Could My Newborn End Up in the NICU?


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By Dr. Margot D. Ahronovich


Dear Reader,

So, you’re having a baby? How exciting! There’s so much to look forward to, from cribs and diapers to breastfeeding, outfits, and toys!

Those are the things we all should be able to think about with a new baby coming. But sometimes, things get a little more complicated. For example, some babies are born prematurely, some babies might have some differences that require further monitoring or intervention, and some babies need extra support at birth. That’s what the NICU (Neonatal Intensive Care Unit) is for.

There are different levels of intensity for a NICU as well. For example, some hospitals are small and limit deliveries to those babies born at full-term gestation and with no significant high-risk factors. Those hospitals generally have a Level 1 NICU that can provide further stabilization and monitoring of a baby. Still, if the baby requires further care, they are usually transported to a higher intensity Neonatal Intensive Care Unit.

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Regional medical centers tend to have a Level 4 NICU that can care for virtually any newborn. These Neonatal Intensive Care Units are staffed with highly trained doctors, nurses, and multiple other specialized medical team members. They are equipped with the highest technology of medical tools to care for the sickest babies and the most premature infants. These hospitals include specialized Pediatric Surgeons and the ability to support a baby on ECMO (a heart-lung bypass machine).

Levels 2 and 3 NICUs vary in their capabilities but provide more intensive intervention, and the need to transfer a baby out is limited to highly complex cases.

The most common reason a baby ends up in the NICU is due to prematurity. Premature birth is defined as birth prior to 37-weeks gestation. In the US in 2019, almost 500,000 babies were born prematurely. There is a global incidence of prematurity of 10% of all births.

Not all premature babies require a Neonatal Intensive Care Unit admission. If they are smaller than about 4 pounds, they often don’t have enough body fat to keep them warm enough without special warming beds. They are less likely to be able to garner enough energy to eat enough to keep their blood sugar levels adequate or be able to hydrate themselves adequately.

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If babies are born prior to 35-weeks gestation, their brains are still maturing, and they often do not breathe as regularly as a more gestationally mature baby. Therefore, these babies are admitted to the NICU to monitor their respiratory and heart rates as well as their levels of oxygen to assure that they are safe.

Post-mature babies may end up in a NICU as well. In addition, babies born AFTER their due date may be distressed in utero as the placenta starts to dwindle in its ability to provide adequate circulation to the baby.

Distressed babies may pass their first stool in utero, which they subsequently breathe in with the amniotic fluid. This substance can clog up their lungs and make it harder for them to breathe.

Many babies born after a cesarean delivery will breathe fast for several hours to a few days. The amniotic fluid that babies breathe in-utero takes longer to get reabsorbed after a C-section. Some of these babies may need further oxygen support or IV fluids until their breathing patterns normalize enough so that they can eat effectively.

During their gestation, some babies are identified as having an anatomical difference and may require Neonatal Intensive Care Unit admission at birth. If your Obstetrician finds any differences in the development of the fetus, they often will request a further evaluation of the fetus by other medical professionals, e.g., a fetal cardiologist, if there is a concern that the heart may be structurally different.

Some regional hospitals have a Fetal Care Center, which can help families organize these specialized appointments and prepare for the birth of the baby. Ask your Obstetrician if this is indicated in your case.

Most babies do not end up in a NICU — most babies born are home within 48-hours of birth. There may be minor issues that require close surveillance, including jaundice, poor feeding, and/or temperature control that can be addressed as an outpatient with your pediatrician. But it is so helpful to feel prepared and to know what to look for when choosing your place of delivery.

Speak with your Obstetrician about your specific circumstances so that you know what to anticipate and be able to plan accordingly. Wishing you the best of health for both you and your baby (or babies, if you’re having twins!).

Sincerely,

Dr. Margot D. Ahronovich


The neonatologists, pediatric hospitalists, and nurse practitioners of Fairfax Neonatal Associates work at Inova L. J. Murphy Children’s Hospital, Inova Fair Oaks Hospital, and Inova Loudoun Hospital as an independent medical group devoted exclusively to provide the best possible care for critically ill newborns in the Neonatal Intensive Care Unit (NICU) and needed support to their parents and families.

The Neonatologists and pediatric subspecialists of Fairfax Neonatal Associates are also a part of the continuum of care at the Inova L. J. Murphy Children’s Hospital Fetal Care Center, where women who are at risk or suspected of carrying a baby with a fetal concern have access to maternal and pediatric specialists and surgeons conveniently on one medical campus. Learn more here.

Learn more about Dr. Margot D. Ahronovich, this post’s author here, and all of Fairfax Neonatal Associates’ providers here.



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