You just had your baby, yay, but now you are being told your little one will need to be spending time in the NICU. Today we are speaking with a NICU nurse, and we'll be answering all of the common questions you might have about NICUs. Thanks for joining us. This is "Newbies."

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our expert today is Theresa Hunt, who is a NICU nurse at a children's hospital in Northeast Ohio. Theresa, thank you so much for joining us. Please tell us more about your family and what got you in the work to being a NICU nurse. Hi. Thank you for having me. I am a single mother of two. I have a 10-year-old daughter and a 7-year-old son.

I've been a nurse for about I think a little over 10 years, maybe 11 years, and the last seven years I have been working in a level three NICU. Okay. I'm so excited. Really quick, so for those who don't know, what are the different levels associated with NICU care? So starting at level one would just be like a normal, like, nursery where they keep the babies.

Sometimes when you're sleeping, they do their normal exams. I believe a level two is more of a special care nursery. They might be able to do some sort of an IV and like some nasal cannula, a little bit of oxygen, but not, not anything more than the nasal cannula with the oxygen on the wall.

And then a level three, where I work, And then there's a age gap, too. I think a special care nursery would take babies, like, at 34 weeks and up or 32 weeks and up or something of that nature. Where I work, we take babies anywhere from 23 weeks and up, and we can do IVs, we can do heavy respiratory equipment.

We just don't do surgery. And then a level four NICU does everything. They do surgery. Yeah. So with a level four, I guess if someone gives birth at a hospital that doesn't have a level four NICU, do then the baby typically gets transferred? Does mom and pediatrician and parents, do they typically find out early on?

Yeah. So sometimes they can find out early on based off of different imaging and things that are done during pregnancy, or even if something occurs during pregnancy where they can kinda get a heads-up and know that mom's gonna be on bed rest for a while, or they need to you know, deliver early.

They can kinda be ahead of the game. At the hospital that I work for, we do deliver. So a lot of times if a mom is still pregnant and they have time, they will just transfer mom to our hospital before she has the baby, that way that they're already, you know, in the hospital and it's a lot quicker process to get baby.

Otherwise, they will transport baby to the hospital after the baby is born. I think this is so interesting. Yay. Okay. Well, we'll start diving into more of today's topic, but first, let's take a quick break. Today, we're discussing the first week inside the NICU and what parents might expect, and we have an expert here today.

So Theresa, first question for you. Tell us a little bit about your shift. I know we talked about the different tiers that hospitals could have, but do you work with newborn babies or babies who have been in the NICU for more than a few days, or kind of a combination of both? A combination of both. So depending on how experienced you are as far as, like, as a nurse in the NICU, how long you've been there kind of depends on what type of babies you will take care of.

We use the term feeder growers a lot, and that would refer to a baby that is not really requiring any more, like, medical equipment. They don't really need IV medication or IV fluids. They don't need respiratory equipment anymore. They are now just there to learn how to eat and grow until they're big enough to go home.

So a lot of times that's what our newer employees will start with and kind of learn that basic stuff. And then the longer you're there, the more experienced you are, the more of the different training classes that we have, and the more skill you gain. That's when you start taking care of the more critical babies that are maybe born a lot earlier.

They're a lot smaller. They require more IV medications and fluids, and they're on, like, respiratory equipment. Some of them might be intubated, where they have a breathing tube down their throat. So it kind of just depends. Since I've been where I am for seven years, I pretty much can do everything so depending on who's there, who had babies yesterday, you know, it depends-- it will depend on what kind of assignment I get.

So, I can do either I'll have a critical assignment where I have one or two babies that were, you know, on the critical side. I might have three babies that are all just kind of there to get a little bit bigger and grow. We have a position where you're the resource nurse, so you don't have an assignment.

You help the other nurses do different tasks if they need help, and then I go to the deliveries whenever they call and say that they need NICU at a delivery. So you kind of answered my next question a little bit, but why might a baby be taken to the NICU? And I'm sure there are more than, what, 10 dozen different reasons, honestly.

