Well, What is a NICU?

When I tell people I’m a nursing student, they almost inevitably ask about what kind of nursing I’m interested in, and to be truthful, I love that question. Telling people that I want to be a NICU nurse often goes one of two ways: me teaching them what a NICU is, or me being told that it takes a “special type of person” to work there. I get excited by either outcome because it’s a chance to conquer the fear of the asker, even if they don’t know they’re afraid of it. I’ve learned that most of the lack of education and of NICU awareness stems from human instinct. Our instinct is to fear facing or even thinking about the kind of vulnerability a NICU baby must be living in. I’ve found that conquering that fear and beginning to see the positive beyond those doors begins with education. So, let’s make the NICU exponentially better understood than the monster under the bed. All of this introduces the question that you and I are going to tackle head-on: what the heck is a NICU?

NICU is the acronym for the neonatal intensive care unit. Simply put, it’s intensive care, but specifically for babies. Munchkins that need this kind of care are medically complex, small, mechanically dependent, and sometimes alarmingly fragile at first sight. Despite all of this, the NICU isn’t meant to be a scary place – it is truly a house of hope! But for you to better understand that, we have to climb up the ladder, or rather the stepstool, of the four levels of newborn care.

Level one newborn care means a well-baby nursery. You know, the kind of glass-windowed nursery you’d find when you went wandering through the halls while visiting your grandparents at the hospital. If you were like me as a kid, seeing the babies was a very cool escape from your extended family and those stiff plastic couches. In some places, you can still go see them, these chunky little babes, lying out, still scrubbed pink from their first bath, wearing their little beanies. Well-baby nurseries and the alternative, rooming-in with mom, are offered at birthing hospitals rather than specialized facilities. They care for healthy, adequately sized babies born at 35 weeks or more, providing the postpartum evaluation, bathing, and rest for mom following birth.

Level two newborn care denotes a special care nursery (SCN). A special care nursery can provide simple respiratory and dietary support, warming, monitoring, fluids, and can care for babies transitioning from the NICU to home. As a general rule of thumb, these nurseries offer their support to infants born at 32 weeks or more, though this can vary a little. Special care nurseries are often offered at birthing rather than specialized facilities. Special care nurseries are often forgotten, but they’re vital – they form the first line of defense if conditions are worthy of transfer to a higher-level unit.

Level three newborn care is (finally!) a NICU. In most states, a level three is capable of providing complex medical care and basic life support measures, at least, and sometimes even surgical care and advanced life support measures. Typically, level 3 NICUs care for babies born at 28 weeks or later and they are present at both birthing hospitals as well as specialized facilities. Level three NICUs are jacks of all trades. They take the babies too difficult for special care nurseries while also providing advanced care to babies not quite critical enough for a level four NICU.

Level four newborn care is the king of them all: the regional NICU. A regional NICU is present generally at children’s and other highly advanced hospitals. The coolest thing about a regional NICU is that they center around referrals – statewide, across state lines, and in some cases even internationally. Level four NICUs provide subspecialty care with highly trained surgeons and complex life support. Often, these units can be distinguished by the provision of innovative treatments such as ECMO (an amazing heart-lung machine) and brain cooling therapy (for treatment of brain trauma acquired through birth). This level of care is a safety net for the smallest and sickest; those born at as few as 21 weeks. These units have helicopters, academic support, groundbreaking research, and the technology to give any baby a chance! How cool is that?

The roots of a NICU are planted in love. As humans, we have an innate desire to keep a baby safe and warm while they grow and change – love means we’ll do anything for them. This is why the NICU is a place for love to dominate, not fear. Love has driven so many nurses, physicians, and therapists into NICU practice. Love has led researchers to find cures. Love has encouraged families to advocate and volunteers to cuddle. So you see, while so much of it is scary, the carers are capable and the Lord is present in every miracle as He is ever-present where there is pure-hearted love. While most babies are born healthy after reaching full term, NICUs are there to catch the growing number of babies who aren’t. Whether it’s underdeveloped organs, low birth weight, genetic disorders, or a simple infection acquired during birth, there are passionate people to handle that. With a little education and awareness, we can appreciate these people, their unit, and the population that they serve.

Thanks for reading and as always, be #nicustrong.

Published by carleyguill

Carley Guill - NICU Nerd, FTL Founder - B.S. Nursing, 2022

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