NICU Family Guide

Welcome to the Neonatal Intensive Care Unit (NICU)

Congratulations on the birth of your baby!

While this is a happy time, we understand that a hospital stay can add a lot of stress and can be a scary time for you and your family. We’re here to help you through it and provide you with what you need to know about your baby’s stay in our Neonatal Intensive Care Unit.

At CHEO we have a level 3 NICU. This means that we provide the highest level of care for babies born at the youngest gestational ages to those at full-term. Your baby is here to receive neonatal intensive care which can include breathing (ventilatory) support and specialty services from one or more of our specialty medical or surgical teams at CHEO.

Transport to the NICU

By this point you have likely met the friendly faces of our Transport Team. They travel with their fully functional portable NICU which has everything your baby needs to make it safely to CHEO. Their isolette is heated and your baby is secured in a 5-point harness. Their equipment allows for transport of the most complex NICU patients and our team is specially trained to care for them en route. Members of the team are usually a registered nurse or respiratory therapist who are trained in both roles, called a transport clinician. They are always only a phone call away and in constant communication with the neonatologist (specialized newborn doctor) who approves and recommends the treatments your baby needs. There may not be room in the ambulance or plane for a parent to accompany their baby, but we do our best to accommodate this when possible.

Unit setup

We have three main rooms, which we call “pods” that are identified by colours – yellow, blue and green. There are two rooms near the central desk that make up the “pink pod” The colours do not represent anything other than the location of your baby. Babies of any degree of illness can be in any pod. There are times when we have to move babies from one pod to the other to balance out numbers and keep the workload even for our nurses.

There is a screen located next to the unit clerk’s desk where you can see the location of your baby and the name of the nurse assigned for that shift. If your baby has moved location within the unit, this will always be up to date. Your baby will never be moved outside of the unit without notifying you first.
We also have one isolation room. It is used for special procedures and patients with suspected infections.

Unit entrance:

NICU clerks desk

Visiting in the NICU

Parent/caregiver presence policy:

When parents and caregivers come with their children and youth to CHEO, they’re not visiting. They are actively working as part of their child’s care team, providing us with vital health information only they would know and giving emotional support in a way only a parent or caregiver can.

In order to help keep everyone safe and minimize the chance of transmission of infections during this pandemic, family caregivers will be screened before entering CHEO's main campus, and will not be allowed to enter if they are sick. All children, youth and family caregivers must enter through the main entrance for clinic visits, or the Emergency Department in urgent cases. Other entrances are closed.

Until further notice and effective immediately:

To limit the number of people in the building, ONE parent/caregiver will be allowed to accompany children and youth while at CHEO, whether in clinic, the Surgical Day Unit or the emergency department.

Children and youth who are admitted as inpatients may have TWO designated parents or caregivers present during the day and overnight. Only those who have been screened daily will be permitted at the bedside.

Siblings who are not designated caregivers are not permitted. We appreciate that this requires you to make childcare arrangements for any siblings, and we are so thankful for your support in doing so.

For some outpatients and their caregivers (e.g. persons with disabilities), a second essential support person may be allowed to aid patients and care teams. For patients and caregivers who require additional support, please contact your clinical area to determine if an exception to ONE parent or caregiver at a time can be granted. For Emergency Department (ED) visits, please discuss your need for an exception on arrival to the ED.

Given the seriousness of this pandemic, it is important that designated caregivers refrain from coming to CHEO if they are feeling unwell or displaying symptoms such as fever or cough. Rest assured, CHEO will find extra support for your child if you are unable to be onsite due to sickness.

Access cards and safety

The NICU is a locked unit. Once you visit the Admitting Office, located near the main entrance, you will be identified as a parent and will receive one unit access pass per family. There is a deposit fee for the pass card which you will be refunded at the end of your stay.

Once you have your access pass, you can swipe yourself in and out of the unit. If you do not yet have an access pass, there is a video phone and doorbell at the NICU doors that you can use for staff to let you in. For everyone’s safety, please do not share your pass with anyone else.

Getting information about your baby

You can call the unit at any time for an update on your baby. When you identify yourself as a parent, ask to talk to your baby’s nurse to receive an update. There may be times when your baby’s nurse is busy caring for your baby or busy at shift change (around 7:30 both in the morning and in the evening) when they cannot come to the phone. In that case we’ll arrange a call back at a more appropriate time.

Handwashing and safety

Babies in our unit are at high risk for infections and hand washing is one of the best ways to keep them safe.

Start by removing your outside jacket (if applicable) and store it in the shelving unit in the corner of your baby’s room, this is your space.

Next, remove all rings, watches, bracelets and any jewelry below the elbows. Please give a good scrub to your hands, being sure to get beneath the nails, between each finger, and the backs of the hands. Dry thoroughly with the paper towel provided.

Hand washing videos:

Cell phones in the unit

You are able to use your cell phone while in the unit. There is a UV cleaner that we recommend you use to sanitize your phone, especially when you first arrive in the unit and before you head into your baby’s room.

It is expected that you use your cell phone for personal use only. You may not take photos or videos of other families or babies without expressed consent.

If you are speaking on the phone, please remember to use a quiet speaking voice or leave the room for your call. As a courtesy to everyone in the room, please use earphones when listening to audio or on a video call. Please keep ringtones and alerts on silent mode.

iPads

If you cannot physically be in the unit due to distance, illness or other circumstances, we can connect with you via teleconference for a brief visit with your baby or to join in daily rounds with the NICU team.