But name some of the common ones that you experience. And obviously, location and hospital change, but what are some things you see that, you know, a baby might need to be taken to the NICU? So, our automatic NICU admissions would be any baby that is born before 35 weeks. They have to come to the NICU.

If they're born above 35 weeks, they are allowed to stay with mom as long as they don't require respiratory support. We would give a baby an IV, say there was an infection risk and they need antibiotics, they would need an IV. Sometimes babies that are born to diabetic mothers, they're sh- they have issues kind of maintaining their blood sugar.

They come to us quite a bit to get replacement of the blood sugar through an IV. We have some babies that are full-term that don't transition well, so they need respiratory support. And then I think the last category, kind of generalized, would be a baby who whose mother was on drugs and the baby is now withdrawing So now they have to come to us also.

So we are talking a little bit about why a baby would go to the NICU. So I'm curious about working with parents, specifically new parents. This is their first baby. How are you navigating the conversations of kind of scary topics with new parents? So you kind of want to start with expectations. You know, you try to kind of let them know that, you know, everything that we're doing, you know, we see a lot and kind of what we typically see, and then sometimes you want to make sure you let them know, like, kind of what to expect.

I think that seems to kind of help people. Like, for an example, a lot of times our babies need IVs. They have really small veins. They don't always last very long. You know, as an adult, you go in the hospital, you get an IV, it might last you the whole time you're there. A baby's IV, depending on how active they are, could last a couple hours or a day.

So I like to tell parents, you know, when they have to get an IV, it might start out in the hand, but, you know, next time you come back, it might be somewhere else, and a lot of times we put them in the head. So I feel like doing stuff like that kind of helps prepare them for things that they might see so that they're not shocked when they come in, and kind of just give them something to look forward to as far as, you know, having that expectation and easing a little bit of the anxiety.

A lot of issue too with new parents is giving them an opportunity to do what they can. A lot of times you're not even able to hold your baby right away. So, you know, having them put their hands in the isolette and holding the baby's hands or helping you with a diaper change or even just offering a binky, those little things, you know, really kind of help start the bonding process, give the parents some control and, you know, feel like they're active in their baby's care.

And I can imagine the care would be different, obviously, for new parents if their baby was born at like 28 weeks compared to 36 weeks. Can you talk a little bit about the difference in care, generally speaking and not dire situations, but the care difference and how involved a parent could be?

Like, what are some things that they could ask to do if their child is born at 36 weeks and just needs a little bit of extra help? So, when they're born earlier they're typically with IVs. They usually have some sort of respiratory equipment. Depending on how early in the situation, they might not even be allowed to come out of the isolette.

But most times they can, and we coordinate that with, you know, the respiratory therapists and doctors, and they can do skin-to-skin still, even, you know, with all the things that they have attached to them. So I like to let them know, you know, when they can do that. Also letting them know you know, "Hey, you can kind of come in here," and asking for help.

Sometimes I let parents help weigh the baby when they're in their bed. You just lift them up and then put them back down, and sometimes I will ask them to help me with that, you know, things like that to help. And then as a baby's older, 36 weeks, you know, and that's a first-time parent, they might need to know, "Okay, how do I change a diaper?

I've never changed a diaper before." Or, "Let me show you how we give baths here," like a quick wipe down. And a big thing is feeding. Babies that are born early do not possess the ability to suck, swallow, and breathe all at the same time. So, it's kind of a process to learn. You know, you can't just sit the baby in the crook of your arm, put the bottle in, and wait till they're finished.

You know, either you really have to pay attention to, you know, are they breathing? Are they sucking? Making sure that they're not choking. You know, we have different positions that we feed them in, and really kind of learning those skills so that they can take their babies home safely would be more things that you work on, like with an older baby.

And getting into feeding, I guess depending on when a baby's born would determine the success rate, right? Of breastfeeding a NICU baby. I've heard so many positive stories, we have a whole breastfeeding podcast, about, you know, NICU babies having long, lovely breastfeeding journeys with their moms. Talk a little bit about that.

