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The "NICU rollercoaster ride" refers both to your baby's progress in
the NICU, which many NICU parents experience as "two steps forward, one step
back," as well as to your own emotional state. Some preemies experience a "honeymoon
period" of two days to two weeks where things go fairly smoothly before
the rollercoaster ride begins. Some preemies continue to improve even after
the honeymoon period, although almost all babies will experience several setbacks
during their NICU stay.
Here is an overview of what you and your family might experience in the first
forty-eight hours after your PROM preemie is born.
- APGAR scoring. One minute after birth, your health care team will
determine whether your baby needs resuscitation by evaluating his or her activity,
pulse, grimace (reflex irritability), appearance (skin color), and respiration
(APGAR). An APGAR score of 7-10 is considered normal; a score of 4-7 usually
requires some resuscitative measures; and a score of 3 or less will require
immediate resuscitation. Your baby will have a second APGAR evaluation five
minutes after birth, and may have a third or fourth evaluation, depending
on the two previous scores.
- Ventilator. If your baby is having any difficulty breathing, he or
she will probably be placed on a ventilator immediately.
- Seeing your baby. In most cases, you will be given at least a quick
peek at your baby before he or she heads to the NICU. Plan to have someone
else in the room take a quick photo of your baby with you and your
partner or spouse before your baby is taken to the NICU. That person can also
take any other photos that are important to you, such as a photo of all of
your babies together if you are having multiples.
- Religious or cultural ceremonies. If there is a religious or cultural
ceremony that must be performed immediately after birth, such as a baptism
or blessing, it can be performed before your baby leaves for the NICU unless
other circumstances require your baby to be taken to the NICU immediately.
Make sure your health care team is aware that you are planning for this ceremony
to take place.
- Who goes where, and when. Soon after delivery, your baby will be
taken to the NICU and will likely be placed under a "radiant warmer" (a small
open bed with a light and warmer above the baby) so the neonatologist can
access the baby easily during the first hour or so. Afterwards, your baby
will be moved from the radiant warmer to an isolette. Your partner or spouse
will likely be allowed to accompany your baby to the NICU and can take photos
for you if you wish. You will remain in the delivery room to complete delivery.
Afterwards, you will probably be given a couple of hours to recover before
you are moved to the postpartum unit or other recovery area.
 It
may be several hours before you are allowed to visit your baby in the NICU for
the first time. Your baby will likely be in a room with several other babies,
unless your baby needs to be isolated because of an infection or other circumstance.
Before you are allowed into the NICU, you will be required to
wash your hands very thoroughly. Some NICUs will require you to wear special
clothing. When you see your baby for the first time in the NICU:
- Your baby will most likely be lying in an isolette, which is a bed
that is covered with plexiglass and has small doors that open to fit your
hands into. It is heated and humidified inside.
- Your baby may have an umbilical IV, arterial IV (inserted into his
or her wrist, ankle, or groin), or a central line (inserted in the
neck, chest or groin) to administer food and medications. Note that in some
instances, an IV will be inserted into a vein in the baby's head.
- Your baby may also be attached to a number of wires to monitor his
or her heart, temperature, oxygen saturation, and blood pressure.
- Your baby may also have a feeding tube in his or her nose (known
as a nasogastric or NG tube) or mouth (known as an orogastric or OG tube).
- You may also see a vibrator or massager in your baby's isolette,
which may be used under your baby's back or on your baby's chest to loosen
up secretions in his or her lungs.
Also, because most PROM preemies do not have fully developed lungs at birth,
your baby will likely be using one of these types of breathing equipment:
- A ventilator attaches to your baby's breathing tube and uses pressure
to either breathe for him or her completely, or assist him or her with breathing.
Babies on ventilators will have a normal, in-and-out rhythmic breathing pattern.
- A high frequency oscillating ventilator (HFOV or oscillator) is a
ventilator that is gentler on your baby's lungs. Babies on high-frequency
ventilators receive smaller quantities of air at lower pressures than a regular
ventilator. The air is administered in rapid pulses and your baby may appear
if he or she were getting a vibrating massage.
- A continuous positive airway pressure (CPAP) machine is a less invasive
way of helping babies breathe than a ventilator. Rather than forcing air into
a baby's lungs through a breathing tube, CPAP forces oxygen or room air through
the baby's nose using a special nasal cannula. The pressure from the CPAP
keeps the baby's lungs inflated after he or she exhales, but the baby initiates
each breath himself or herself.
- Babies who can breathe entirely on their own but require additional oxygen
may have a nasal cannula placed in his or her nostrils. The cannula
allows oxygen or room air to flow to the baby, without the pressure of the
CPAP. Alternatively, some babies who can breathe on their own use an oxygen
hood which is a clear plastic shell that encompasses the baby's head and
delivers oxygen without the pressure of CPAP.
- Your baby's oxygen saturation levels will be monitored to determine how
well he or she is processing the oxygen he or she inhales. If your baby's
oxygen saturation drops below 90%, the NICU staff will give your baby additional
oxygen. Oxygen saturation is monitored via a wire attached to your
baby's hand, wrist, foot, or toe and the sensor is usually rotated every 12
hours. The NICU staff can show you the monitor that displays the oxygen saturation
measurement, as well as how to use the other machines to check it for accuracy.
Next page >> Article by Jodi Donnelly, Mommy to Anthony PROM @ 16
weeks, born in 2004 @ 31.5 weeks, 41 days in NICU and now thriving
and Kay Squires, september 2005
Special thanks to Inkan, Jen, Jody, Lise, Sonya, Valerie, Beth and the members
of the PROM list
© 1998-2024 Inkan, The PROM Page
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