Room setup

Each room is set up with a bed most appropriate for your baby. This can be a heated overbed, an isolette or a cot. Sometimes there is a lot of equipment setup on all sides of your baby’s bed, depending on their needs. You may use the pull-out bedchair or the rocking chair. The cupboards in the corner are for you to store your jacket, purse and other personal items. Some parents choose to wear indoor shoes while in the unit or bring linens for their baby and store them here.

You’re welcome to bring a photo or a drawing from a sibling to personalize the space. Some choose to bring books to read to their baby and store them here. We can provide a breast milk pump for this corner, and there is a white light switch that is dimmable for you to access an overhead pot light.

Meals

In the Ronald MacDonald family lounge across the hall, there is a small kitchenette where you can store meals and heat up with a microwave. Be sure to mark food with your name. There is a second family lounge located on the 5th floor (5 West).

You are welcome to have a small snack or drink from a covered beverage at the bedside, however larger or smell-producing meals are to be kept outside of the unit. You’re welcome to eat your meal in the family lounge, at one of the many picnic tables outside or at the Rainbow Café seating on the 1st floor.

Visit CHEO’s Ammenity page for more information on meal options available.

Accommodations

There is a pull-out bed chair at each baby’s bedside where one parent can stay the night. The NICU and PICU share a few parent sleep rooms located in the Ronald McDonald Family Lounge. These sleep rooms are reserved for parents arriving from out of town at night or parents whose child is extremely sick or awaiting surgery in the morning and want to remain in hospital. They are intended for short-term accommodation.

Visit CHEO’s Amenities page for information about Ronald McDonald House and Rotel which are located next to the hospital.

Parking

Parking is available on-site. To purchase a parking pass, visit the security office, located on the 2nd floor near the emergency department. Many parking pass options are available and our Security team can help you find the most economical option.

Unit map

The NICU is located on the 3rd level. The main entrance is located on the 2nd level of CHEO. Visit our Maps and Locations page to see maps of each floor at CHEO.

Baby in the NICU, resting under a green knit blanket

Your baby's stay in the NICU

Who's who in the NICU

You will meet many new faces throughout your stay in the NICU. It takes a large team to cover all the needs of the babies in our unit.

Staff Neonatologist

This is the physician in charge of your baby’s care while in our unit. A neonatologist is a doctor specialized in the care of newborn babies. They lead the team in rounds everyday and are the ones most responsible for your baby’s medical care. We have a team of more than 10 neonatologists who rotate through 1-2 weeks of service at a time. There is always a covering neonatologist overnight and on weekends.

Care Facilitator

An experienced nurse who oversees the nurses in our unit. They guide the flow of patient admissions and discharges in and out of the NICU. They also coordinate the unit’s staffing needs. They are an extra set of hands when nurses in the unit are busy and can help solve issues that arise.

Clinical Manager

The clinical manager oversees the day-to-day workings of the NICU. Our manager is responsible for the recruitment, development and appraisal of staff. Our manager has a background in nursing and understands the challenges that arise everyday. They help implement and develop policies and directives.

Medical Student

At certain times of year we have some medical students in the unit. They have not yet graduated medical school and are undergoing training. They assess patients and attend rounds. They will be assigned one patient to follow, however they cannot write physicians orders and are always supervised in making any decisions.

Neonatal Fellow

These are doctors who have graduated medical school, finished their pediatric residency and are now studying to specialize in Neonatal Care to become neonatologists. Our fellows work between the Ottawa Hospital’s General Campus NICU and our unit at CHEO.

Neonatal Nurse Practitioner

Our nurse practitioner is a constant in the unit and works with babies who are expected to have a longer stay. You will see them at the bedside and on rounds with the team on weekdays.

Pharmacist

A critical care pharmacist attends rounds with the team daily to ensure all of your baby’s medications are the most appropriate treatment and have proper dosing. They help plan and make IV nutrition called TPN.

Registered Dietician

Registered Dietician - We have a dedicated dietician who can suggest the best feeding plan for your baby whether your baby is being fed milk, formula or by IV fluids. They monitor your baby’s growth and nutrition.

Registered Nurses

There is a large team of neonatal nurses who are highly trained in the care of newborns. They provide assessments and daily care for your baby and join you in advocating for your baby’s needs. They will help you learn how to care for your baby and provide teaching for you to go home.

Residents

We have many pediatric residents at CHEO. They are physicians and have graduated medical school. They are receiving several years of training in pediatrics. They have a strong presence in the unit and rotate on a block schedule throughout different areas of the hospital.

Respiratory Therapist

Specialist who assesses your baby’s breathing and maintains supportive measures such as a ventilator or other non-invasive supports. There are 1-2 RT’s in the unit per shift and are called to the bedside whenever there is an emergency or just to check in on the breathing equipment. They attend rounds daily.

Social Worker

There is a dedicated social worker in the NICU and one dedicated for cardiology patients. They will check in to see how you’re doing and assess whether you need emotional, financial or other help. They can help coordinate a place to stay for families who are coming from out of town.

Specialist or Consulting services

Many babies come to CHEO for a specialty service. While your baby is still cared for by the Neonatal team, we may consult other doctors to look at a specific issue. We commonly work with General Surgery, Cardiology, Neurology, Radiology, Ear Nose and Throat (ENT) doctors, Genetics and many other specialists.

