Care for Premature or Very Ill Babies
Both Emory University Hospital Midtown, Emory Johns Creek Hospital, and Emory Decatur Hospital are home to level III neonatal intensive care units (NICUs) for premature or very ill infants. At our Midtown location, the NICU is part of the Special Care Nursery (SCN).
The SCN is made up of a neonatal intensive care unit (NICU), and a neonatal intermediate care (NIMC) nursery. All of our doctors, nurse practitioners (NPs), and other health care staff members care for all infants in both units. Though we try to have the same staff member consistently care for your infant, rest assured that all of our SCN staff members are well trained and experienced and can care for any baby.
What to Expect When Your Baby Is in the NICU
We know that having your baby in the NICU can be frightening and overwhelming. We will work to help you and your family understand and adjust to this new experience. This website can help you know what to expect. Do not hesitate to ask your baby's doctor or nurse if you have more questions, and please, never feel that your calls, visits or questions are an inconvenience.
We believe that the parent-child relationship is key to the long-term health of the child. Our goal is to support you and your baby in the SCN until you can take your baby home.
As the parent of a baby in NICU, you are not just a visitor, but an important member of the team dedicated to providing the best care available for your baby. We provide 24-hour visitation for parents so that you can be with your baby whenever it is convenient for you. In addition, we encourage you to take an active role in your baby's care when visiting.
Our NICUs contain a special nursery where babies with many types of medical problems are cared for in a family-centered, developmentally friendly environment.
Our NICUs are staffed with specially trained doctors, nurses and other health care professionals who are experts in the treatment of ill and premature newborns. We provide each baby the personal attention his or her condition requires.
About the Special Care Nursery
The Special Care Nursery (SCN) is located on the third floor of the Medical Office Tower (MOT) of Emory University Hospital Midtown. To call the SCN, please call 404-686-2261.
Special Care Nursery
Emory University Hospital Midtown Medical
Office Tower 3rd Floor
550 Peachtree Street,
NE Atlanta, GA 30308
Parking passes for parents are available at a reduced rate in the parking garage. The closest Marta train stations are North Avenue and Civic Center.
Who's Who in the NICU
The neonatal health care teams at Emory University Hospital Midtown are made up of dedicated professionals specially trained in caring for premature infants. During your baby's stay in the Special Care Nursery (SCN), you will work together with each team member as a valuable part of the care team.
- Neonatologist: A neonatologist is a specially trained doctor who is board certified in pediatric medicine and the care of newborns. Neonatologists lead our care teams and will oversee the care of your infant. A neonatologist is available 24 hours a day in the SCN.
- Neonatal Fellow: A board-certified pediatrician who is specializing in neonatology by training for three additional years under the supervision of board-certified neonatologists.
- Neonatal Nurse Practitioner (NNP): NNPs are registered nurses with additional education and training in the care of newborns. An NNP works with a neonatologist to assess your baby's condition and care for your baby. An NNP is available in the SCN 24 hours a day to quickly respond to medical emergencies if needed.
- Registered Nurse (RN): An RN provides the daily care for your baby. All RNs in the SCN are specially trained in the care of newborns and will help you learn about and care for your special baby.
- Respiratory Therapist (RT): An RT provides help with any breathing issues your baby may have and with setting up and monitoring equipment that assists with breathing.
- Physical Therapist (PT) or Developmental Specialist: PTs work with babies to determine how their nervous system is developing and help them properly develop their muscles. They also help with feeding issues such as helping premature babies learn to feed.
- Social Worker: Our social worker is available to provide emotional support throughout your baby's stay in the SCN. The social worker can also be a source of information for community resources such as Women, Infants & Children (WIC) benefits, parent groups, and helpful hotlines, and can assist with Medicaid benefit applications and insurance issues. The social worker also helps with discharge planning, such as arranging for home health care and medical equipment and providing referrals for support groups and other services you may need once your baby leaves the hospital.
- Lactation Consultants: A health care professional who provides assistance with breastfeeding and can help resolve breastfeeding challenges. A lactation consultant can also help with breast milk pumping and breastfeeding for mothers of babies who need to remain in the SCN for extended stays.
