The Jennifer Gandel Kachura Neonatal Intensive Care Unit at Sinai Hospital NICU Parent Handbook The Jennifer Gandel Kachura Neonatal Intensive Care Unit at Sinai Hospital NICU Parent Handbook

Dear Parents: You may have a lot of questions about your baby’s health and how long he or she will need to stay at Sinai Hospital’s Neonatal Intensive Care Unit (NICU). It may be hard to imagine a time when your baby will be strong enough to bring home. It is normal to feel this way. The good news is that most NICU babies grow up to be normal, healthy children. This booklet will address common concerns, tell you about the NICU and the people who care for your child, and services that are available at Sinai Hospital. You are an important part of your baby’s recovery. We want to work with you to give your child the best care possible. Please feel free to talk with us at any time about your questions or concerns. Let us know how you are feeling. Helping you deal with your emotions is an important part of our job. Even though you cannot take your baby home just yet, his or her birth is still a special event to share with loved ones. We join you in welcoming your child into your family and the world. The NICU staff

NICU: 410-601-6077 Special Care Nursery: 410-601-6078 2401 W. Belvedere Ave. Baltimore, MD 21215 CONTENTS

1 Understanding the NICU Your healthcare team (Neonatologist, Pediatrician, Resident, Neonatal Nurse Practitioner [NNP], Registered Nurse [RN], Lactation consultant, Nutritionist, Social worker, Respiratory Therapist [RT], Students) Getting information about your baby What you can do for your baby Your feelings

7 Visitation Parking Illness and visitation

9 Premature infants Size, feeding, breastfeeding, formula feeding

11 Milestones in development Regular sleeping, waking Problems of prematurity (Apnea, Bradycardia –“Slow Heart Rate,” RDS, Jaundice, temperature, infection)

13 Frequently asked questions

14 Going home Mt. Washington Pediatric Hospital Feeding at home Sleeping Patient services (Family room, dining facilities, gift shop, Pastoral Care and Chaplaincy Services)

18 Newborn weight conversion table 19 Temperature conversion table UNDERSTANDING THE NICU The NICU is a place where necessary. This special place specially trained doctors, nurses exists to help your baby. and other staff care for babies who are premature or too sick Your healthcare team to be at home. Sometimes infants In the NICU, the staff functions need to stay in the NICU because as a team to ensure each baby something occurred during the receives the best possible care. birthing process. These babies Here is a brief description of the have special needs that cannot staff members who may be caring be provided for in a standard for your baby: newborn nursery. All of the equipment used in the Neonatologist NICU has alarms. When an alarm A doctor who specializes in goes off, it does not always mean taking care of sick newborns. that there is a problem with your The neonatologist directs the child. For example, an alarm may medical care. You will find that sound upon sudden movement, the neonatologist in charge coughing or crying; it does not will change from week to week. mean that your baby’s condition Pediatrician has changed. The staff quickly A doctor who provides medical responds to alarms and the baby’s care for children until age 21. needs and is prepared to take care After discharge from the NICU, of any problem that may occur. your pediatrician will assume The NICU may seem overwhelming care of your baby. at first, but the staff is there to assist and answer any questions Resident you may have regarding your A doctor who has graduated baby’s care. The physician staff from medical school and is is also available to answer your undergoing hospital training. questions at any time. Do not be Residents are very involved afraid to ask questions. Remind with your baby’s care, doing yourself often that even though a assessments and planning stay in the NICU is not what you medical care. wished for your baby, it is

1 Neonatal Nurse Practitioner Lactation consultant (NNP) A registered nurse who has A registered nurse who has specialized education and advanced training and experience training in breastfeeding. The in managing the care of premature lactation consultant will support and sick newborns. The NNP you and guide you through the works under the direction of breastfeeding process. a neonatologist. Nutritionist Registered Nurse (RN) A staff member who has special A nurse who has specialized training in meeting the nutritional education and preparation to needs of preterm infants. He or care for premature and sick she will evaluate your baby’s newborns. He or she observes nutritional state and make and monitors your baby’s recommendations about caloric condition and progress. The intake, vitamins and mineral RN also coordinates and supplements. carries out your baby’s plan of care, along with notifying Social worker the members of the health A team member who provides care team of any changes counseling and support while with your baby. assisting with discharge planning. The social worker will also

