We realize that having an ill or premature infant is usually unexpected and often frightening. We also recognize that you are the most important person in your baby’s life and we are committed to providing support to your family. From the moment of admission, we want you to participate in your baby’s care. As your baby’s condition improves, you will be able to assume more responsibility for his or her care.

• The Neonatal Health Care Team
• Equipment and Procedures
• You and Your Baby
• Preparation for Discharge or Transfer
• Glossary

The Neonatal Health Care Team

Many health professionals are involved in caring for your baby. Following is a list of people you will encounter while your baby is in the NICU and an explanation of each person’s role in your baby’s care.

A neonatologist is a pediatrician who has completed specialty training in the care of newborn infants. The neonatologists at California Pacific Medical Center supervise the care of your infant while in the NICU.

There is a pediatrician or nurse practitioner in the hospital 24 hours a day to provide any medical care your baby may require. Neonatal nurse practitioners are nurses who have completed specialized training in the field of neonatal nursing and patient management.

Your baby’s bedside care is also provided by registered nurses trained to work with small and sick babies. Each baby is assigned a nurse for every eight-hour shift around the clock.

Respiratory therapists are trained to care for babies with breathing problems. They work with doctors and nurses to provide respiratory support for infants who need extra oxygen or help with breathing.

Social workers are available to provide support for parents of NICU infants. Because they work closely with the medical team and are aware of your baby’s condition, social workers can provide information about services for your child, assist with hospital procedures and help answer financial and other questions. If you wish to talk with someone who has had similar experience, the social worker can also put you in touch with another parent.

Clinical pharmacists are in the unit to help the doctors and nurses with medications and intravenous fluids.

Registered dietitians evaluate all babies to make sure they are getting adequate nutrition for healing and growth.

The Whitney Follow-up Clinic neonatologist and developmental psychologist are available to parents with infants in the NICU during the recovery phase to answer questions regarding your baby’s development.

If your baby was born at California Pacific, he or she may also be cared for by your own pediatrician, together with the neonatologist and nurses who staff the NICU. If your baby was transferred to California Pacific, the neonatologist assumes care of your baby, together with the other physicians and nurses. The staff keeps your own pediatrician closely informed of your baby’s condition and progress.

The neonatal health team at California Pacific is committed to helping you understand what is happening to your baby in the NICU. We provide periodic parent/health team conferences to share information and answer any questions you have.

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Equipment and Procedures

Warmth—When you first visit, your baby will probably be in an incubator or isolette. The incubator provides an environment of warmth. Some babies are put on a special bed with an overhead warmer to keep the baby’s temperature normal. A special wire, or temperature probe, is taped to your baby’s skin and connected to an electronic thermometer, which continuously shows the baby’s temperature.

Monitoring—Your baby will have monitor leads on his arms, legs or chest. These monitor leads are connected by wires to a machine that displays heart and respiratory rates. The monitors help the doctors and nurses monitor your baby’s heartbeat and breathing. Babies having breathing problems may have a monitor called a pulse oximeter. This is a band-aid like probe which is wrapped around the hand or foot. A red beam of light is transmitted to measure oxygen saturation in the blood. Sometimes a second machine called a transcutaneous monitor is used to measure oxygen and carbon dioxide through the skin. None of these wires, leads or probes cause discomfort to your baby.

Oxygen Therapy—If your baby has breathing difficulties, he may need extra oxygen. In this case, a clear plastic box or hood is placed over the head to deliver warm, moist oxygen. Sometimes, a ventilator (breathing machine) may be used to help your baby breathe. This machine is attached to an endotracheal tube (ET tube) inserted in the mouth to the windpipe, helping the baby to breathe. Other babies require extra pressure in their lungs to help keep the lungs inflated. CPAP (Continuous Positive Airway Pressure) provides this pressure via a soft facemask or nasal prongs. Babies may also get extra oxygen through a thin plastic tube with little prongs going into the nose (nasal cannula).

Blood Samples—Blood samples are often drawn when your baby arrives in the unit and throughout the hospital stay. We obtain samples by taking a small amount of blood from the baby’s heel, vein, umbilical vein or artery catheter. One of the most common tests is for blood gases, which measures the amount of carbon dioxide and oxygen in the baby’s blood.

Your baby may need a transfusion while in the NICU to replace blood removed for lab tests. Blood is provided by the blood bank. If you desire, you may select the donors for your baby through the Designated Donor Program. If you would like to use Designated Donor blood, ask your baby’s nurse or doctor for information.

Phototherapy and Exchange Transfusions—Phototherapy or “bili lights” are special fluorescent lights used for babies with jaundice, a yellow skin coloring that commonly occurs in newborns, particularly premature infants. The lights help your baby get rid of excess bilirubin—a pigment that makes babies jaundiced. We protect your baby’s eyes with eye pads when under the light. Sometimes, when bilirubin levels are high, an exchange transfusion may be necessary, which involves exchanging the baby’s blood with fresh, whole blood containing normal bilirubin levels. This procedure helps decrease the jaundice.