Volunteers

We have a team of vetted baby whisperers who help keep babies happy when they need a cuddle and their parents or nurse are unable to be there or busy with other matters. The volunteers help us with other tasks around the unit if all of the babies are happy or already resting at the moment.

Monitors and alarms

One of the first things you will notice is that we attach many wires to your baby. The three stickers on their chest and abdomen will monitor their heart rate and breathing rate. The glowing red light on their hand or foot measures their oxygen saturation.

These alarms are very sensitive and will sometimes ring unnecessarily when your baby is moving or the wires are not in a good position. Nurses are trained to know very quickly when these alarms require immediate action and when it is a false alarm. If you are worried, always look at your baby for reassurance of how they are doing.
The nurse will always determine whether your baby needs help. Even if a false alarm is loud and seems hard to ignore, please never turn it off yourself. The monitors are connected to each other and centrally. Nurses across the room can see what is happening on your baby’s monitor even if they are not at your bedside. Rest assured that if your baby needs help, someone will be right there to help them.

What do those numbers mean?

Green: Heart Rate
White: Oxygen Saturation %
Red: Arterial Blood pressure
Blue: Respiration (breathing) rate
Orange: cuff (non invasive) blood pressure
Yellow: Invasive Respiratory monitoring (breathing tube)

Specialty services available

At CHEO we have specialist doctors and teams for almost every system in your baby’s body. Specialty services will be consulted only when they are needed. These include teams such as General Surgery, Cardiology, Respirology, Genetics, Neurology, Ear/Nose/Throat (ENT), Nephrology, Opthamologists, Anesthesia, Pain and Symptom Management, Feeding (occupational therapy) or physiotherapy and many more. All of these specialists act as a consultant while your baby is still under the primary care of a Neonatologist.

Home criteria

All babies have the same basic criteria to go home:

breathing on their own
feeding on their own (or established via a tube for home)
gaining weight and maintaining temperature
teaching and equipment in place if necessary to make sure you have any specialized equipment your baby needs at home.

With all of those goals met your baby is set to go home!

Breathing

Many of the babies in our unit have breathing difficulties at birth. Once these issues are resolved, they sometimes still have “spells” or short pauses in their breathing.This is most common with premature babies and it causes their heart rate and oxygen saturations to drop. As the respiratory center in your baby’s brain develops this will stop happening. Your baby will eventually breathe consistently even while in a deep sleep. We require babies to be spell-free for seven days prior to discharge to be sure they will not do this at home.

Feeding

Most babies do not start to coordinate their suck, swallow and breathing pattern until somewhere between 32-34 weeks gestational age. Many of the babies in our unit have additional issues as they may not start eating by mouth until later than this. Your baby needs to be breast or bottle feeding reliably before they go home. If it is determined that feeding issues may last a long time, we may set up tube feedings and equipment for home.

With the first two criteria met, the last piece that lets us know your baby is ready for home is weight gain. Weight is monitored every day. If weight gain is not a concern, we may space it out to once or twice a week.

Maintaining temperature

For premature babies who have been in an isolette or overbed warmer, we need to make sure they are big enough to maintain their temperature. If they spend too much energy trying to keep warm, they will not grow well and may tire out more easily. In an open cot with normal clothing and bundling, your baby should be able to maintain a normal range temperature before going home.

Parent learning

Some babies will have specialized needs for home. All follow up appointments, home medications, and home equipment needs will be arranged before you are discharged home. We will make sure you know what appointments you need to attend, how to give and obtain any medications your baby requires, and are comfortable using and adequately supplied with any medical equipment they may need at home. Some conditions require further parent teaching and we need to be sure you have received any education you need to safely bring your baby home.

Hearing Screen

All babies in Ontario receive a hearing screen within the first two months of life. We try to get this done while your baby is in hospital. If your baby is discharged before it is done we can arrange for the screen to be done in the community.

CHEO staff gathered for daily rounds

How to get involved in your baby's care

Daily rounds

Every day our NICU Team meets for their daily rounds. Rounds start at 9:30 but it takes a few hours to get around to each patient. The team reviews your baby’s condition over the last 24 hours and makes a plan for the next 24 hours. There is sometimes open discussion or teaching for residents included and a lot of medical terms being said. The team will make sure that you understand all of the important pieces of what was said and give you an opportunity to ask questions. Some parents find it helpful to write down their questions so they don’t forget them when the whole team is there to ask. If a lengthier discussion is needed on a certain topic, sometimes we need to prioritize and come back later to discuss details.

We can arrange to have you attend rounds by secure video conference or fill you in on discussions later in the day if you cannot be there in person.

Handling times

Because sleep is so important for your baby’s development, we try our best to set a schedule for your baby’s care or “handling” to minimize disruptions. If your baby is being fed, all of their care is then clustered around their feeding times. Often these times are every three hours and either start from 8am or 9am and continue around the clock every 3 hours.

If your baby is not being fed, we may aim to provide care every 4 hours. There may be occasions we will adjust these times to coordinate with a test that needs to be done or based on your baby’s cues.

Interacting with your baby

Sometimes the tubes and wires can be scary and overwhelming. Your baby is still there behind all of it and there are many things you can do to care for them. You can talk or sing to your baby in a quiet voice, but sometimes it is hard to know what to say to your baby. For these times, we are lucky to have books donated to the unit as a special gift from the family of Jack & Mia. You can read this book that is given to your family or any other book you choose to bring in.

