  As a team including the family will help the growing and development of your baby while in the NICU.

    Neonatologist – A neonatologist is a pediatrician with an advanced knowledge and skill set in caring for babies who are critically ill.

    Pharmacist – Another team member is the pharmacist; they help to provide consultation such as dosages, frequency and the best medication(s) for your baby.  They can also help to answer questions that you may have about the medications your baby is on.

    Child Life Specialist (CLS) – At Markham Stouffville Hospital, the Child Life Specialist (CLS) is an integral member of the healthcare team.  The CLS assists in helping your baby through their developmental stages and meeting their milestones through play and tummy time.

Going Home

Although many medications and herbal products are safe while breastfeeding, some are not. It is always best to ensure that a prescription medication, over the counter drug or herbal remedy including teas is compatible with breastfeeding.

CPR

It is highly recommended parents to take CPR course prior to discharge. You'll learn techniques for handling a life-threatening emergency – if an infant/child is choking or isn't moving or breathing because of a fall or a near drowning. The techniques are different for babies and older children, so it is important to learn both.

The following are various websites that provide information on how and where to take the course:

St. John Ambulance   http://www.sja.ca/

Red Crosshttp://www.redcross.ca/what-we-do/first-aid-and-cpr

Heart to Heart http://www.heart2heartcpr.com/?gclid=CO2f6__9lLkCFek7MgodpkQAQg

Vital CPRhttp://www.vitalcpr.com/

Follow-Up Care

Babies who have required care in the NICU may require additional follow up appointments after discharge such as:

Early physician follow up (within 1-2 days) Neonatal follow up clinical referral

 

It is recommended to have a pediatrician who is more familiar with premature babies’ millstones and growth patterns, if possible.

  • Early intervention referral
  • Eye examination referral

 

Going Home

Although many medications and herbal products are safe while breastfeeding, some are not. It is always best to ensure that a prescription medication, over the counter drug or herbal remedy including teas is compatible with breastfeeding.

        Asking Questions

        While your baby is in the NICU, please ask as many questions as you need to understand what is happening to your baby. Your baby’s nurse will be the best person to ask as they spend the majority of time caring for your baby.

        Keep a Questions Journal
        We suggest that you keep track of information and questions in a notebook or journal. This will help you to review and digest this information.

        Self Care

        When your baby is in the NICU it is important to remember to take proper care of yourself so that you will have the energy to take care of your baby. Remember to take it easy and to listen to what your body is telling you.

        Sleep / Relaxation

        Try to catch up on sleep when your baby is sleeping If you are having difficulty sleeping, try and find things that work for you, i.e. Warm bath/shower, herbal tea, listening to music Taking time for relaxation may help decrease stress and anxiety (deep breathing, meditation, progressive muscle relaxation).

         

        Lifestyle

        Allow yourself ‘time out’ each day. Having things in your day that are enjoyable ‘just for you’ may help. A great stress buster also. A short walk can do wonders for your energy levels and decrease fatigue. Regular gentle exercise such as walking, swimming, yoga, tai chi and dancing can help relieve muscle tension as well as mental tension. Endorphins (feel good chemicals) are released which can help to elevate mood levels.

        Exercise

         

        Social Support

        You may need additional support in the first few months. Possible sources of support could include: family, friends, neighbours, mother’s groups, church group, community centres, maternal child health nurse and your GP.

        Healthy eating/Drinking

        Do I need extra calories while breastfeeding?
        Yes, you might need to eat a little more — about an additional 400 to 500 calories a day — to keep up your energy.

        What foods should I eat while breastfeeding?
        There is no need to go on a special diet while breastfeeding your baby. Instead, focus on making healthy choices to help fuel your milk production. Opt for a variety of whole grains as well as fruits and vegetables.

        How much fluid do I need while breastfeeding?
        It is important for breastfeeding moms to stay hydrated. Be sure to drink frequently, preferably before you feel thirsty. Have a glass of water nearby when you breast-feed or pump for your baby. Aim to drink at least eight glasses of water or other liquids a day.

        Pain Management:
        When recovering from a vaginal delivery or c-section it is important to take your pain medication as directed.  This medication has been prescribed to you to help you heal and is safe for breastfeeding/pumping mothers.

        Sibling Adjustment to the NICU

        As part of our Family-Centered Care approach, we want to help you take care of the needs of your older children with baby brothers or sisters in our NICU. It is important to support your other children and make sure they know they are loved and cared for, too. Having a sick or premature baby in the NICU can be made easier for children when they know why their baby brother or sister is staying in the hospital. This is best done in simple words with only a few details. You can tell them the baby isn’t ready to come home from the hospital yet and must stay until they are well enough and/or big enough to come home. It may also help to let them know the baby is being well cared for by the doctors and nurses.

        Children may need to talk about their feelings. Normal and common feelings can include:

        Anger – the new baby is getting all the attention Confusion – not understanding what is wrong with the baby or why she has to stay in the hospital Embarrassment/shame – the new baby is different from other babies Fear – worry that the baby will not get better, fear of parent’s actions (crying, yelling) Guilt – feeling that the illness or prematurity is their fault Loneliness – Mom and Dad are not home as much, and they are left with a baby sitter more often

         

        Taken from:  http://lifeslittletreasures.org.au/prematurity-resources/support-for-families/survival-guide-to-nicu-and-care/siblings-of-premature-infants/

        Storybooks can also be a useful way to help explain to siblings (depending on age) what is happening with their baby brother or sister and what they can expect when they visit the NICU.

        In our NICU we have two available to borrow: No Bigger Than My Teddy Bear by Valerie Pankow and Waiting for baby; A sibling visits the NICU by Jennifer Bracci.

        Children may change their behavior, which can be normal while your baby is in the NICU. If this lasts a long time or keeps getting worse, ask your child’s pediatrician to suggest resources that may help. Children may go through changes such as:

        Acting out to get attention or relieve stress Being well behaved to win back your love/attention or make things better Having trouble eating or sleeping Complaining of feeling hurt, sick or in pain Bed wetting or other bathroom problems Acting younger than they really are Withdrawing from you or other family members.

         

        Where to Eat, Rest, & Relax

        We understand that this may be a stressful time for you and your family.  Rest assured that we here at Markham Stouffville Hospital are here to support you through this experience.  While spending time with your baby in the NICU, there are places that you can visit to rest, relax and to eat.

        Ronald McDonald Room

        Care by Parent Room
        Located towards the back of the NICU are two care by parent rooms that you may wish to use during the day to rest, relax, sleep or pump.  There is a nominal fee charged for the use of these rooms.

        Druxy's/Cafeteria
        Located in Building A on the 1st floor. Offering fresh coffee, tea, juices, pastries, and lunch items.

        Tim Hortons - Available in the Main Lobby with full service

        Dale’s Pharmacy
        Located in the medical building.  At Dales not only are you able to fill your prescriptions and purchase over the counter medications but you will also find a selection of baby supplies and breast feeding supplies.  There are wipes, Vaseline, diapers, bottles, expressed breast milk storage supplies, nipple shields and other products that you may find helpful during your baby’s stay in the NICU.

        Waiting Room Café
        Located in the medical building by Dales Pharmacy.  Here you will be able to enjoy freshly prepared sandwiches, salads, soups and many others.

          NICU Glossary

          We use many medical terms in the NICU. Download a list of terms you may come across during your stay with us; you are always welcome to ask questions about anything you hear.