Intravenous and Gavage Feeding—If your baby is too ill or small to eat, we may place an intravenous line (IV) for fluids and sugar water. This line also assists with delivering medications to your baby. The IV may be placed in the infant’s foot, hand, umbilicus (belly button) or scalp. (Placing the IV in the baby’s scalp requires shaving some of his hair). If your baby cannot eat for a long time, sometimes a very tiny, flexible IV is placed and threaded into the vein to give the baby more sugar. This central line is more stable and usually does not need to be changed until we disconnect it. Babies who are gavage fed are given milk through a tube passed from the mouth to the stomach.

Studies—To continue improving care for sick infants, learn more about illnesses affecting newborns and find more effective methods of treatment, we conduct numerous clinical studies at California Pacific. A physician may contact you to ask if your baby could be involved in a particular study. We never involve an infant in a study without the parent’s permission.

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You and Your Baby

Your First Visit. When you first see your baby in the NICU, he or she may seem smaller and different than you initially remembered. Despite the isolette, equipment and specialists surrounding him, this newborn is still your baby. Interacting with your baby is very important to his recovery and your own peace of mind. We encourage you to touch your baby and become involved in his care when possible. As your baby recuperates, you will be able to hold and feed him. You are not a “visitor,” but an essential part of your baby’s care.

You may find your first visits to the nursery very difficult. Feelings of fright and distance are normal and will be resolved in time. Remember that it takes time to become comfortable with a new person. Your baby is a unique person with his own special personality. Each visit will bring him closer to you.

Kangaroo Care. Even when your baby is still very small, you may be able to hold and cuddle him by placing the baby directly on your chest, skin to skin, inside your clothing. This is called “Kangaroo Care.” Your doctor or nurse will let you know when your baby is ready for this.

Your Baby. At first, most of your baby’s time will be spent sleeping. However, there probably will be short periods of time when he will be wide awake. As you get to know your baby, you will become aware of his patterns. When your baby is awake, we encourage you to play with him. As you spend more time with your baby, you will become familiar with his likes and dislikes, and know what comforts and soothes him. Babies can become overstimulated with handling, and the staff will help you recognize these clues. It takes time to feel comfortable with your baby, and the nursing staff will help you with this process. With time, the staff will rely on you to tell us about your baby—what soothes him best and what makes him happy.

Feeding. If your baby is ill or very small, he may not be fed right away. If you had planned to breastfeed your baby, you can still do so. By pumping your breasts, you will be able to maintain your milk supply and we can save your milk by freezing it. This milk will be used when your baby is ready to take milk, until he is strong enough to breastfeed directly. Please ask your baby’s nurse for information on how to collect and store your milk. There is an electric pump near the nursery for your use, or you may ask your nurse for information about renting one. Consultants at Newborn Connections will also be happy to help you. Please ask your nurse to contact a lactation specialist there, or you may call directly at 600-BABY. Newborn Connections also offers a library of books and videotapes that cover prematurity. You can visit them at 3698 California Street, 1st floor (one block away).

Smaller babies often cannot suck well and need to be fed through a gavage tube. As the baby becomes stronger, he will begin to take part of his feeding by nipple.

When your baby is strong enough to feed with a nipple or at the breast, we encourage you to feed him during your visits. This is a good time for you to get to know each other better.

Visiting. Parents are welcome in the unit at any time. Upon arrival, you will receive a brochure outlining visiting guidelines in the NICU for other family members and friends. Some general guidelines are as follows:

1) We request that you scrub your hands before touching your baby. Hand washing is very important.

2) For the protection of your baby and others, if someone in your family has an illness that may be infectious, we ask that you not bring them into the nursery until they are well. If you or your child have been exposed to chicken pox recently and have not had the disease, please inform your doctor or nurse before visiting. You may bring toys and clothes to the unit for your baby. Please ask your baby’s nurse which items are appropriate. You may feel free to take pictures of your baby.

3) We encourage you to bring siblings with you when you visit your baby.

Telephone Calls. Please call the unit whenever you have questions or just need an update. Your baby’s nurse or doctor is happy to speak with you at any time. Information about your baby is given only to you—the parents—and to your pediatrician and obstetrician. Please ask your friends and relatives not to call the unit, but to get information through you.

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Preparation for Discharge or Transfer

Transfer. When your infant no longer needs intensive care, he may be transferred to the Transitional Care Room (located near the Well-Baby Nursery). Sometimes, babies are transferred to their original hospital or to a hospital closer to your home. Your pediatrician will resume primary care for your baby at that time. These transfers are always made with your consent. A trained neonatal nurse oversees the transport.

