Neonatal Intensive Care Unit (NICU)
The CHI Health Neonatal Intensive Care Unit (NICU) is a special nursery where babies born prematurely or born at term with special needs are cared for around the clock by our specially trained multidisciplinary team. CHI Health has a Level III NICU at Bergan Mercy and Creighton University Medical Center and a Level II NICU at Lakeside in west Omaha.
Our highly secure NICU has private rooms that offer parents the opportunity to stay with their infant throughout the hospital stay. Our goal is the same as yours – to help your baby become healthy as soon as possible.
Conditions Treated in the NICU
A premature infant is a baby born before the completion of 37 weeks gestation. A premature infant has organs that are not fully developed. The infant needs special care in an intensive care nursery until the organ systems have developed enough to live without medical support.
Specialized care in the NICU is needed until the infant reaches a stable body weight and is able to feed by mouth, maintain body temperature and not have any apnea or bradycardia that require help. This period varies for each baby and may take weeks to months. The hospital stay usually extends to around the baby’s due date. In very small infants, other problems may complicate treatment and a longer hospital stay may be needed. Some examples of extended hospitalization could be apnea and bradycardia events, oxygen requirements, adjustments of medications and feedings.
Respiratory distress syndrome (RDS), also called hyaline membrane disease, is a breathing problem in newborns. It may start within minutes to hours after your baby is born. It is the most common reason babies are admitted to the NICU.
In premature infants the lungs may not make enough surfactant. Surfactant is a liquid that coats the inside of the tiny air sacs of the lung tissue. Surfactant keeps the tiny air sacs open so your baby can get enough oxygen as he breathes and get rid of the carbon dioxides. Without enough surfactant, the air sacs collapse and cause breathing problems. In infants born closer to term and those born to mothers with medical conditions or genetic factors, RDS is caused by immature lungs or impaired lung function. This impairment blocks the baby’s air sacs and decreases the lungs oxygen and carbon dioxide exchange.
Close monitoring of your infant’s heart rate and breathing rate will be needed. Treatment of RDS is based on the infant’s needs. Treatments range from close monitoring of the infant, providing extra oxygen, providing extra pressure to the lungs to help them work better and to doing all the breathing for the infant with a ventilator. As your infant gets better, the support provided for your infant’s breathing will be slowly decreased or “weaned”.
Apnea of Prematurity
Babies have a shallow breathing pattern, this is called periodic breathing. Apnea is a medical term that means a baby has stopped breathing for a short time. Apnea occurs in at least 85% of infants who are born at 35 weeks or less. Part of your baby’s brain that controls breathing has not matured enough to have regular breathing. Most experts define apnea of prematurity as a condition where the infant stops breathing for 15 to 20 seconds during sleep. The uneven breathing patterns may begin after two days of life and have episodes that can be present for to two to three months after birth. The breathing pattern for infants born early is short fast breaths, some slow deep breaths and short pauses in breathing. The lower the infant's weight and the more premature the infant is at birth, the more likely he or she will have apnea of prematurity.
When your baby has an apneic event they might also have a change in color (such as blueness around the mouth) or a drop in heart rate. Treatment for apnea depends on how long your baby’s pause in breathing is and how low their heart rate or color changes. Treatment options are observation, medications and techniques to open your baby’s airway and remind your baby to take a breath. As your baby matures, they will have less apnea events that will last shorter periods of time and not need the NICU team to help breathing.
Neonatal infection, also known as “sepsis,” is when the baby’s body has or is suspected to have germs in their body. These germs may be acquired prior to birth or after birth or any time while in the hospital. The infection can be from bacteria, a virus, a fungus or a combination of any of these types of germs. The infection may involve several parts of the infant’s body or may be limited to just one organ (such as the lungs with pneumonia). Signs of infection are not specific; changes in heart rate, temperature (usually cold), breathing, feeding, activity (some get fussy, some get very sleepy), cry. Blood tests are commonly performed to evaluate for an infection. A urine and spinal fluid tests may be needed to help guide treatment. The initial diagnosis of sepsis is determined by how the baby looks and acts. It is important to begin treatment before the results of tests are available. Babies need different types of treatment when fighting an infection and close monitoring. Specific treatment and support for your baby will be discussed with you by the NICU team.
Jaundice is a condition that makes a newborn’s skin and the white part of the eyes look yellow. Jaundice is one of the most common conditions requiring evaluation and treatment in newborns. It happens because there is too much bilirubin in the baby’s blood. Bilirubin is a substance made when the body breaks down red blood cells. This is a natural process of the body to get rid of old red blood cells so the body will produce new red blood cells. This process happens in all humans. During pregnancy, the mother’s body removes bilirubin from the baby through the placenta. After birth, the baby’s body must get rid of the bilirubin on its own. The baby’s liver is too immature to handle this at first. Bilirubin backs up and causes a yellow coloring to the skin. The body gets rid of bilirubin in urine and stool. For most newborns, it is a benign temporary condition and usually is not a problem. In some cases, too much bilirubin may be caused by infection, a problem with the baby’s digestive system, or a problem with the mom and baby’s blood types. Your baby may have one of these problems if jaundice appears less than a day after birth. In healthy babies, some jaundice usually appears by 2 to 4 days of age. It usually gets better or goes away on its own within a week or two without causing any health problems. When a baby has a yellow coloring to their skin, blood is drawn for a bilirubin level. There are a couple treatments for jaundice. Increasing fluids or using a special light called phototherapy are the two most common.