There’s a misconception that the NICU is the “preemie club”. Did you know that approximately 60% of babies in the NICU are actually full-term infants??
And guess what? I was actually one of them. That’s me in the photo above!
Not all the information on Blooming Littles is for preemies. Actually most of it applies to ALL NICU babies and families! Let’s talk about some developmental considerations for this specific group of infants. Plus, I’ll link some helpful articles from the blog to help you on your journey.
Full-term, NICU parents–I see you, and I’m here for you.
DEVELOPMENTAL CONSIDERATIONS FOR THE FULL-TERM BABY
As a neonatal therapist, we care for term babies with the same attention and proactive intervention as preemies.
Regardless of medical involvement or age, every baby in the NICU should be provided with developmentally-supportive care, including:
- Supportive positioning in flexion and midline
- A healing environment to support sensory regulation
- Cue-based caregiving and interaction
- Protection of sleep
- Comforting support for management of pain and stress
- Access to kangaroo care and positive touch experiences
- Family-centered care
NICU therapists (physical therapists, occupational therapists, and speech language pathologists) are uniquely equipped to care for the developmental, sensory, feeding, and occupational needs of full-term babies in the NICU.
Not every term baby admitted to the NICU will have access to teaching and education with a neonatal therapist (some may not even need it!).
Here are some articles from the blog that you can use to promote bonding, sensory processing, development, and confidence as you care for your baby in the NICU.
Spend some time exploring the blog, these are great articles to get you started.
Let’s jump into some of the most common reasons babies born older than 37 weeks spend time in the NICU.
One of the largest categories of term babies admitted to the NICU are those needing respiratory (oxygen) support for breathing problems. These babies may need a nasal cannula (prongs in the nose that deliver oxygen), or the baby may need a breathing tube and ventilator.
These breathing devices may be paired with medications or other interventions to support breathing.
It can feel a little bit like fitting puzzle pieces together when the medical team is figuring out just the right type and amount of breathing support for your baby.
Some common reasons a baby may need to be admitted to the NICU for breathing support include:
- Persistent pulmonary hypertension of the newborn (PPHN)
- Transient Tachypnea of the Newborn (TTN)
- Respiratory distress syndrome
- Meconium aspiration
Term babies may be in the NICU, because they are having neurologic symptoms or have a confirmed or suspected neurologic diagnosis. Neurologic conditions have to do with how the brain and/or spinal cord function.
There are a wide variety of neurologic conditions that may be a result of the labor and delivery process, a genetic condition, metabolic issue, or perinatal depression.
Oftentimes it’s completely unexplained.
These babies may need equipment to monitor for seizures or cooling equipment (equipment used for a baby who has a perinatal injury called Hypoxic Ischemic Encephalopathy). As well as consultations for genetics, neurology and/or neurosurgery.
Some neurologic conditions seen among term babies include:
- Neonatal strokes
- Hypoxic ischemic encephalopathy
- Brachial plexus injury
- Brain injuries
Hypoglycemia is low blood sugar.
Some babies are at risk for hypoglycemia, like if mom had gestational diabetes. Sometimes there are interventions that can be started in the newborn nursery to prevent the need for NICU admission.
Babies at risk for hypoglycemia include:
- babies born to moms with gestational diabetes,
- infants with lower birth weights, or
- delayed feeding after birth.
If their blood sugar doesn’t improve in the newborn nursery, they may need additional intervention and medical support in the NICU.
NEONATAL ABSTINENCE SYNDROME (NAS)
Neonatal abstinence syndrome (NAS), sometimes more specifically called Neonatal Opioid Withdrawal Syndrome (NOWS), is a group of symptoms that may occur when a pregnant woman takes opioids such as heroin, codeine, oxycodone (Oxycontin), methadone, or buprenorphine.
The drugs cross the placental barrier and lead to the baby’s drug dependence, as well as the mom’s.
NAS is a group of problems and symptoms created by that sudden discontinuation of exposure to illicit and licit drug exposure in the first couple of days after birth.
Withdrawal symptoms in babies can include:
- High pitched cry
- Tremorous, jittery movements
- Difficulty sucking
- Poor weight gain
- Quick breathing rate
- Difficulty calming
- Poor sleep
- Loose stools
- Tight body muscles (hypertonia)
When a baby is withdrawing from maternal drug use, it can influence their feeding abilities and disrupt their neurologic ability to self-soothe.
Sometimes, if the symptoms of withdrawal escalate after birth, the baby will be transferred to the NICU for medical management.
Babies with NAS require special care and attention and may be in the NICU several weeks as they go through withdrawal.
This is the medical term for “jaundice”.
Jaundice is a condition that occurs in babies when something called bilirubin builds up in the bloodstream.
Infants with jaundice may have a yellow undertone to their skin, if their levels are high enough. To help their bodies break down the bilirubin, they are treated with a phototherapy light.
Some units may provide phototherapy lights in the newborn nursery, or a baby may need to be admitted to the NICU for further intervention.
The earlier a baby is born, the more at risk they are for infections. But, a common reason babies need NICU intervention after 37 weeks is for possible or confirmed infection.
Maternal chorioamnionitis is an infection that may require an infant to be placed on antibiotics. Sometimes chorioamnionitis is managed in the newborn nursery, but if the baby needs further medical intervention, they will be transferred to the NICU.
Group B strep (GBS) is another infection that affects both the mom and baby and will require antibiotics and further medical intervention. Moms are often tested for GBS once they are 36 weeks pregnant. If they test positive, the medical team is proactive and begins antibiotics for mom prior to delivery.
Fun fact: Did you know I was born with Group B strep? My mom was incredibly sick, and I spent some time in the NICU as a baby.
GENETIC AND CONGENITAL CONDITIONS
There are a lot of different genetic conditions— some will require NICU care, and some may be able to discharge home from the newborn nursery.
I work in a large level IV NICU. We have access to medical specialties needed to take care of babies with multisystem involvement.
We have babies flown in from surrounding states, AND I work in an area of the country that has a high incidence of genetic and congenital anomalies or conditions.
Some examples of genetic conditions we may see in the NICU are:
- Down Syndrome
- Trisomy 18
- Trisomy 13
Plus, thousands more!
Sometimes, parents know about these diagnoses before birth, because it was seen on a prenatal ultrasound.
But other times, many parents are learning about their baby’s genetic or congenital condition after their baby is born.
If your NICU baby is full-term, you’re not alone.
There is an army of warrior moms and dads who have walked this road.
One. day. at. a. time.
Was your baby full-term, but have a NICU stay?