Discharge. Preparation for discharge begins long before your baby actually goes home. In deciding when your baby is ready to leave the hospital, several factors are considered, such as weight, the ability to gain weight, maintain body temperature and take all feeding orally. We will help you become comfortable providing total care for your baby.

Follow-up Clinic. The Whitney Newborn Intensive Care Follow-up Clinic at California Pacific provides special services to infants and children who have received care in the NICU. If these services are appropriate for your baby, the clinic personnel will contact you shortly after discharge. The first clinic visit usually occurs three or six months after your due date. Evaluation includes a complete neurological and developmental examination, hearing test and physical exam. The visit serves as a developmental examination and does not take the place of your usual pediatric visit. The evaluation typically takes an entire morning. Prior to the first clinic visit, a home visit may be made to discuss the care of your baby and assess his progress. For more information about the Follow-up Clinic, please call 600-0830.

Financial Arrangements. Financial concerns contribute to the crisis of having your baby in the NICU. Sometimes, if you add your baby to your insurance policy when he is born, the insurance will cover all or part of the baby’s hospital bill. Check your policy to determine your coverage.

If you have no insurance, you should inquire about MediCal (California’s medical assistance program for the medically needy). You may apply through your social services department. The NICU social worker will help you with information about this program.

California Children’s Services is available for a limited time for some illnesses. Consult your doctor, neonatologist or social worker about this program. If appropriate, he will direct you to apply at the nearest office in your county.

You may also call the Financial Counselors at California Pacific Medical Center for assistance in understanding your insurance policy or other financial coverage that may be available to you, and with questions or concerns about your hospital bill.

To speak with a Financial Counselor, please call the number that corresponds with the first letter of your last name.

Last name beginning with:
A-G, call (415) 750-6362
H-O, call (415) 750-6442
P-Z, call (415) 750-6395

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Glossary

You may find many words the doctors and nurses use unfamiliar. We have compiled a list of most commonly used terms and their definitions.

• Anemia: Too few red blood cells.


• Apnea: A pause in breathing for short period of time. Common in premies.


• Bilirubin: A pigment produced from the breakdown of red blood cells. When in excess, bilirubin appears as yellow skin known as jaundice.


• Blood Gases: A blood test to check the level of oxygen, carbon dioxide and acidity.


• Bradycardia: Slowing of the heart rate to lower than normal.


• Catheter: A plastic tube to put fluids into or to take them out of the body.


• CPAP: Continuous positive airway pressure. It is continuous pressure applied to the lungs through a mask or endotracheal tube and helps the baby’s breathing.


• Designated Donor: Someone chosen by you to donate blood for your baby.


• Edema: Presence of too much fluid in body tissues causes a swollen appearance.


• Endotracheal Tube: A tube inserted into the mouth to the windpipe to keep the airway open.


• Gavage: Feeding by a tube passed through the mouth into the stomach.


• Gestational Age: The time period in weeks from conception to delivery.


• Glucose: Sugar


• Hematocrit: The concentration of red cells in blood.


• Hyperalimentation: Nourishing the baby with a glucose, fat and protein solution through the veins. Also called Total Parenteral Nutrition (TPN)


• Hypoglycemia: Blood sugar level below normal.


• Jaundice: Yellow color in the skin from excess bilirubin.


• Meconium: Dark greenish waste products that accumulate in the bowel during fetal life and are eliminated shortly after birth.


• Meconium Aspiration: The condition in which the baby breathes in meconium that is in the amniotic fluid.


• Carbon Dioxide: Waste gas eliminated by the lungs.


• Patent Ductus Arteriosus: A blood vessel that allows blood to bypass the lungs. It should close shortly after birth.


• pH: Amount of acid in the blood.


• Phototherapy: Treatment of jaundice by use of special lights on the baby’s skin to breakdown the bilirubin.


• P02: Blood oxygen level.


• Pulse Oximeter: A probe that wraps around a hand or foot, connected to a machine, which measures how much oxygen the blood is carrying.


• Respirator: Also known as a ventilator; a machine used to deliver air and oxygen into the lungs with pressure to help the baby breathe.


• Sepsis: Infection in the blood or other body tissues.


• SGA: Small for gestational age; lower birth weight than expected for age.


• Suction: Mechanical removal of mucous from the nose or throat or endotracheal tube with a plastic tube.


• Transcutaneous Oxygen or Carbon Dioxide Monitor: A button-like probe on the baby’s skin to measure the amount of oxygen or carbon dioxide in the blood without taking blood test.


• Umbilical Catheter: A small plastic tube inserted into one of the arteries of the umbilical cord.


• Vital Signs: Temperature, heart rate, respiratory rate, blood pressure.


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