The Neonatal Intensive Care Unit can be a frightening and intimidating place for the uninitiated. Parents whose baby is admitted to the NICU have no choice but to confront the scary images. Their baby may not look at all like the baby they had imagined due to premature birth or other factors, and their baby will likely be attached to all kinds of high-tech monitoring and life-sustaining equipment. It's a lot to take in all at once. Below are some pictures of what "real life" in the NICU looks like.
A tiny finger reaches out to curl itself around a father's finger. This 26 week gestation baby's hand (including fingers) is about as big as a quarter. Development of the senses and of neurological reflexes is well under way during gestation, although in most cases incomplete in premature babies. Still, premies respond to touch, voice, sound and motion. A healing touch is always welcomed, and bonding between parent and infant is critical to the baby's future well-being.
Weighing in at about one and a half pounds is this very premature baby (born at 26 out of 40 weeks of pregnancy). He is undergoing resuscitation in the Delivery Room and has a mask over his face attached to an inflation bag to supply him with oxygen. You can see the clamp across his umbilical cord, which has only recently been cut. If you look closely, you can also see he has a hat on, to help him stay warm in the Delivery Room. A good outcome begins with skilled resuscitation in the Delivery Room.
This premature infant is undergoing phototherapy to treat jaundice, or hyperbilirubinemia. The baby has a special protective shield over her eyes to protect them from the bright light. Jaundice is a very common problem among premies and is usually taken care of with a couple of days of phototherapy. The baby is also "nested" in a soft, developmentally appropriate boundary inside her bed. Premature infants like to be contained, with boundaries around them, which is how they are used to feeling when in the womb.
Born at 24 out of 40 weeks and weighing barely one pound, this baby was born at what Neonatologists call "the edge of viability." Survival for a baby born this early has improved tremendously over the years and is now about 50-60%; however, such babies are at risk to develop long-term developmental problems. The baby is connected to a ventilator to help him breathe. This picture was taken before artificial fingernails were prohibited among healthcare workers in the NICU; artificial fingernails were linked to the occurrence of hospital-acquired infections in immune-compromised premature infants.
This growing premie is snuggled comfortably in her nest. She has a nasal cannula to provide her with oxygen, and the tube in her mouth goes down to her stomach (orogastric tube). The purpose of the tube is to decompress her stomach, so it doesn't fill up with air as the oxygen is flowing into her nose and upper airway, and also to provide an avenue for her feedings, since she is not yet able to take a bottle or to breastfeed.
Kangaroo care, or skin-to-skin contact, has been an invaluable way to help improve survival of low birthweight and premature babies in undeveloped countries around the world. It helps keep babies warm, stabilize their heart rate and breathing, strengthens the parent-infant bond, and leads to earlier breastfeeding. In the U.S., kangaroo care is some of the best "quality time" parents get with their infants while they are in the NICU. Here, a mother is "kangarooing" her premature twins.
Nasal CPAP (continuous positive airway pressure) is a life-sustaining support treatment (and a good alternative to a mechanical ventilator) for all sorts of respiratory problems in the NICU, most often respiratory distress syndrome (RDS). In addition to having the nasal CPAP prongs in his nose, this premie has heart monitor leads on his chest and an orogastric tube in place. The dark dot near the baby's middle is the stump of the umbilical cord just about ready to fall off.
A special "thank you" to the parents who have graciously allowed me to use pictures of their babies on this page, on the cover of the book, and throughout the website.