NICU Nuggets: Be in the Know

Let’s begin with two basic ideas. First, the neonatal intensive care unit (NICU) is not where anyone chooses to be. And second, should your newborn have to visit the NICU, you want a team of experienced people there.

Dana Braxton, a mom of two from Overland Park, knows these truths too well. She jokingly refers to herself as a “repeat offender,” having experienced the NICU with not one, but both of her children, Myles, 4, and Will, 1.

“You go through every emotion possible,” says Braxton, who owns a business called Stretch-n-Go that teaches preschoolers about fitness. “I think every NICU mother feels guilt, guilt that you weren’t able to adequately protect your child.”

Only about 10 percent of infants nationwide visit the NICU. Rarely can your doctor predict whether your baby will end up there or not. Most of the time, says Dr. Dena Hubbard, a neonatologist with Sunflower Neonatology Associates in Overland Park, newborns’ visits to the NICU are for reasons that could not have been prevented. A woman may go into labor early. (Any baby born at a gestational age less than 38 weeks is considered premature.) Even in a perfect pregnancy, the transition from life in-utero to life ex-utero can be just plain traumatic.

“It just happens,” says Hubbard. “It’s not anybody’s fault.”

When Jessica Howlett’s second child, son Liam, was born at 34 weeks with Down Syndrome, Howlett knew a NICU stay was inevitable. A neonatologist herself, Howlett was caught in a web of emotions.

“It’s hard,” she says. “You can plan for all you can think of and still be surprised.”

Aside from being born early, issues with breathing and eating are the most common problems that land an infant in the NICU.   

“Every day [in utero] matters,” says Hubbard. “We want to keep the woman pregnant as long as is safe for her and the baby.”

According to the American Academy of Pediatrics, the NICU comprises four levels of newborn care. Ranked from least to most critical, they are:

Level I – Well baby nursery: a nursery for infants who were born at 35 weeks or later and are stable. While this level is not technically classified as a NICU situation, it lays a foundation for healthy newborn care.

Level II – Provides care for infants born at 32 weeks or later and who weigh more than 3 lbs., 2 oz. Breathing support is required on a short-term basis (typically for 24 hours or less).

Level III – Provides care to all infants with a critical illness. This level relies heavily on subspecialists to treat acute problems. For example, pediatric surgeons perform delicate surgeries, and pediatric ophthalmologists handle eye problems.

Level IV – The regional NICU is specially designed for newborns with the most critical needs, such as heart surgeries and ongoing mechanized support for the heart and lungs. Children’s Mercy Hospital is the only hospital in Kansas City that operates a Level IV NICU.

While lengths of stay in a NICU vary from infant to infant, Hubbard says a baby’s due date is often a good gauge to estimate how long an infant’s stay will be. For example, if a baby is born at 36 weeks (three to four weeks early), a parent can tentatively plan on that newborn’s being in the NICU for three to four weeks.

“The NICU is definitely not what anybody dreams of,” says Hubbard. “It’s not what you want to happen, but when it does happen, you’re really glad the NICU team is there.”

Communication is crucial every step of the way, agree both Braxton and Howlett. “Things can get to be a blur,” says Braxton. “You just put your faith in the nurses and the doctors.”

“There are so many people to help you through everything,” Howlett says.

Support groups, such as the Circle of Hope at Overland Park Regional Medical Center, are available to families with NICU needs.

“Our goal is a healthy baby,” Hubbard says. “We treat these babies like they are our own. When they get sick, we share that. We share the heartbreak and the joys with them.”

Hubbard says she encourages parents to think of a NICU stay simply as a detour to get a healthy baby home.

 “Babies that land in the NICU are born to parents who have done everything perfectly,” she says. “Parents have an active job on the NICU team that no one else has. It can still be a beautiful experience.”

The NICU: A Glossary of Common Terms

C-PAP (continuous positive airway pressure): a breathing machine that supplies a steady, gentle airflow.

ET or ETT (endotracheal tube): a breathing tube that goes through the mouth or nose into the windpipe.

HFV (high-frequency ventilator): a machine that provides hundreds of little breaths per minute.

Incubator: an enclosed plexiglass box that protects a baby from temperature changes.

NG (nasogastric) tube: a feeding tube that goes through the nose to the stomach.

Neonatologist: a pediatrician who specializes in treating sick newborn babies.

Neonatal nurse practitioner (NNP): a nurse practitioner who specializes in the care of sick newborn babies.

Pulse oximeter: a tool that measures the oxygen level in a baby’s blood.

Radiant warmer bed: an open bed with a heating device.

Kate Meadows, a mom of two in Louisburg, writes about parenting, family and inspirational topics. Her most recent essay appeared in Chicken Soup for the Soul: Multitasking Moms. You can find her online at or on Facebook at Kate Meadows Writing and Editing. 

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