Articles

Key takeaways

• Neonatal units offer different levels of care.
• Parents can bond with their baby and be involved in their care, even if they need medical support.
• Expressing breast milk can provide important benefits for premature or unwell babies.
• Seek support from staff, social workers, and parent groups whenever you need it.

Understanding the neonatal care unit

Neonatal units provide different levels of care for babies. The level of care your baby needs depends on factors such as their gestation, size and medical needs.

• Transitional care – when your baby is well enough to stay with you, either in the postnatal ward or in the neonatal unit.
• Special care units – these provide care for babies who need extra monitoring, support and treatment.
• Local neonatal units – these units provide special care, high dependency care, and some intensive care.
• Neonatal Intensive care units (NICU) – these units provide the highest level of care, including intensive medical and sometimes surgical care.

About a quarter of all babies in a neonatal unit receive intensive care.

If your hospital does not provide the level of care your baby requires, your baby may be transferred to another hospital. If you are still admitted to hospital, your team will try to transfer you with your baby if possible.

The medical team

A doctor who specialises in caring for newborn babies, especially those who are premature or unwell (a neonatologist) leads the care in the neonatal unit.

A doctor who specialises in caring for babies and children (a paediatrician) may also be part of the team.

A nurse who specialises in looking after sick or premature babies in hospital (a neonatal nurse) will care for your baby.

The neonatal unit environment

The special care baby unit can feel strange and confusing at first. It may have little natural light. You might hear beeping machines and see other parents and families.

Common equipment

Babies who are very small are often nursed in special beds that keep them warm (incubators).

You can still touch, talk to and bond with your baby while they are in an incubator.

Some incubators have open tops. Some have holes in the side that allow you to place your hands inside to touch your baby.

Your baby may have tubes and wires attached to their face and body. Your baby’s nurse will explain what they are for and how they help your baby.

Common treatments and what to expect

Babies in neonatal care may need various treatments. The medical team will explain these to you.

Respiratory support

Some babies need help with breathing.

A breathing tube may be placed through your baby's mouth or nose into their windpipe (intubation). This tube is connected to a machine that helps them breathe (a ventilator).

There are different types of ventilators:

• Conventional ventilators – gently push air (with or without added oxygen) into your baby's lungs through a breathing tube.
• High-frequency oscillating ventilators – deliver very small amounts of air (with or without added oxygen) into the lungs very quickly. These small breaths are given many times each minute.

Some babies are given surfactant, a medicine that helps keep the lungs open and makes breathing easier.

Your baby may be given continuous positive airway pressure (CPAP). CPAP delivers air through small tubes in their nose or a mask. The gentle pressure helps keep the lungs inflated while your baby continues to breathe by themselves.

Phototherapy for jaundice

Many babies develop jaundice, which can make their skin and the whites of their eyes look yellow.

Jaundice is treated using a special light called phototherapy. Your baby is usually undressed and placed under a very bright blue light, often inside an incubator. Soft eye pads or a special box protect their eyes.

Some babies can have phototherapy by lying on a special light-emitting blanket called a biliblanket.The light helps break down the chemical called bilirubin that causes jaundice.

Phototherapy will have breaks so you can feed, change and cuddle your baby.

If their jaundice does not improve, intensified phototherapy may be needed. This means using stronger light or more than one light source.

Feeding tubes

Babies born before around 34 to 36 weeks often need help with feeding. They may not yet have developed the coordination needed to suck, swallow, and breathe safely at the same time.

If your baby needs support with feeding, they may be given a feeding tube.

There are two common types of feeding tube:

• A nasogastric (NG) tube is passed through your baby’s nose into their stomach.
• An orogastric tube is passed through your baby’s mouth into their stomach.

Breast milk or formula can be given through these tubes until your baby is ready to feed by mouth.

Parenteral nutrition (PN)

Some babies need extra help getting the nutrients they need. They may receive parenteral nutrition (PN), a liquid mixture of nutrients given directly into their bloodstream through a vein.

PN contains a mix of nutrients, including:

• vitamins
• minerals
• carbohydrates
• proteins
• fats

PN is often used for babies who are born very early or who are too unwell to take enough nutrition through feeding. If PN provides all of your baby’s nutrition it is called total parenteral nutrition (TPN).

Your role in your baby's care

Being involved in your baby's care and decisions is important. It can help you feel more confident and prepare you for caring for your baby at home.

Bonding with your baby

It is natural to feel anxious if your baby needs special care. You can talk to your baby, as they will recognise your voice. This can help both of you.

Once your baby is stable, you will be able to hold them. Nurses can help you take your baby out of the incubator.

Skin-to-skin contact involves holding your baby close to you. They are usually dressed only in a nappy and placed under your clothes. This is also known as kangaroo care.

Skin-to-skin contact can:

• help you bond with your baby
• calm both you and your baby
• support breastfeeding
• keep your baby warm
• help regulate your baby's heart rate, breathing, and blood sugar levels

If you cannot hold your baby skin-to-skin, you can hold their hand or gently touch them. Any touch from a parent can comfort them and help you bond.

Involving yourself in care

Staff will keep you informed and involve you in decisions about your baby's care and treatment. Some treatments may also need your consent.

You can be involved in your baby's daily care. You may be able to change their nappy, wash them, and change their clothing.

Feeding your baby

Your baby may be too small or sick to feed themselves at first. Collecting your breast milk to be stored and given to your baby later is known as expressing breast milk. This can be done by hand or with a breast pump.

Your breast milk has particular benefits, especially for sick or premature babies. It contains important nutrients, including proteins, fats, and minerals. It is easy to digest and helps protect your baby from infections.

The first milk you produce is called colostrum. It is often thicker and more yellow, and it helps boost your baby's immune system. Around two to four days after birth, your milk will become whiter, and your breasts might feel fuller. This is when your milk is "coming in."

If you have a low milk supply, or unable to provide enough milk, the medical team may prescribe breast milk from a screened donor. Alternatively, a formula for preterm babies may be given.

Donor milk and fortifiers

For babies who are born very early or have a low birthweight, donor milk can help protect them from a serious bowel condition called necrotising enterocolitis(NEC). Babies born premature or sick may also need extra vitamins and minerals.

Your baby's doctor may prescribe a powder to add to your breast milk. This is known as a breast milk fortifier and helps with growth and bone development.

Emotional well-being

It can feel isolating to have a baby in the neonatal unit. It is normal to feel overwhelmed, anxious, or low.

Looking after yourself is an important part of caring for your baby. Sharing your thoughts and emotions with people you trust or a professional can be helpful. Many neonatal units offer emotional support services, such as counselling or support groups.

Getting information and support

The staff looking after your baby will ensure you receive information, communication, and support.

Communicating with staff

Ask the nurse to explain what everything is for and how you can be involved in your baby's care. Hospital staff should explain your baby's treatment and why it is being given. The consultant neonatologist or paediatrician should arrange to see you.

Emotional and practical support

It is natural to feel anxious. Talk over any fears or worries with the hospital staff. Hospitals often have their own counselling or support services. Charities also run support and advice services.

A hospital social worker may be able to help with practical issues, such as travel costs or support with caring for other children.

Support from family and friends

It is important to get support from your family and friends. If you have other children, try to get family and friends to help. Tell your other children what is happening and include them if you can.

You might find it useful to nominate one trusted person to communicate updates to a wider group of friends and family. This can give you more time to focus on your baby and your own wellbeing.

Staying with your baby

Some neonatal units may be able to offer accommodation for parents to stay near their babies overnight. Staff will help you stay together whenever possible. If you and your baby are separated due to a transfer to another hospital, staff will arrange transport for you.