You can also hold their hand or show them a small toy. If they are well enough you may be able to try supervised tummy time to help strengthen their back and neck muscles.

You can always get involved in your baby’s care by taking their temperature and washing their face or cleaning their mouth and eyes when needed. You may need some help with the wires at first, but you can help change your baby’s diaper around the time of their feed or handling time.

Family members who cannot visit in-person may want to spend time with the baby by video call. We kindly ask that you use earphones and a quiet voice to respect the space of the other babies in the unit.

Bathing and care

When your baby first arrives in the NICU, they usually have several tests or procedures, consults, or exams from physicians which makes daytime quite busy. We also like to give you time to cuddle your baby during the day. This means that we usually reserve bath time for the night shift as there is more available time. Weights tend to be done at the same time as the bath and on Saturday nights we take all of your baby’s weekly measurements (height and head circumference).

As your baby gets better and is moving closer to home, days become less busy with tests and procedures. At this point we encourage parents and caregivers to be more involved in daily care and we can teach you how to bathe your baby during the day or evening if you prefer. While this routine usually works well, let us know early if there is another arrangement that we can try to accommodate.

With your baby’s handling times, you’re welcome to provide care such as eye and mouth care when needed and a diaper change. The nurses will help you navigate all of the equipment and wires.

Feeding, supports and pumps

It is common in the NICU that babies are not ready to feed by mouth for the first while for various reasons depending on their condition. In this case, your baby will receive all of the nutrition they need via an IV. This total parenteral nutrition is called TPN and is made up of sugar, electrolytes, vitamins and the fats your baby needs to grow. It is made especially for your baby based on their blood values.

If your baby is ready to receive small amounts of breast milk or formula, this will be offered by a nasogastric tube (NG). The NG tube is inserted in their nose or mouth, travels down their esophagus to their stomach and can deliver milk. If your baby has no issues breathing and is showing signs that they are ready to bottle or breastfeed, they will be allowed to try feeding by mouth. Sometimes it takes a few tries for them to learn how to feed by mouth and build enough energy to get through an entire feed. We often use a feeding tube to give any remaining milk they were unable to take by mouth.

All of our nurses have extensive training and experience helping mothers with breastfeeding.

From day one we will get you set up with a breast pump and all the information you need to know about pumping. We have pumps available at the bedside and will provide you with one breast pump kit for your stay. It is your responsibility to care for the kit and safely store your milk. If possible, we would like to use fresh milk to feed your baby. Any milk not being used within one hour after pumping needs to be kept cold in the refrigerator or on ice and labeled with the date and time you pumped. Our pumps cannot be removed from the hospital. If you choose to go home overnight and need to pump, you may need to purchase or rent a pump for home. We can instruct you where to find a rental pump. In the meantime, you can always use hand expression to help keep your supply up and for comfort.

Expressed breast milk (EBM) can be stored:

in the fridge for up to 48 hours
in the freezer up to 3 months
in a deep freezer up to 6 months

Once thawed out, it is good for 24 hours.

Kangaroo care

As much as possible, we encourage all parents to provide kangaroo care which involves uninterrupted time for either parent to hold your baby skin to skin. Your baby will be in just a diaper and rest on your bare chest.

We recommend that you make sure you’ve had something to eat and drink and gone to the bathroom prior to holding your baby. This will help make sure you are available for at least 60 minutes but kangaroo care can last several hours if you’re able. It can take some time after transferring to your skin before your baby really settles in and it is best to minimize disruption. This time is so precious with your baby and we advise you to soak it all in and not pick up your phone and maintain skin to skin contact with your baby for as long as possible.

Benefit of Kangaroo Care for babies

Skin-to-skin or kangaroo care has been shown to have many benefits for your baby. It helps them:

Regulate their breathing, heart rate and temperature
Prepare them for breastfeeding
Manage pain during painful procedures
Decrease crying and stress

Studies show when you and your baby are skin to skin in the same environment, you produce antibodies to microorganisms in this environment which. These antibodies appear in your breast milk within a few hours and the immunity is passed on to your baby. It also is shown to help with sleep and brain development

Benefits of Kangaroo Care for parents:

decreases parental stress
helps you gain confidence in caring for your baby
is an opportunity to bond with your baby
improves milk production and eases the transition to breastfeeding
decreases risk of postpartum depression

Modified Kangaroo Care

If your baby’s condition prevents them from being held, there are modified forms of kangaroo care you can provide.

Finger Holding – your baby can hold your finger as a comfort measure

Hand hugging – place one hand around your baby’s head and the other cupping their feet to help calm them and feel secure.

Nesting or encircling baby – you can lean over their bed and wrap your arms around your baby

More information

About Kids Health reference

Linens and clothes

You may choose to bring in some blankets, facecloths, or clothes for your baby. Make sure items are washed in a scent-free detergent prior to bringing them in. Your home should be smoke-free before your baby’s arrival as the scent of smoke can cause them difficulty breathing. Make sure your items are labeled with their name (usually on a tag). While we try our best to keep things clean, babies are messy beings. Blankets will frequently be soiled and have to be brought home to be laundered. Just in case, do not bring items that are very precious to you or you would not like to be lost or accidentally damaged.