1 have information for you about support in assisting with services in the hospital and in students’ career development. the community. Getting information about Respiratory Therapist (RT) your baby A team member who helps manage the oxygen needs of We encourage parents to ask your baby and who may also questions at any time. We want assist with drawing lab work. to give the best care possible and help your family through Students this difficult time. The NICU Sinai’s mission includes teaching. team will set up family meetings As a result, you may sometimes early during your baby’s hospital see student doctors, nurses or stay to review the plan of care. respiratory therapists. Anytime you need to speak Students are always under to anyone on staff, please let the direct supervision of an someone know. The neonatologist experienced team member. We is available if you have questions appreciate your cooperation and concerning the plan of care. If you cannot be at the hospital, What you can do for your baby please call the NICU whenever In the NICU, there are things you wish. Information regarding you can do for your baby’s a baby’s condition will be given comfort and care. Sitting at the only to the parents. bedside, gentle touches and soft, soothing voices provide the love NICU and attention your baby needs. 410-601-6077 or 1-800-444-8233 As your baby becomes stronger, SPECIAL CARE NURSERY you will be able to hold, rock, 410-601-6078 feed and bathe your baby, as well as change diapers. It’s a good idea to designate As tiny as your baby is, he or someone to be responsible for she is able to communicate his updating your friends and family. or her wants and needs. Learn Ask your baby’s nurse about your baby’s stress signals that setting up special times for indicate too much is happening Facetime or Skype if you are and that he or she needs a break. unable to come in to visit.

4 Your baby may: baby will be ready for skin-to- • Fuss skin care. • Cry The positioning of your baby • Hiccup is very important. Having your • Arch or turn away baby’s hands and legs bent toward • Stiffen his or her arms or legs the middle helps prepare him Let your baby rest when he or she or her for eventual crawling is tired. and using his or her hands Skin-to-skin care is a form of together. You will notice holding that is encouraged in the different positioning aids are NICU. It involves holding your used to help facilitate proper baby inside your shirt against your growth and development. skin. Both parents can participate. To help make the NICU feel Studies show that the baby’s more like home, you may be breathing rate, heart rate and able to bring small items such oxygen levels stay steady during as brightly colored pictures, skin-to-skin care, which helps photos of family members or a them to grow and develop better. mobile if your baby is in a crib. Please ask your nurse when your You are the most consistent also feel fear and anxiety about person in your baby’s life during your baby. his or her hospital stay. If you Your body is healing, because observe any changes in your baby’s you have just given birth. Keep condition, please notify a member your rest and sleep schedules of the healthcare team. as close to normal as you can. If you are having difficulty Your feelings dealing with your feelings, let the social worker or other NICU During this stressful time, you staff know. They want to know may experience a wide range of how you are doing. If you need feelings. Many parents feel guilt more support than what the staff and anger, as well as wanting to or your family can provide, blame their spouse, doctors and there are additional resources even themselves. You probably available.

6 VISITATION We encourage you to visit and security desk before entering the ask that you follow the visitation unit. Parents must only release guidelines to ensure the safety and their infant to authorized staff privacy of our patients and their wearing a proper Sinai ID badge. families. While your baby is working on Visitors designated on the “friends getting stronger, the NICU staff and family” list may visit at any is working hard to protect him time. Please fill out this list before or her from germs. Parents, siblings you are discharged. and all other visitors must sanitize We welcome brothers and sisters. their hands before entering and Please ask your nurse for sibling upon leaving. Good hand sanitizing visitation guidelines. is the most important way to protect your baby from germs. All visitors must obtain friends and family passes from the At times you may be asked to Blaustein lobby registration/ leave the NICU and wait in the Family Lounge because of medical procedures or emergency situations. Water is available to parents in the lounge, and snacks are available upon request. Enjoy Mason’s Library and pick a book to keep and read to your baby.

