Admissions in the NICU
When a baby is admitted to the Neonatal Intensive Care Unit (NICU), it can be an overwhelming experience for both healthcare providers and families. Whether the admission is expected due to a known prenatal condition or an unexpected event at delivery, NICU nurses play a crucial role in ensuring a smooth transition for these fragile patients.
Understanding the key steps of a NICU admission—from initial stabilization to ongoing management—helps ensure the best possible outcomes. Let’s break it down.
Common Reasons for NICU Admission
Babies are admitted to the NICU for a variety of reasons, including both premature and full-term conditions. Some of the most common include:
Prematurity – Babies born before 37 weeks often need respiratory support, thermoregulation assistance, and feeding support.
Respiratory Distress – Conditions like Transient Tachypnea of the Newborn (TTN), Respiratory Distress Syndrome (RDS), Meconium Aspiration Syndrome, and Persistent Pulmonary Hypertension of the Newborn (PPHN) can require interventions such as CPAP, intubation, or surfactant therapy.
Sepsis or Suspected Infection – Neonates with risk factors for infection or showing signs of temperature instability, respiratory distress, or poor perfusion may need blood cultures, CBC, and empiric antibiotics.
Birth Trauma or Hypoxic-Ischemic Encephalopathy (HIE) – Infants with low Apgar scores, difficult deliveries, or perinatal asphyxia may require close monitoring, therapeutic hypothermia, or respiratory support.
Congenital Anomalies – Structural defects such as congenital heart disease, gastroschisis, or congenital diaphragmatic hernia require early NICU interventions.
Preparing for a NICU Admission: Setting Up for Success
Before a baby arrives in the NICU, preparation is key. A well-equipped and organized team can make a significant difference in the first critical minutes.
What should be ready?
Radiant warmer or isolette (pre-warmed for thermoregulation)
Neopuff or bag-mask ventilation for immediate respiratory support
Intubation & airway equipment readily available
Umbilical line or IV supplies for vascular access
Glucose checks & fluids to manage hypoglycemia risk
Documentation tools to ensure seamless care transitions
Pre-briefing with the team is essential to assign roles, review the baby’s history, and anticipate complications.
Immediate Priorities During NICU Admission
Once the baby arrives, the team must act quickly and efficiently. The first hour, often called the "Golden Hour," is critical for neuroprotection and overall outcomes.
Key priorities include:
Thermoregulation – Preventing hypothermia with plastic wraps, warmed beds, and minimal handling for preemies.
Respiratory Support – Initiating CPAP, oxygen therapy, or intubation based on the infant’s needs.
Vascular Access – Umbilical venous catheters (UVCs) for critical neonates, peripheral IVs (PIVs) for more stable babies.
Glucose & Fluid Management – Starting D10, D10 with protein, or higher dextrose concentrations if needed for hypoglycemia or metabolic instability.
Infection Control – Blood cultures and antibiotics for at-risk neonates (e.g., maternal chorioamnionitis, prolonged rupture of membranes).
Golden Hour: Best Practices for Optimal Outcomes
The Golden Hour—the first 60 minutes of life—has a profound impact on a preterm infant’s survival and long-term health. Following evidence-based practices can help minimize complications:
Fluid Resuscitation – Preterm infants may need 10 mL/kg NS or blood products for hypovolemia or anemia.
Inotropic Support – Dopamine, dobutamine, or epinephrine may be required if the baby is hypotensive despite fluid boluses.
Minimal Handling – Preventing unnecessary stimulation helps reduce intraventricular hemorrhage (IVH) risk in preemies.
Delayed Cord Clamping (if appropriate) – Benefits include improved circulation and reduced need for transfusions.
Parent Communication & Support
For families, NICU admission can be overwhelming. Clear communication from the start helps ease anxiety and builds trust. Nurses should:
Explain why the baby needs NICU care in simple, reassuring terms.
Encourage parental involvement, such as kangaroo care and early bonding when medically appropriate.
Set expectations for monitoring and treatments so families understand the baby’s condition and potential length of stay.