- Unit Clerk: The unit clerk is the first face you see when entering the SCN. The clerk greets families, answers phones, makes referral appointments and provides other assistance as needed.
- Nurse Technician: Our nurse technicians keep your baby's bedside stocked with supplies and clean linens and make sure that all of our equipment remains clean and in good shape. They also help the unit clerk greet parents and answer phone calls.
- Chaplain: Our chaplains are available 24 hours a day, seven days a week for spiritual and emotional support, prayers and sacraments/ordinances. Your own minister, priest, rabbi or other spiritual advisor is always welcome to visit the SCN and provide for your spiritual needs.
What You Need to Know When Your Baby Is in the SCN
The Special Care Nursery (SCN) is filled with different sounds and noises. Each piece of equipment, including the beds, ventilators, monitors, and intravenous (IV) pumps, has a different alarm. The purpose of these alarms is to tell the staff to check on your baby. Do not let these alarms frighten you; there may or may not be something wrong. Some alarms are actually good news!
Your experienced nurse can tell with a brief glance whether your baby needs assistance or not. So, relax and enjoy your time with your baby and know that we are monitoring the sounds in the SCN.
The SCN is open to parents and grandparents 24 hours a day. All other visitors must be accompanied by a parent.
To protect all of our babies and to keep noise at a minimum, only two people at a time are allowed at the bedside, and at least one must be a parent or grandparent. During procedures and emergencies, visitors may be asked to leave the nursery temporarily. During flu season, these visitation guidelines may be adjusted to provide the best possible protection of our infants.
To help us protect your baby, if you are sick, please do not visit until you have been cleared by a doctor or nurse. Small, young babies catch infections very easily and may not be able to fight them off as well as older children and adults. If you have any signs of an infection, such as a fever, cough, sore throat or other cold symptom or you have recently been around someone with an infection like chickenpox, call and talk with your baby's nurse before coming to visit.
Sibling visitation is encouraged in order to help the infant become a part of the family. All siblings must be screened for infectious illnesses at each visit. Parents are required to complete a Sibling Visitation Survey for all children before they visit the SCN.
Siblings should be accompanied by a parent during all visits. How often children visit and how long they stay during each visit should be determined based on each child's age and his or her attention span. An adult should supervise children in the waiting room at all times.
To help reduce the risk of infection in the SCN, all staff members and visitors are required to wash their hands for three minutes (three-minute scrub) each time they enter into the SCN. Scrub sinks with brushes are located just inside the units for your use. Foam hand sanitizer is located at each baby's bedside to use after changing diapers, touching your cell phone, etc.
Each day, your baby's physician, nurse practitioner (NP) and other team members will visit your baby's bedside together to discuss the care plans for the day. You are invited to listen to the discussion and ask any questions you may have. This visit is always done during the day shift, but times vary depending on the number of patients in the SCN.
It is our belief that health care providers and family members are partners, working together to best meet the needs of each child. Parents and other family members provide important strength and support for the baby. Your insights can help improve the care provided by the professional staff and help us design better programs and friendlier experiences.
Getting to Know Your Newborn
What Do Preterm Babies Look Like?
Preterm babies can look a little different from babies born at term. Late preterm babies will often just look a little smaller than babies born after 37 weeks. Babies born very early or extremely preterm (less than 32 weeks) can be very tiny and frail looking. These babies usually look quite thin because they have not developed layers of body fat yet.
Preterm babies are often born covered with thick, white, greasy cream called vernix. This protects their skin in the watery environment of the uterus and is slowly absorbed into their skin over the first couple of days following birth. Since the skin is not fully developed, you may be able to see the blood vessels beneath. This gives premature babies a reddish-purple skin color. Their skin may feel "sticky" and can bruise easily.
Most very premature babies also have very soft hair, called lanugo, which may cover most of the body. It disappears as the baby grows.
