The birth of a baby is a wonderful and joyful experience for any parents. At the same time it can be a very complex process. Many physical and emotional changes occur both in mother and baby. Importantly the baby must make many physical adjustments to life outside the mother's womb. Leaving the mother’s womb means that baby can no longer depend on the mother's blood supply and placenta for important body functions.

Baby in a neonatal intensive care unit (NICU)

Before birth, the growing baby entirely depends on mothers blood supply through placenta. Majority of the work of the fetus like breathing, nutrition is taken care by placenta. When a baby leaves the womb, its body systems must change. For example:

• The lungs must breathe air.
• The heart and lung blood circulation changes.
• The digestive system must begin to process milk and excrete waste.
• The kidneys must begin working to balance body fluids and chemicals in the body and excrete waste.
• The liver and immune systems must begin working on their own.

Your baby's body systems must work together in a new way. In some cases, a baby may have some difficulties in making this transition. Preterm birth, a difficult birth, or birth defects can make these changes more challenging. With advent of science, these challenges can be met. 

What is Neonatal intensive care unit (NICU)?

Newborn babies who require intensive medical care are often put in a special area of the hospital called the neonatal intensive care unit (NICU). The NICU has advanced technology and trained healthcare professionals to give special care to the tiniest babies. Some hospitals don’t have the staff for a NICU and babies must be moved to another hospital. Babies who need intensive care do better if they are born in a hospital with a NICU than if they are moved after birth.

Which babies need special care?

Most babies admitted to the NICU are preterm (born before 37 weeks of pregnancy), or have low birth weight (less than 2 kg), or have a health condition that needs special care. Twins, triplets, and other multiples often are admitted to the NICU. This is because they tend to be born earlier and smaller than single birth babies. Babies with health conditions such as breathing difficulty, heart problems, infections, or any other birth defects are also cared for in the NICU.

Below are some factors that can place a baby at high risk and increase the chances of being admitted to the NICU. High-risk factors include the below.

Maternal factors include:

• Being younger than age 18 or older than age 40
• Diabetes
• High blood pressure (hypertension)
• Bleeding
• Multiple pregnancy (twins, triplets, or more)
• Too little or too much amniotic fluid
• Premature rupture of membranes (also called the amniotic sac or bag of waters)

Delivery factors include:

• Baby did not cry at birth (fetal distress or birth asphyxia)
• Buttocks delivered first (breech birth) or other abnormal position
• The baby's swallowed first stool (meconium) passed during pregnancy into the amniotic fluid
• Umbilical cord wrapped around the baby's neck 

Baby factors include:

• Baby born at gestational age of less than 37 weeks or more than 42 weeks
• Birth weight less than 2,000 grams or over 3500 grams
• Birth defects
• Respiratory distress including rapid breathing, grunting, or stopping breathing (apnea)
• Seizures
• Low blood sugar (hypoglycemia)
• Need for special treatment or procedures such as a blood transfusion

Who will care for your baby in the NICU?

Specially-trained healthcare providers who take care of NICU include:

Neonatologist. He/She is a pediatrician with additional special training in the care of sick and premature babies. The neonatologist supervises pediatric fellows and residents, nurse practitioners, and nurses who care for babies in the NICU.

Neonatal fellow/Pediatric resident. This is a pediatrician getting extra training in the care of sick and premature babies. He or she may do procedures and direct your child's care.

Neonatal nurse practitioner. This is a registered nurse with extra training in the care of newborn babies. He or she can do procedures and help direct your child's care.

Lactation consultants. These are healthcare providers with extra training and certification in helping women and babies breastfeed. They can help with pumping, maintaining milk supply, and starting and continuing breastfeeding.

NICU team members work together with parents to create a plan of care for high-risk Newborns