Parking Visitors may park in the main visitor lot located in the front of the hospital. The first 30 minutes of parking are free. Parents only are given a parking pass each time you visit. Please ask your baby’s nurse or the administrative associate at the desk in the NICU for a pass prior to leaving. If you wish to be escorted mumps, German measles, strep to your car, call the Security throat, whooping cough, hepatitis, Department at x2-5036. croup, tuberculosis, respiratory syncytial virus (RSV), roseola, Illness and visitation and/or fifth disease. Notify a nurse Any visitor, especially a young or doctor if you have any of the child, can bring illness into the following symptoms during nursery. For the safety of your a visit: fever, cough, runny nose, baby and all the babies in the cold, cold sore, sore throat, nursery, we ask that you follow vomiting, diarrhea, rash or skin these additional guidelines infection, conjunctivitis (pink eye), regarding illness and visitation: or an open wound or sore. Notify your baby’s doctor or Thank you for your cooperation nurse before visiting if you or a in following these guidelines. visitor has been exposed in the last Please feel free to discuss any four weeks or during your baby’s questions or concerns you have stay to chickenpox, measles, with your nurse.

8 PREMATURE INFANTS Size a pacifier, they may not be able Premature babies are naturally to suck, swallow and breathe smaller than full-term babies. all at the same time. This means Many weigh less than two pounds. that these babies need to be fed During the first few days of life, through a very small plastic tube your baby will lose a few ounces. that is inserted through their This is normal. All babies are mouth or nose into the stomach weighed everyday. The neona- (oral or nasal gastric feeding tologist, residents and nutritionist tube or OG/NG tube). After work together to create the best the feeding tube is inserted, feeding plan for each individual breastmilk or formula will baby in order to promote healthy be fed through the tube into growth and development. the infant’s stomach (gavage feedings). When the baby Feeding has matured enough to suck, Although many premature babies swallow and breathe, he or she may have the ability to suck on will be started with breastfeeding or given formula/BM depending • Providing breastmilk is on your choice. something only you can do for It is going to take some time for your baby. It gives your baby your baby to grow strong and the best possible start in life. healthy. Some of the best things • Breastmilk gives your baby you can do right now are to be added protection from infection supportive, talk to him or her, and and is more easily digested than give the special care and concern formula. he or she needs to feel secure and loved. Formula feeding If you can’t or choose not to Breastfeeding breastfeed, we have special Perhaps you never considered formula designed for premature breastfeeding or are not sure infants. Your physician will how to start now that your baby choose the formula that will has special needs. In either case, meet your baby’s unique needs. we want to let you know that breastmilk is ideal for your baby.

10 MILESTONES IN DEVELOPMENT Because your baby was premature, Problems of prematurity he or she was not able to complete Below is a list of medical development in the womb. Recent problems that are common in studies have shown that most NICU babies. Your baby may premature infants do as well as have some of these problems other children once they have or none at all: had a few months to catch up. Remember, every baby is different. Apnea Some babies progress fast in one It is very common for the brain area, but take longer in others. of the premature baby to “forget The NICU staff will provide to tell” the lungs to breathe. your baby with developmentally This may result in apnea, which appropriate care. They will do this is the absence of breathing for by positioning, holding, touching, more than 15 seconds. It is usually and playing with your baby in accompanied by a decrease in the ways that help your baby’s senses baby’s heart rate (bradycardia). develop. They may talk with him When apnea occurs, breathing or her and show pictures and can usually be restored by objects. As your baby grows and gently touching or stimulating changes the NICU nurses will the baby. To detect apnea and teach you about your baby’s bradycardia (A’s and B’s), all developmental needs. premature babies are electronically monitored in the nursery for heart Regular sleeping, waking and respiratory rates until their brain matures and they “grow Premature babies spend most of out” of these spells. their time asleep. Sleep is important, as this is the time when they Bradycardia – “Slow Heart Rate” grow. As they get older and are This condition is usually awake more, they will begin to accompanied by apnea. Heart look around, listen to sounds monitors in the NICU alert the and respond to things going on staff when a baby’s heart rate is around them. too slow. Because bradycardia usually goes hand-in-hand with apnea, it is treated in the same way.