The head of a preterm baby may look unusually large for the size of the body, and the arms and legs might look quite long. Very preterm babies have very little fat covering their bones. However, as they grow and develop more fat, their head, arms and legs should begin to look more "normal" for their size.
It is not unusual for a very preterm baby's eyelids to be stuck shut at the time of birth. Do not worry about this, as they will open in time.
The ears are also still developing and may be very close to the head and have little cartilage, the material that gives the ears their final shape. If the ears are folded or bent, they may stay in a folded position for a while. Do not worry. With time, the ears will develop cartilage that will make them spring back into place when touched.
How Do Preterm Babies Act?
It is common for very preterm babies to move very little, and when they do, it is usually in a "jerky" or "startled" fashion. This is because their reflexes are not fully developed and they have little control over their muscles. Since they also have weak muscles, you will have to look closely to see signs of increasing strength and ability. For instance, you may see the baby moving or bending an arm or a leg.
You may also see a suckling response if you put your finger near the baby's mouth. As he or she sleeps, eats and gains weight, the body shape and skin will begin to look more like that of older babies.
How Can I Interact with My Preterm Baby?
Following birth, the baby may not be awake or alert enough to focus on you, but your touch and voice are important. Babies usually respond better to a gentle but firm touch. At first, frequent touches may be too stimulating. Placing your hand over the chest using firm, gentle pressure may be very calming. Alternatively, you can hold the baby's arms and legs by tucking them in towards the body.
During pregnancy, the baby was used to hearing the mother's voice, so speaking softly and repeating the baby's name can be soothing.
Positioning is important, and you will see the nurses change your baby's position often. Placing the baby on the stomach, back or sides nestled in a blanket can help him or her feel snug and secure as if back inside the womb. Keeping your baby's hands and legs tucked in close to his or her body may also be soothing and calming. Being able to get his or her hands up to the face and mouth can be especially soothing for the baby.
You can also help keep your baby's eyes covered to protect against bright lights.
When your baby is stable enough to hold, the nurses will help to hand you the baby, along with whatever tubes and wires there may be. They will also stay close by in case you or the baby needs help. You may be a little nervous at first, and it may even be a little stressful for the baby. You can help by cuddling the baby with a gentle, firm hold, talking softly and keeping him or her warm and wrapped in a blanket.
There is another special way to hold your baby, called skin-to-skin or kangaroo care. This is when the nurse places the baby upright on a parent's chest while wearing only a diaper, then wrapping the baby in your clothing, with a blanket placed on top. Your baby will be soothed by your warmth, smell, heartbeat, and breathing.
At first, any kind of holding or interaction may be tiring or stressful for the baby. However, the baby will give you clues that let you know when he or she is calm, happy and able to handle interaction. Babies also let you know when they are tired or need to be left alone.
Signs that indicate the baby feels good are:
- Placing his or her hands on the face or ears or clasping them together
- Relaxing the arms and legs
- Suckling or attempting to suckle
- Looking at and listening to you
- Dozing off to sleep
Signs that say, "I need a rest" include:
- Hiccups and spitting up
- Stiffening the arms and legs
- Spreading out the fingers and toes
- Avoiding eye contact
The latter signs do not always mean that your baby wants to be left alone. Sometimes a brief rest or position change is all he or she needs to calm down. By learning your baby's signals, you will be able to determine his or her needs, likes and dislikes. This will be something you will continue to work on even after you leave the hospital.
Taking your baby home can be a happy time, but if your baby has been in the SCN, it may also be a bit scary. Parents often want to know how they can tell if their baby is ready to leave the hospital. Your baby is becoming ready to go home if he or she is:
- Having no episodes of apnea (forgetting to breathe)
- Able to stay warm all the time without an incubator or warmer
- Breastfeeding well or taking all feedings from a bottle
- Gaining weight consistently
- Medically stable
As your baby gets closer to being discharged from the hospital, it is important to begin preparing for this transition. Some of the ways you can get ready are:
- Become more involved with your baby's routine care by learning how to feed, change diapers and give baths.