Transition to pediatric care

As your baby’s health improves, they may not need NICU care any longer. If they are not requiring the specialty care of our NICU, there are times when it is appropriate to send them back to their birth hospital or transition to another unit at CHEO before they’re ready for home. While the care may look different in different areas, know that this is a positive move towards the goal of you bringing your baby home. This will give you the opportunity to become even more involved in your baby’s everyday care.

What you can do to ease this transition?

Get involved in your baby’s care early on. While you are in the NICU, try to learn as much as you can to become the expert in your baby’s care. If your next step is the inpatient wards at CHEO, parents are expected to stay with their baby. Most parents who have had their baby home already want to stay and are used to caring for their child. This parent-led care model can be a big change for parents of babies who have been in the NICU but this is progress towards going home! Learning how to lead your baby’s care early on will help.

Ask for help! Child Life is there to improve your child’s experience. They can help coordinate volunteers to cuddle your baby when you need a break. Social Workers are there to support you and help you navigate the health care system. Spiritual Support are there to listen and help you through difficult times. Patient Experience is there to respond to questions or concerns you may have about your time at the hospital.

A mother and father holding their baby

Feeding in the NICU

Most babies who need to come to the NICU may not be able to feed as they normally would for the first few days or longer. For various reasons, both term and premature babies may have issues with breathing or digestion that prevent them from feeding. Initially, they will receive all of the sugars and electrolytes they need by intravenous (IV) fluids.

If you plan to breastfeed or provide your baby with expressed breast milk you should start expressing milk as soon as possible. In the first few days your milk is darker and thicker, called colostrum. Save every drop! We call it Liquid Gold and it contains many protective factors to line your baby’s digestive tract. Even if your baby isn’t ready to feed, we can put a small drop in their mouth which we call Oral Immune Therapy (OIT). It helps get your baby’s bowel started on the right track.

IV feeding (TPN)

If it is determined that your baby cannot eat for more than a few days, we will add in extra nutrition that includes all of the vitamins, proteins and fats they need to grow and thrive. This intravenous (IV) nutrition is called Total Parenteral Nutrition or TPN. Your baby’s TPN is prepared every day and adjusted to your baby’s specific nutrition needs based on their blood values. They will have regular blood work drawn to make sure they’re getting the right amount of everything they need. We will often make adjustments in the rate of TPN as we try giving your baby more of your milk by mouth or through a feeding tube.

Tube vs bottle feeding

When a baby is ready to start receiving milk, there may be several reasons why we need to start with a tube or bottle feed. Premature babies start to develop a stronger suck and coordinate with their swallow around 32-34 weeks gestational age. Some full term babies may not be able to feed by mouth if they have breathing, neurological, digestive or other issues. If your baby’s breathing or suck prevents them from being able to take their feed by mouth, we will insert a nasogastric (NG) tube in their nose that will deliver the food directly to their stomach. This allows your baby to safely receive milk without the risk of choking (aspiration). Tube feeding allows them to save their energy for growth and development.

After not feeding for some time, your baby will start with a small amount of breast milk or formula. This small amount of milk that is meant to get your baby’s digestive tract used to the idea of feeding is called a trophic feed. When your baby is tolerating trophic feeds we will slowly increase the amount of milk they receive.

Breastfeeding in the NICU

Your breast milk is designed to give your baby everything they need. Mothers of premature babies produce milk with a different makeup than those of full term babies. It has more calories and a different nutritional makeup that changes as your baby grows. When your baby is old enough and healthy enough for breastfeeding, they will begin showing signs of readiness to feed. Opening their mouth, rooting and showing a strong suck are all some of the signs they’re ready to start feeding. Even for full-term, healthy babies this sometimes takes a bit of practice, patience and learning for both mother and baby. Your baby’s nurse can share tips to help you succeed.

For more information on breastfeeding, please visit our CHEO Breastfeeding resource page

Pumping in the NICU

For parents who are choosing to breastfeed, expressed milk is the best gift you can give your baby until they are ready to go to the breast. It contains so many nutrients and protective properties for their bowel and immune system. It’s no secret that expressing your milk is a lot of work. Even if only for the first few feeds, mother’s milk is proven to provide your baby with lifelong benefits.

After delivery, the hormone prolactin which helps you produce milk increases. You need to stimulate the breast tissue to encourage milk production. Early breast massage or hand expressing is the best and easiest way to remove this early milk called colostrum. We encourage you to express your milk every 2-3 hours. It may be helpful to set an alarm to keep you on track. During the first few days or weeks it will be necessary to pump through the night as prolactin levels are highest between 02:00-04:00 in the morning. You can find breast Pumping instructions here.

We recognize that it is a balancing act between sleep, nutrition, your pumping schedule and all of your demands. While you may have never considered pumping when you envisioned taking care of your newborn, keep in mind it is hopefully one step towards breastfeeding your baby one day soon.

A Pumping log that may be helpful for you to track the times and amount you pump each session. You may be able to notice trends such as whether your supply increases or decreases based on stress, nutrition, when you spend time near your baby or frequency of pumping.

Hand expression

There are many advantages to expressing milk by hand and it may even be the best way to express colostrum during the early days. Colostrum is particularly thick, rich and nutritious for your baby, but the thick milk can be difficult to extract using an electric pump. Hand expression really helps you get deep into the tissues to help stimulate production and clear the ducts.

Here is a short video from Dr Jane Morton at Stanford University that explains the technique.