11 RDS temperature; therefore, they RDS stands for respiratory distress are placed in isolettes until they syndrome. In this condition, the are mature enough to maintain baby has trouble breathing. RDS their own body temperature. is a common problem in preemies It’s very important for them because their lungs have not to stay warm so that they developed enough to work on continue to grow and develop. their own. The baby may be placed A premature baby lacks caloric on a device to give oxygen support reserves, and so IV fluids are to help him or her breathe. used to provide the necessary caloric energy needed until your Jaundice baby is able to breastfeed or Jaundice, often called “yellow formula feed on his or her own. jaundice,” is a term for yellowing Infection of the skin due to the buildup of a substance called bilirubin in the blood. The immune system fights infection. Jaundice is treated with special lights It is not fully developed in preterm (bililights) that help the baby’s body infants; they are less able to fight break down bilirubin. It can then be infections than older children and passed in the urine or stool. adults. Your baby will be watched for signs of infection and given Temperature antibiotics if needed. Remember, Premature babies do not have the number one defense against the ability to maintain their body infection is good hand hygiene! FREQUENTLY ASKED QUESTIONS How long do premature babies Do premature babies receive have to stay in the hospital? blood transfusions? Most preterm babies stay in the Babies who require frequent blood hospital until their due date. testing may need a transfusion. Many premature babies will Do premature babies feel pain? require several blood transfusions. Most preterm babies will try to Due to modern screening techniques cry during certain procedures, used by blood banks, the risk of and we believe they do feel pain. acquiring a disease from a blood We provide comfort measures transfusion is extremely low and try to give pain medications to (around one in a million). the babies before each procedure. Consent will be obtained prior A pain assessment tool is used to your baby’s first transfusion. consistently to monitor if they Arrangements for you to provide are experiencing pain. directed donor blood can be made upon your request. GOING HOME The NICU guidelines for when babies are ready to go home are: • Your baby can keep warm on his or her own. • Your baby is able to breathe on his or her own (some babies do go home on oxygen). • Your baby can breastfeed or feed from a bottle. • Your baby’s medical condition is stable. • Your baby is gaining weight. Although you are happy your baby is The nurses will also teach going home, you may be a little you how to take your baby’s nervous, too. This is normal. The temperature and how to tell if he NICU nurses will help you get or she becomes ill and you need ready, guiding you as you practice to call the doctor. If your baby is your baby’s daily routines before going home on oxygen or will be you take him or her home. You wearing some type of monitor, may be able to spend the last few you will be trained to use it and days “rooming-in” with your the nurses will instruct you in the baby in the NICU. Rooming-in use of any medicines. will allow you to care for your baby as if you were home, and While your baby is in the the nurses will be there to assist NICU, it is a good time to take you as needed. a course in cardiopulmonary 14 resuscitation (CPR). Chances will provide concentrated efforts are you will not need to use on your baby’s feeding, growth CPR on your baby, but knowing and discharge planning. Pulmonary it could save your baby’s life. disease and other problems related Check with your nurse about to prematurity, including feeding signing up for a class. issues, are also addressed. Your Prior to going home, your baby baby’s physician and social worker will also have to pass a car seat will speak with you when the time test. This test will ensure your is appropriate to prepare for the baby does not drop his or her transition: heart rate or oxygen while being Mt. Washington Pediatric Hospital strapped in the car seat. Please talk 1708 W. Rogers Ave. to your baby’s nurse if you have Baltimore, MD 21209 questions about what kind of car 410-578-8600 seat to buy. mwph.org To prepare for taking your baby Feeding at home home, it will help if you spend as much time with your baby while Much of your baby’s care at home he or she is still in the NICU. The will revolve around feeding. Many staff will do all they can to help mothers think that once their prepare for this exciting event. premature babies come home, they will breastfeed like healthy infants. It is important that you find However, mature feeding usually a pediatrician whom you feel develops during the first two to comfortable with. This doctor will three weeks at home. This means take over the care of your baby the extra