What conversations do you have with new moms who want to breastfeed their NICU baby, but for instance, I didn't know that they couldn't, you know, suck and swallow like a full-term baby. So, what type of conversations do you typically have with them so, we always ask when they're born, what is their plan?

Do you plan to breastfeed? Do you plan to, you know, kind of just do formula? If they plan to breastfeed, if their baby is not able to go to breast yet, we obviously, you know, give them everything we to pump and give encouragement on how to kinda keep their supply, and then they're exclusively, like, pumping for a good amount of time until the baby's old enough to eat.

Typically, even if they're not able to, like, eat, if they're not old enough yet, 'cause around 34 weeks, 32 to 34 weeks is when the doctors will say, "Okay, now they can start eating," and it's safe enough for them to, you know, swallow. We-- What we will do is have mom pump and then put the baby to an empty breast, and we call it nuzzling.

So baby's still getting tube fed, but they're able to start getting familiar with the smells, you know, licking around, and then that kinda mimics the sensation of breastfeeding even though they're not actually breastfeeding. Their bellies are getting full by the tube feed, while at the same time they're kind of, like, licking and learning and, like, practicing at breast.

We do have a lactation consultant that comes around and works with breastfeeding moms. We do weighted feeds a lot of time because while they're in the NICU, a big part of it is, you know, measuring feeds and looking at growth, so. I can't say, there are a few times when a mom has been able to exclusively breastfeed.

Those are more of the full-term babies that are kind of admitted for other issues. But as far as, like, the premature babies, we do allow parents to breastfeed and practice breastfeeding, and they can continue working on breastfeeds once they go home. But they do usually have to also work on bottle feeding because we have to make sure that the baby's getting the proper volumes for the proper weight gain.

So, they do a little bit of both with, you know, while they're admitted And I guess what can parents do? I'm imagining parents who know that they're going to, you know, have an induction early or a scheduled cesarean. So, what can parents do to prepare themselves for their baby being taken to the NICU?

What are, like, your top, I don't know, like two, three questions or four questions that you think they should definitely ask their NICU care team? So typically when they put in a consult for the NICU, one of our providers will go over to the mom if she's admitted, explain the process of what may or may not happen, you know, what the baby might need.

And then we also, if they're able to get up, they are allowed to come over to our unit. We do tours, kind of show them around, kind of give them a rundown of what to expect, which I think is really nice 'cause then when they do have to come, you know, they've already kind of gotten a, a lot of information.

I think the number one thing people wanna know is how long will the baby have to be there when can they expect the baby to come home. And a lot of times we try to say that there's an estimate of due date. It could be longer, could be sooner, but that's like a rough estimate that we like to tell parents.

And then I personally, a step further, like to tell them all the things that need to happen before the baby can go home. So, if the baby is small, if they're in an isolette, you know, they have to get big enough that they can be in a crib and maintain their temperature. They ha- you know, they have to be able to bottle feed without the supplement of, you know, tube feeding.

They have to come off of, you know, this respiratory equipment. Like, different little milestones they kinda have to cross in order to go home. And that just kinda lets the parents know that they're getting closer And I guess follow up to that is I've heard-- I've had a few friends who've had babies born premature.

Can you talk me through just a little bit about the adjusted age? I think that is so interesting, specifically when, in terms to milestones. I'm thinking of one of my old friends, and she kept saying like, "Yeah, my daughter is six months, but four months adjusted," or maybe I'm backwards and she's four months but six months adjusted.

I'm not really sure. Can you break that down for those who don't understand? So, so once they're born, like say the baby is born at 36 weeks if a week goes by, now they are adjusted to 37 weeks. And so even though that baby is a week old, they're the equivalent of 37 weeks. So that's, that's the way, you know, I best understand it.