Baby led feeding cues

To know when your baby is ready to feed, we will look for cues they are ready to feed. When the medical team has cleared your baby to feed, we will look for signs they are ready to feed such as sucking, rooting or opening their mouth, licking, or bringing their hands to their mouth. If your baby is sleepy, there are some ways of gently waking them. It might be necessary to try timing feeds with moments when they are already awake and keen to feed. With time, they will feel more hungry and be keen to feed.

If your baby is not feeding by mouth yet, it is important to create positive oral experiences for them. Providing opportunities for non-nutritive sucking such as a pacifier or soother, allowing them to nuzzle at the breast, or sucking on a clean, upside down finger in their mouth to soothe all help create a positive oral experience for your baby. You can also gently stroke their cheek and speak to them when they are happy. Providing a drop of breast milk on their tongue, called Oral Immune Therapy and may be a positive oral experience that also allows them to smell and taste your breast milk while also providing them with antibodies from your milk.

Monitoring growth

Whichever type of nutrition your baby is receiving, their growth will be closely monitored. We measure their weight daily if possible. The doctors, dietician and nurses will make adjustments to their feed if needed. Premature babies or those with a cardiac condition may require extra calories or nutrients added to their milk.

A baby being fed by NG tube

What about my child’s specific condition in the NICU?

Please see the selection of helpful information that may be relevant to your stay in NICU or useful for when you’re at home with your baby,

Extremely Premature Infants

Having a baby earlier than expected can be scary and overwhelming. Every aspect of their care is carefully monitored. The Canadian Premature Babies Foundation can help guide you through your experience and connect you with other families in a similar situation.

Decision-making, Symptom Management and Palliative Care in the NICU

We are fortunate to work closely with an incredible team based out of Roger Neilson House called the Pain and Symptom Management (PSMT) and Palliative Care Team. They offer many supports both in our unit and ongoing with patients who may need future respite care. Our team likes to involve this team as early as possible for all of the facets of care they can help guide. You can find out more about their program here.

Helping siblings through grief

Blood Transfusions

Both term and preterm babies who are sick or admitted for a longer time in the NICU are susceptible to anemia or low blood blood counts. In optimal settings, babies have a very small amount of blood in their bodies and they are slower to produce new blood cells. Add to that the frequent blood tests we may need to take for sampling and the risk is that much higher. There are signs we look for to see if the baby needs more blood volume, such as high heart rate, more oxygen needed, or having spells (dropping heart rate and oxygen saturations with pauses in breathing).

The physician will explain the risks and benefits of a blood transfusion and will have you give consent prior to giving blood.

Glossary, handouts and more

A-Z glossary

A

ABO incompatibility

Occurs when the mother has a blood type that does not match with baby’s blood type. It can cause jaundice and anemia in the baby, which will be monitored.

Acidosis

An excess of acid in the blood.

Arterial line

A catheter placed in the artery to monitor blood pressure (invasive) and can be used to draw blood work.

Anemia

Low level of red blood cells or hemoglobin in the body.

Antibiotics

Medicine used to treat bacterial infection
Apgar Score - Scoring tool used at birth that gives a quick idea of how well your baby is doing in the first few minutes of life.

Apnea

A pause in breathing that lasts more than 20 seconds. Common in premature babies.

Aspirate/Aspiration

When a fluid or air is removed from the baby’s body.
When baby breathes milk or fluid into their lungs

B

Bilirubin

Yellowish substance made when red blood cells are broken down. Normally processed by the liver and excreted in urine and stool. When it builds up you can notice your baby’s skin or eyes having a yellow/orange colour.

Bili lights

Phototherapy or light treatment that breaks down bilirubin to prevent or treat jaundice.

Breast milk fortifier

Calories and nutrients added to breast milk. May be in powder or liquid form.

Blood gas

Blood sample that tells us how well your baby is exchanging oxygen and carbon dioxide when they breathe.

Birth weight

Measured weight at the time of birth. Sometimes birth weight may be estimated depending on your baby’s condition.

Blood pressure

Can be measured non-invasive lay by using a pressure cuff that inflates or measured invasively by an arterial line in the arms, legs or umbilical cord.

Bolus

An amount of fluid given over a short period of time.

Bradycardia - Slow heart rate. In babies this is noted as under 100 and often worrisome under 60 beats per minute.

C

Catheter

A thin, flexible, plastic tube. There are many types and it may go by different names depending on where it is placed.

Chest X-ray

An X-ray to look at your baby’s chest to see placement of tubes or look at the condition of their lungs or heart.

Chest Tube

Inserted by a physician or advanced practitioner. A chest tube is used to drain fluid or air in the lungs.

CPAP

Continuous positive airway pressure. A machine to help your baby breathe that pushes air through a mask or prongs in their nose to help keep the smallest air sacs in their lungs open and make it easier for them to breathe.

Cyanosis

A blueish colour that is caused by low oxygen saturation. Acrocyanosis is a blueish colour to the hands and feet which can be normal during the first few days of life.

Corrected Gestational Age

The baby’s current age in weeks, starting from the date of conception. For example, a baby born at 35 weeks gestation who is now 5 weeks old would be 40 weeks corrected (term).

D

Desaturation (desat)

When the oxygen level in the blood falls below a set target. This target may vary depending on the baby’s age or condition.

E

EBM

Expressed breast milk. The milk a mother produces.

ECHO

Echocardiogram is an ultrasound of the heart that shows the structure and function of the heart.

Edema

Swelling caused by extra fluid in the tissues of the skin.