effort and patience it took once he or she leaves the hospital. to breastfeed your premature baby in the hospital needs to continue Mt. Washington for the first weeks at home. Before Pediatric Hospital discharge, your healthcare team There may come a time when will set up a feeding plan for you your baby does not require the and your baby. Usually, you will acute care that a NICU provides; feed your baby on cue, not on a however, your baby isn’t quite fixed schedule, and usually at least ready to go home either. At this eight times per day. Your baby time your baby will have the should not sleep longer than five opportunity to be transferred hours at a time. You will need to to Mt. Washington Pediatric see your pediatrician and have Hospital’s Center for Neonatal your baby’s weight checked within Transitional Care. This setting one to three days. 15 If you are feeding formula or Dining facilities supplementing breastfeeding, your The Greenspring Cafe, Cafe baby may go home on a special Shalom, MarketPlace and Subway premature formula for a short offer a variety of meals and snacks. time and then be switched to regular formula when appropriate. The Greenspring Cafe, located on the main level of the hospital, serves Sleeping breakfast, lunch and dinner daily. Breakfast: 6:30-10 a.m. Unless your baby’s doctor has Lunch and dinner: 11 a.m.-8 p.m. given special instructions that state otherwise, the American Academy The MarketPlace offers Starbucks of Pediatrics recommends you coffee, assorted sandwiches, place your baby on his or her back pastries, soup and snacks. to sleep to protect against sudden Monday-Friday: 6:30 a.m.-midnight infant death syndrome. It is not Saturday: 9 a.m.-midnight recommended to place your baby Sunday: 9 a.m.-midnight on his or her tummy to sleep. Cafe Shalom offers kosher meals, beverages and snacks. It is under Patient services the Orthodox Rabbinical Family room Supervision. Monday-Thursday: 11 a.m.-7 p.m. Through the generosity of several Friday: 11 a.m.-2 p.m. donors, we are able to provide Closed Saturday and Sunday. you with sleeping facilities for a Boxed kosher meals are available limited period of time while your at The MarketPlace. baby is in the hospital. The purpose of the room is to Subway has sandwiches, soup provide a private resting space and salads available 24/7. for two primary care providers who are actively involved in Gift shop the care of their newborn. You The Sinai Hospital Gift Shop will be encouraged to actively is operated by the hospital’s participate in your child’s auxiliary. It offers a wide array scheduled care. If more than of personal items and presents one family member desires to for a loved one, including stay in the available rooms, flowers and cards. It is located priority is given based upon the on the Weinberg Pavilion’s baby’s condition or the family’s first floor. For more information, needs. Please see your baby’s nurse call 410-601-5791. if you are interested in staying. 15 16 Pastoral Care and • Bikur Cholim visitations serve Chaplaincy Services Jewish patients along with staff Meeting your spiritual needs Rabbis. is an important part of the • Cholov Yisroel: Milk, yogurt healing process. Sinai Hospital and cottage cheese are available accommodates the spiritual upon request. needs of individuals of all faiths. • Fresh glatt kosher food is Please call the Office of Pastoral prepared daily. Care and Chaplaincy Services at x29680 or 410-601-9680 to request • Jewish holiday rituals are a visit from a member of the clergy. observed. During evenings and weekends, • Manual bells for Shabbat are please inform your nurse if there is available to summon nurses. an emergency need for a chaplain. • On Sabbath and Holy Days, an The chapel is located on the first alternative paper menu will be floor corridor between the main provided by the hostess the day hospital and the Blaustein building. before. It is open at all times and has Bibles • Sabbath candles, challah, grape and devotional materials available. juice, Chumashim and prayer books are available. For Observant Jewish Patients • A Shabbat entrance and elevator Sinai Hospital has been in the are available from Friday sunset mainstream of Jewish thought and to Saturday sundown and on tradition for more than 150 years. Jewish Holy Days. By strict adherence to Jewish law, we assure observant patients that • Signatures are not required their spiritual and medical needs when Jewish law prohibits are treated with equal concern. writing; your word is enough. • • Accommodations can be arranged Sinai Hospital is within the eruv. for family members to stay with • Sinai Hospital Kosher Food you during Shabbat if medical and Nutrition Services is proud attention and/or space permit. to be certified by the kosher • All Kosher trays, dairy and meat certification. will be sealed and taped under • Sinai Hospital’s senior chaplain the supervision of a mashgiach. is a Rabbi.