So even though a child might be three months old, they're only adjusted, you know, based on how early they were born. So like a lot of times our babies stay anywhere from like, you know, a couple days to I think, I think three months is kind of like the max for our stays. A lot of times, two months for sure.

So, you know, you might tell your friend that, you know, your baby's two months old, but they're only corrected to, you know, 37 weeks if they were born, you know, two months ago. So that kinda continues once they go home If that makes sense. So you're kind of comparing how long they've actually been alive to what it would be if they were born at the correct time.

Well, we got more questions coming up, but first let's take a quick break. Welcome back to Newbies. We are continuing our topic about NICU stay and the questions you might wanna ask if you know that your baby is going to have some time in the NICU, or if you are a new mama and your baby is already in the NICU.

So we covered a lot in the last section, but I have a couple of more questions. I guess specifically for the parents who, I like that you mentioned that most parents wanna know when their baby's getting out, right? I can only imagine that would be the number one question. So for them who already have their babies in the NICU and are tuning in and listening, what are some things to kind of keep them optimistic, right, about their baby hitting their milestones?

So what, any positive feedback or advice do you have for parents who are patiently waiting to, you know, have their baby graduate? I think the best thing if possible, which I know is not always possible for everyone is to really be there. Hmm. To you know, really kind of absorb everything that's happening so that you can also kind of help and practice.

You know, sometimes depending on how busy the hospital is and the workload especially for, more so for older babies that are getting closer to going home and practicing, you know, feeds. You know, if it's kind of a crazy time and the pa- nurse doesn't have time, you know, they might skip, you know, a bottle feed versus a tube feed because, you know, they don't have time.

But Honestly, like, we can do everything we can, parents can do everything they can, and it's ultimately up to the baby, you know? They're the ones who dictate, you know, when they come. They're the ones who dictate how long they're gonna stay, when they're gonna eat. So, you know, I think the best thing to do is to know that you're doing everything that you can.

You know, this isn't your fault. There isn't anything that you could have, you know, done differently. Sometimes things just work out this way. And just be there and, you know, love on your baby as best as you can. I love that. I think we didn't even get into your shift. Tell us a little bit about the shift you do.

Okay. I know, because I know you. Yeah. But tell us a little bit about the shift you do. And I guess, I know every hospital's different, but- Mm-hmm ... do you get a lot of, and I know you've done multiple different shifts, right, amongst your hospital, but do you get a lot of experience seeing parents? Like, what are the visiting hour- are there different visiting hours?

I feel like that might even be a taboo question, but tell us your shift and your experience with working with parents at this odd hour. Okay. Yeah. So I work the night shift. I work 7:00 PM to 7:00 AM. I actually, we have other shifts, too, where nurses will work 3:00 AM to 3:00 PM or 3:00 PM to 3:00 AM. Mm-hmm.

Which, the 3:00 AM just seems the oddest to me, 'cause I cannot imagine going into work, you know, at 3:00 in the morning. But- Yeah ... so it's honestly kind of the same, you know, from day shift to night shift because we kinda work, so we work around the baby's feeding schedules. We call, we call it cluster care.

Because a lot of the babies aren't naturally supposed to be here yet, we really try to mimic the environment of the womb. Mm-hmm. We try not to bother them too much. G- let them, you know, sleep as much as they can. They, they grow when they sleep. So, depending on their feeding schedule, could be every four hours, could be every two hours, could be every three hours.

So night or day, you know, we go in, we wake them up, change diapers, you know, do an assessment where we, like, listen to their lungs, you know, kinda check them out, make sure everything looks good. And then we feed them, either if they're allowed to take bottles or if they're allowed to if we're doing tube feeds and, you know, kinda leave them be until the next time.

So, the only difference I would say are a lot of, sometimes we get some kids that are, like, older who we don't have to mess with as much. Like, they're really close to term or over term- Mm-hmm ... meaning between 37 to, like, 40. I think the oldest I think I've seen is, like, 42 weeks. Mm-hmm. You know, those babies we might leave alone a little bit more.