Electrolytes

Important chemicals such as sodium and potassium in the blood that must be in balance for the body to work properly.

Exchange Transfusion

Extremely high levels of bilirubin may need to be treated by removing blood from the baby and exchanging it with donor blood to bring down their bilirubin levels.

Extubation

Removing a breathing tube.

F

Fontanelle

There are two soft spots on a baby’s head where skull bones have not yet come together. These are normal and will close within a year.

Full Term

A baby who is born between 37-42 weeks gestation

G

Gastroschisis

A birth defect that allows an opening of the abdominal wall and the baby is born with abdominal organs outside the body.

Gavage feed

feeding by a tube in the nose (NG) or mouth (OG) which is common when a baby is too premature to eat, or has breathing, digestive or other issues that don’t allow them to take food by bottle or breast.

Gestational Age

The length of time between conception and birth, measured in weeks and days.

GERD

Reflux (or gastroesophageal reflux disease) similar to heartburn, when stomach contents come back up the esophagus. This may cause discomfort or cause premature babies to spell.

GBS

Group B Streptococcus is one of the most common infections babies can be born with and can be quite serious for them. Mothers are routinely swabbed for this around 36 weeks gestation and given antibiotics before the baby is born if possible.

G-Tube

Feeding tube on the abdomen that is surgically placed directly to the stomach. Used for babies who cannot feed by mouth for the long term.

H

Head Ultrasound

Test to check brain structure and blood flow. Routinely monitored in premature babies who are at risk for brain bleeds due to the fragile vessels in their brain.

Heel Prick/Poke/Stick

A way to take blood for testing but using a small lancet on the baby’s heel. Also known as a cap (capillary) sample.

HFO

High frequency oscillation. A type of breathing machine that provides tiny, fast breaths that makes your baby’s chest appear to wiggle. It is a gentle mode of ventilation used when we have difficulty with conventional breaths.

High flow oxygen

Similar to CPAP, a non-invasive breathing support.

Heart Murmur

Additional sound heard in a baby's heartbeat. Sometimes normal in the first day or two of life, but may be an abnormal finding.

Hypoglycemia

Low blood sugar (glucose) level

Hypotension

Low blood pressure

I

Infusion

Slow, continuous introduction of a solution or fluid into the bloodstream.

Intubation

Procedure of placing an endotracheal tube in an airway.

IVH

Intraventricular hemorrhage. A bleed in the brain (into the brain’s usually fluid-filled ventricles) that is common in premature babies. Graded on severity from 1-4.

Isolette

Heated, humidified, double-walled bed for premature babies.

IUGR- Intrauterine growth restriction. Term used when a baby has slow growth in utero.

J

Jaundice

Yellow colour seen in the skin and eyes common in newborns within the first couple weeks of life. Measured by the bilirubin level which is caused by the breakdown of red cells. If levels are too high, baby may need phototherapy (bili lights) to treat it.

K

Kangaroo Care

Parent holding and undressed baby skin-to-skin on their bare chest.

L

Lipids

Fats delivered by IV which is one part of TPN

Long line

Short of a central line, a long line can deliver IV fluids and medications and remain inserted for up to 30 days.

Level III-B unit

Unit classification that will care for babies of any gestation who require surgical or specialized care.

Lumbar Puncture

Also called a spinal tap. A needle is placed in the lower spine to remove a small amount of spinal fluid for testing. Often used to detect infection in the brain called meningitis.

M

MRI

Magnetic resonance imaging is a test that provides a detailed view of the structures in the body. There are other MR tests that can be performed as well. This is one of the few tests babies must be brought out of the NICU to have done.

Meconium

Dark black or brown, sticky stool babies pass in the first few days.

Meningitis

Infection in the brain that is confirmed with a lumbar puncture to test the cerebrospinal fluid (CSF)

N

NEC

Necrotizing enterocolitis. A condition in the gut of neonates where the wall of the bowel swells and becomes fragile or loses blood flow. It can be very dangerous. The gut may only require some rest and antibiotic treatment before resuming feeds slowly, but in severe cases it may require surgery.

Neonatal

The newborn period of the first 28 days of life.

Newborn Screen

Metabolic screen done on all babies in Ontario. It consists of 5 drops of blood on a paper, usually done by a heel poke. It tests for 5 groups of diseases that are treatable but not usually detected in the newborn period.

NG or feeding tube

Nasogastric tube (NG) is inserted in the nose and travels to the stomach. It can be used for feeding or for draining the contents of the stomach.

Nasal Prongs

Small, flexible tube that delivers oxygen into a baby’s nose.

Nitric Oxide

Gas delivered to open the airways in babies with high pressures in their lungs (pulmonary hypertension)

O

OIT

Oral Immune Therapy involves giving a small drop of freshly expressed breast milk into a baby’s mouth. It allows them to receive antibodies and benefits from the milk before they may be able to feed.

P

PDA

Patent Ductus Arteriosus. A blood vessel that keeps blood away from the lungs when the baby is in utero (when lungs are fluid filled) and usually closes shortly after birth. When it stays open (patent) longer than normal it may interfere with normal blood flow and heart and lung function. We may try medication to close it, or surgery may be necessary.

PHDM

Pasteurized Human Donor Milk. Human breast milk that has been donated to a bank and sterilized to rid it of any possible infection. It still contains many benefits of breast milk and may be easier to digest than formula. It is given to babies who meet certain criteria and may not have their own mother’s milk.