17 NEWBORN WEIGHT CONVERISON TABLE Pounds (lb) and Ounces (oz) to Grams (g)

POUNDS

OZ 0 1 2 3 4 5 6 7 8 9

0 0 454 907 1361 1814 2268 2722 3175 3629 4082

1 28 482 936 1389 1843 2296 2750 3203 3657 4111

2 57 510 964 1417 1871 2325 2778 3232 3685 4139

3 85 539 992 1446 1899 2353 2807 3260 3714 4167

4 113 567 1021 1474 1928 2381 2835 3289 3742 4196

5 142 595 1049 1503 1956 2410 2863 3317 3770 4224

6 170 624 1077 1531 1984 2438 2892 3345 3799 4252

7 198 652 1106 1559 2013 2466 2920 3374 3827 4281

8 227 680 1134 1588 2041 2495 2948 3402 3856 4309

9 255 709 1162 1616 2070 2523 2977 3430 3884 4337

10 283 737 1191 1644 2098 2551 3005 3459 3912 4366

11 312 765 1219 1673 2126 2580 3033 3487 3941 4394

12 340 794 1247 1701 2155 2608 3062 3515 3969 4423

13 369 822 1276 1729 2183 2637 3090 3544 3997 4451

14 397 850 1304 1758 2211 2665 3118 3572 4026 4479

15 425 879 1332 1786 2240 2693 3147 3600 4054 4508 Note: 1000 Grams = 1 Kilogram

18 TEMPERATURE CONVERSION TABLE Farenheit (F) to Celsius (C)

Farenheit Celsius Farenheit Celsius 97.0 36.1 101.2 38.4 97.2 36.2 101.4 38.6 97.4 36.3 101.6 38.7 97.6 36.4 101.8 38.8 97.8 36.6 102.0 38.9 98.0 36.7 102.2 39.0 98.2 36.8 102.4 39.1 98.4 36.9 102.6 39.2 98.6 37.0 102.8 39.3 98.8 37.1 103.0 39.4 99.0 37.2 103.2 39.6 99.2 37.3 103.4 39.7 99.4 37.4 103.6 39.8 99.6 37.6 103.8 39.9 99.8 37.7 104.0 40.0 100.0 37.8 104.2 40.1 100.2 37.9 104.4 40.2 100.4 38.0 104.6 40.3 100.6 38.1 104.8 40.4 100.8 38.2 105.0 40.6 101.0 38.3

19 NICU Parent Handbook

2401 W. Belvedere Ave. Baltimore, MD 21215-5271 410-601-WELL TDD: 410-601-4900 or 1-800-601-4944 lifebridgehealth.org CHILD_0092_2/19