We might not check their vitals as much. We might not weigh them as often. You know, kind of try to mimic that environment. You know, we try to keep them up during the day, do tummy time, you know, give them like toys and things like that, versus at night we try to let them sleep. So, and then each shift kind of has their own responsibilities.

We do our baths at nighttime when I'm there, which kind of stinks for the parents, but you know, if they wanna do a bath, if they're not gonna be there at night, they are more than welcome to do so. You on the day shift, but like as a routine, we do the baths at nighttime. We change like the IVs, all the bags and tubing, like that's gotta be a sterile process just to keep everything nice and clean for the baby, so we usually do that at nighttime.

We do all of our weights at nighttime. Babies get weighed every night just so that we can track their growth. And so, there's just different tasks at night. As far as visiting goes at my hospital the mother and then we give her a support person, so that could be dad. If dad's not around, you know, that could be mom or whoever her support person is.

They are allowed to be at the hospital with baby 24/7. Mm. And then we have, we give them a certain color. Ours are green. Those are for those two people, and then we give them four other bands that they can kinda give off to other support people. Those people are only allowed in during visiting hours, and they're not allowed to bring anyone with them, but they could come, you know, without the parents during the visiting hours.

And then the parents are allowed to bring whoever they want, whether they have a band or not. And then right now I live in Ohio, so it's cold. And it's currently right now cold and flu season, so we do not allow children into the NICU. Anyone under 18 is not allowed between-- It changes every year. I don't know how they track, you know, the flu and things like that.

But for this year, it started in November, and then usually between March and April is when they'll kinda lift that flu ban, and then siblings and other visitors are allowed to come and visit. I like that you mentioned the whole process of how everything has to be sterilized. That totally makes sense.

What are some things you've seen moms have in their hospital bag? Do they call it a NICU bag? I think that's so cute. Yeah. That they can safely bring, you know, if they are doing tummy time, if it is a little bit of an older baby who maybe just has a little bit of breathing issues. What are some things that maybe are ideas that you've seen for other NICU moms who are curious about just bonding with their baby?

Can they bring onesies? What type of toys have you seen? Kind of answer that. So, we actually provide everything that they need. Oh, awesome. The only things that parents I've seen bring in, maybe they bring in, like, a sound machine that they might want the baby to use or different little toys.

They're not allowed to really have those things, like, in the crib, you know, 'cause of safe sleep. But, you know- Mm-hmm ... they kind of bring things in to decorate their room. Some parents can-- are definitely allowed to bring clothes, but we do provide clothing there. We have swings for babies. We have those little, like, crib attachment toys.

We've got, like, these little fishy, I think it's, like, a Baby Einstein. It's, like, a little fish tank-looking toy that we'll put up on the crib, you know, for an older child who, you know, might need that stimulation. Typically, when they do tummy time, we have, like, mats that we'll put them on. Usually therapy will work with that 'cause they do the physical therapy with the babies during the day.

So, I'm not really there for those sessions, but I know that's a part of, like, what they do based on the baby's age, you know, what things they should be doing, and what type of, like, stimulation do they need. So, but yes, I mean, as far as what the parents bring We provide everything. I mean, they, I've seen, like, some sound machines, but we have swings.

I think I have seen a parent bring a swing in like a personal swing, but typically we provide everything that they need. We all-- we use the same bottle at the hospital that I work at. We use Dr. Brown's bottles. Mm-hmm. And I think the parents can bring in whatever. We used to have them bring in whatever bottle that they were going to use before they left, but we've recently switched to, like, only using Dr.

Brown. So, I think closer to going home, you know, that's something that they can bring in, say they wanna try something else. Once the baby's eating well, we can try it, because they wanna make sure that you don't go home and use this completely new bottle and the baby doesn't eat well, and then you have- Mm-hmm

you know, issues. So, we typically will like to try to do it while they're in the hospital before they go home. That makes sense, and I know for a lot of breastfed babies, it's so hard to find a bottle that they like. It is. So, I can imagine if, you know, a NICU baby has consistently had this, you know, this type of bottle, that makes so much sense.