PICC line

Peripherally inserted central catheter looks similar to a regular IV in the arm or leg, but it is a long line that is threaded through the vein to sit at the larger vessels of the heart. It can deliver TPN or medications for as long as needed.

PIV

A peripheral Intravenous is a regular IV. In babies can be inserted into a vein in the hands, feet, arms, legs, or very superficially in the scalp. Babies don’t instinctively protect their IV as adults do. Combined with their fragile veins, the sites don’t always last very long.

Preterm or premature

A baby born before 37 weeks gestation.

Pneumothorax

Medical term for a collapsed lung. It is a pocket of air in the space between the lungs and the chest wall. Larger air leaks may need a needle or chest tube to remove the air as it becomes very difficult to breathe.

Phototherapy

Blue lights that help to lower bilirubin levels and treat jaundice.

PPHN

Persistent pulmonary hypertension of the newborn is high blood pressure in the lungs. This makes it difficult to exchange gasses properly and results in breathing problems.

Pre/post saturations

A measurement of oxygen saturations on the baby’s right hand/wrist and another limb. This gives a quick measure of worsening pulmonary hypertension or a heart condition.

R

Reflux

Similar to acid reflux. Stomach contents backing up into the esophagus. May be painful and may cause small babies to briefly drop their heart rate or stop breathing (spell)

Replogle Tube

Used to keep the airway clear in babies with TEF. It is inserted in the nose or mouth to the back of their throat where their esophagus comes to an end. It has 2 channels in the tube. One continuously infuses saline, while the other continuously suctions away the saline and secretions.

Retractions

Pulling in of muscles that indicates increased work of breathing.

RDS

Respiratory distress syndrome is a breathing problem caused by lack of surfactant in premature babies.

ROP

Retinopathy of prematurity is a disease that affects immature blood vessels in the premature baby’s eye. Babies less than 30 weeks gestation are scheduled for regular eye checkups. In severe cases a laser treatment may be needed.

RSV

Respiratory syncytial virus is similar to a cold, a respiratory infection that can be serious for premature infants and all newborn babies. Some babies will qualify for a vaccine and require this monthly if they are sent home between November-April.

S

Saturation

Percentage of oxygen present and measured in the blood. The red light sensor on your baby’s hand or foot is measuring this.

Skin to skin

See Kangaroo Care under letter K.

Sepsis

A blood infection that requires treatment with antibiotics.

Spell

Apnea and bradycardia in premature babies. Apnea is a pause in breathing of at least 20 seconds that causes their heart rate to drop (bradycardia) and usually accompanied by a drop in their oxygen saturation. It is commonly due to immature breathing centers in the brain and should resolve as they reach term. Sometimes these resolve quickly on their own, but they may require stimulation or intervention to correct.

Stoma

Surgical opening connected to the bladder or bowel that allows waste (urine or feces) to drain out. When connected to the bowel, the name defines which part of the bowel it is connected to, usually colostomy (colon) ileostomy (ileum) or jejunostomy (jejunum). It appears as a small, round, pink piece of flesh attached to the outside of the body. It is covered with a bag to collect the waste.

Sucrose

24% sucrose is a form of sugar in water (less sugar than common syrups such as antibiotics or fever medication) and it’s been proven to reduce pain during tests and treatments in babies up to 18 months.

Suction

Removal of secretions or mucous from lungs, breathing tube, or airway.

Surfactant

Slippery, soapy substance that allows your baby’s lungs to easily open and exchange oxygen. Babies born before 34 weeks may not have produced enough surfactant and may require it to be given via a breathing tube.

T

Tachycardia

Abnormally fast heart beat.

TEF

Tracheoesophageal fistula is a birth defect where there is a small connection between the baby’s windpipe (trachea) and food pipe (esophagus). This will require a surgical correction. See Special Conditions below.

TFI

Total Fluid Intake. This is a set number of milliliters based on your babies age and condition that they need per day. This number is always multiplied by their weight. It is expressed in mLs/kg/day.

Tube (ETT)

Breathing tube. It can be inserted in the nose or mouth to assist a baby with mechanical ventilation. It requires special monitoring and is always at risk of being accidentally removed.

Transfusion

Premature babies may have immature marrow and not produce blood quickly enough. Sometimes oral iron may help boost their stores, but some may require a blood transfusion.

TTN

Transient tachypnea of the newborn is caused by fluid on the lung after birth causing the baby to breathe very quickly. Your baby may need pressure of CPAP and may not be able to feed by mouth while they are breathing so quickly.

Tachypnea

Fast breathing rate

TPN

Total parenteral nutrition is vitamins, proteins, sugars, minerals and fats your baby needs to grow well given by an IV or central line.

U

UAC

Umbilical arterial catheter is a central line placed in the belly button’s artery to monitor blood pressure and may be used for blood sampling.

UVC

Umbilical venous catheter is inserted in the vein in the belly button and is used to deliver fluid, medicine or nutrition to your baby.

V

Ventilator

A machine that helps your baby breathe. Monitored by the Respiratory Therapist.

Handouts

Websites

About Kids Health — a health education website for children, youth and their caregivers from Toronto’s Sick Kids Hospital.

Ottawa Public Health - Healthy Babies, Healthy Children

Health Canada Vaccination Schedules

Post Partum Depression support page

Skin-to-skin and kangaroo care