When you first visit the NICU you will be amazed at the array of equipment surrounding your baby. The rest of this section covers some of the most common equipment you encounter in the NICU.
Radiant Warmers and Incubators
Your baby often arrives in the NICU on a radiant warmer (a cart with a mattress on top and a heat source overhead).
This helps your baby stay warm, and at the same time, allows easy observation by the NICU staff. It also allows easy access for any procedures or examinations that the staff may need to perform.
When your baby is stable and having fewer procedures each day, the baby can be moved to an incubator, commonly called an isolette (a large plexiglass box with a mattress inside).
Some NICUs have warmers with tops that come down and convert the warmer directly into an isolette, so that your baby does not need to be moved from one to the other.
The isolette helps to maintain a stable body temperature until the baby gets big enough to do this on his own. Babies usually need help staying warm until they reach a weight of about 2,000 grams (4 pounds, 7 ounces).
Monitors for Heart Rate, Breathing Rate (Respiration), and Blood Pressure
The NICU staff must be able to quickly detect any changes in your baby's heart rate, breathing rate, and blood pressure. To do this, they connect your baby to a monitor that displays this information. These instruments are equipped with alarms that sound if there are any abnormalities. This can make the NICU a rather noisy place.
An alarm is not always a cause for concern. A baby's movements or crying can trigger an alarm. But, just to be sure, the NICU staff check each sounding of an alarm to see if there is a problem.
Pulse Oximeters and Transcutaneous Monitors
To assess how well your baby's lungs are working, NICU staff may use a pulse oximeter or a transcutaneous monitor. These devices measure the level of oxygen saturation in your baby's blood; the transcutaneous monitor also measures the carbon dioxide level in the blood. The staff does not need to use needles to get blood for these measurements. Instead, the pulse oximeter uses a probe wrapped around a finger, hand, or toe to read the oxygen level through the baby's skin. The transcutaneous monitor uses a small electrode on the baby's skin to measure oxygen and carbon dioxide levels.
Equipment for Administering Oxygen
There are several ways that NICU staff can administer oxygen to babies who are breathing on their own, but are having difficulty getting enough oxygen. A baby's head can be placed inside a plastic box called an oxyhood. This allows breathing in an oxygen-enriched environment and can be used to give close to 100% oxygen, if necessary. A cannula can also be used to deliver oxygen. This is a small plastic tube with prongs that fit just inside the baby's nose. The baby can sleep with the oxygen cannula in place. The cannula allows for easier feeding, bathing, and performance of other activities than when a baby is using an oxyhood.
Continuous Positive Airway Pressure (CPAP)
Sometimes, when a baby has trouble breathing, special plastic prongs are placed in the baby's nose to allow delivery of extra pressure to help the baby's lungs stay inflated (CPAP), as well as extra oxygen. The pressure may come from a ventilator or from a device using a column of water, called bubble CPAP. CPAP is used commonly for babies with RDS or HMD, either instead of intubation (see below), or after an endotracheal tube (see below) has been removed. CPAP can also be used to treat babies with apnea of prematurity and bronchopulmonary dysplasia (BPD).
Endotracheal Tubes and Ventilators
When a baby is having trouble breathing, has not improved with CPAP, or needs to be treated with surfactant, a tube (called an endotracheal tube) may be placed in the windpipe (trachea). This procedure, called intubation, may have been done in the delivery room, or it may happen later in the NICU. After the tube is inserted, the baby is connected to a ventilator that pushes a mixture of oxygen and air into the lungs. Ventilators can be set at different settings that vary the amount of oxygen, the amount and kind of pressure, and the point in the breathing cycle when help is given. The baby usually breathes on his own in between breaths assisted by the ventilator. Depending on the severity of the baby's lung problems, he may be on a ventilator for several hours, or for as long as several months. During this time, though, you can usually hold the baby when you visit.
The endotracheal tube can become dislodged, either from movement of the baby or because the tape securing the tube gets loose. It is usually obvious that something is wrong because the baby shows immediate signs when the pressure and oxygen supply is cut off and alarms begin to sound. The staff immediately reinserts the endotracheal tube.
Your baby is gradually weaned from the ventilator as his breathing improves. The NICU staff will slowly reduces the number of breaths, the amount of pressure, and the amount of oxygen that the ventilator is providing until the baby is breathing on his own. Once the endotracheal tube has been removed, he may need some extra pressure and/or oxygen for a time, which can be given through CPAP, in an oxyhood, or through a nasal cannula.