Geez, you are full of wisdom. Thank you so much for coming on. Oh, no problem ... last fun question is tell me maybe, if you can remember, one of just, like, your favorite NICU graduation stories. I don't know if you've had a baby who maybe didn't seem like they were gonna make it or was really- I- ... really early.

Yeah. What's one of your favorite stories that you can share to, I guess, give some of our moms who are listening some hope that, you know, it's tough right now, but most babies get through it, I'm assuming. Don't quote me on that. Yeah. Yeah. At least where you work. But anyway, tell me a really good story that might uplift our mamas.

Okay. Well, my favorite story since I've been there was a mom. She I don't remember why she had to deliver early but I know she was very close between, like, late 20 tw- 22 weeks, like, not quite 23. And typically for sure 23 weeks and up, they're coming to us. Mm-hmm. I think the 22 week itself, 'cause we count 22 weeks and then 22 and one day, 22 and two days, you know, we count each day until you get to the 20- to the next week.

So, that 22 range is up to the providers and up to the parents. They really give them a good information about, you know, risks and benefits and all those things, and kind of work with the parents to decide how we should proceed. So anyway this mother's baby was not quite 23 weeks yet. They gave her conversation, gave her everything she needed to know, pros and cons, what it would look like, and this mother decided that she did not want to send her baby to the NICU.

She was gonna have her delivery, let her baby go, and go on. And her baby came out, did okay. You know, nothing was happening. It was really hard for the mom. She asked one of the, one of the nurses offered to take the baby, hold the baby, you know, kind of give her a break 'cause it was very emotional, overwhelming.

Mm-hmm. And the nurse says that she was in her office with this baby. Some, you know, song comes on. I can't remember what song, but it was, like, a "I'm a fighter"- Aw ... you know, very uplifting song. And she cried, and she called our providers in the NICU and said, you know, "We got this baby. This was the plan. It hasn't happened yet.

What should I do?" Yeah. So our provider goes over. They put a pulse ox on the baby to check the oxygen level, and it's amazing, as high as it could be. And they went to mom and said, you know, "What do you wanna do? She doesn't seem like, you know, she seems like she wants to be here." So, they brought the baby over and did everything that, you know, you'd normally do for a baby of that age, which is even more interesting because a baby that young, you would not be holding.

We would have that baby in the bed. We would not even allow that baby to move very much for risk of a brain bleed. Mm-hmm. That's kind of just a standard precaution we do 'cause they're at higher risk at a younger age. So, you know, she had not done all those things, and she wasn't properly, you know, warm.

Like, our babies are normally in a very high heat isolette the younger they are. So, you know, despite all those things, we bring the baby over, and I believe she's 4 years old now. No deficits. Aw. No, you know, anything. And it's just, like, my favorite story to tell 'cause- I just couldn't, we j- none of us could believe it.

You know, usually, you know, sometimes you, the earlier you are born, the higher you are of risk of deficits and- Mm-hmm ... different, you know, complications. So that was just, like, a really amazing story to hear, you know, that they were willing to kind of not do anything and let her go, and she decided otherwise.

So. I love that story. I think that's such a fighter. I want to, Yeah ... I wanna hear the song she was listening to that uplifts me. I'll have to ask her 'cause she still works there. I know it was by Andy Grammer, who I know is, like, a positive- Yeah ... uplifting kind of artist, but I don't know exactly what song it was.

But yeah, I mean, I would tell her mom all the time, "I think she's gonna be president or something important-" "... because she, she's killing it, and she's already, like, feisty." So. Oh, I love it. Yeah, that's such a good note to end our episode. Well, Theresa, thank you so much for joining me. That wraps up our show for today. Thanks for listening. If you love Newbies as much as we do, please consider checking out our amazing businesses that sponsor our show week after week, and we'd also love for you to tell another new mama about this resource, which of course, is absolutely free.

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