- If your baby is going home on medications, learn what they are, what they do and how to give them. Also, be sure to fill any prescriptions and have the medicine on hand before the baby leaves the hospital.
- Get the items you will need to care for your baby at home, including a crib, a car seat, diapers, clothin, and blankets, as well as feeding equipment and supplies such as bottles, a breast pump and formula, if applicable.
- Choose a pediatrician to care for your baby after discharge from the hospital. Let your baby's nurse know who you have chosen so information about your baby can be shared with the pediatrician's office.
- CPR instruction is required for all parents of babies going home on oxygen or with a monitor. It is also required for parents of babies born at 34 weeks or less. Ask your baby's nurse about CPR training.
- If you smoke, stop if at all possible or at least be prepared to only smoke outside. Babies who are around cigarette smoke are more likely to get respiratory infections during their first year and have an increased risk of other health problems.
Once you and your baby are home, there are a few things to keep in mind:
- Limit visitors during your first days at home. Ask friends and family members with colds to visit later when they are feeling better. When you and your baby do have visitors, ask them to wash their hands before handling your baby.
- Some babies have trouble getting used to sleeping in their new home. They may have gotten used to sleeping with a light on and some sounds in the background. You may find that your baby sleeps better with a light on and some soft music playing in the background.
- BACK TO SLEEP: Babies do need to spend time on their stomachs to develop head and trunk control, but when you put your baby to sleep, remember that you should place him or her on their back (BACK TO SLEEP). In addition, the crib mattress should be firm and flat, and you should not use soft bedding or pillows in the crib.
- Take your baby to all of the recommended follow-up appointments. All babies will need to be seen on a regular basis by a pediatrician or primary care doctor. In addition, some babies need to be followed by an ophthalmologist (eye doctor) to monitor their vision; a developmental team to monitor their growth and development; or a pediatric pulmonologist (lung doctor) if they are on a monitor or oxygen therapy.
Discharge checklist you and your nurse will review as discharge is approaching:
- Hearing screening (all infants)
- Car seat test (infants born at less than 37 weeks or less than 2000 grams at birth)
- State metabolic screening on day seven and day 28 after birth, or prior to discharge
- Hepatitis B vaccine (after consent) and any other required vaccines
- CPR training for parents of babies born at 34 weeks or less
- Circumcision, if applicable (after consent)
- Pediatrician name and telephone number provided and an appointment made
- Rooming in (if needed)
- Respiratory syncytial virus (RSV) immunization for at-risk infants
- Developmental follow-up clinic appointment for infants less than 1250 grams, or as needed
- Other follow-up appointments as needed
Nutrition and Breastfeeding
Good nutrition is important for the growth and development of all babies, but especially for those born early and those who are unwell. At first, many babies are too small or too weak to nurse or suck. The SCN staff uses special techniques to feed them until they are able to breastfeed or bottle-feed.
- At first, babies who are not able to feed by mouth will be provided nutrients through an intravenous (IV) line. You may hear this referred to as “NPO,” meaning “nothing by mouth.” Your baby will have an IV placed in a vein that is then connected to tubing attached to a bag of fluid containing the nutrients your baby needs. This fluid may be clear and contain glucose (sugar), or it may be a yellow fluid called TPN (total parental nutrition) or hyperalimentation (HAL) fluid. TPN fluid contains glucose, protein, vitamins, minerals and electrolytes needed for growth. This fluid is especially made for your baby based on his or her lab results, which are re-checked often so that the fluid contents can be adjusted if needed. Also, your baby may have a white fluid that contains lipids, which supply the fats needed for growth. TPN and lipids can meet all of your baby’s nutrition needs until he or she is able to have your breast milk or formula. Medicines may be given through this IV line, too. If you plan to breastfeed, please continue to pump every two to three hours when your baby is unable to feed. This milk will be frozen and saved for later use. Breastfeeding help is available if needed.
- Babies unable to take a bottle may be “tube-fed” until they are able to breastfeed or bottle-feed. Tube-feeding means that the baby will have a small tube passed through the nose or mouth and down into the stomach so that special infant formula or breast milk that you have pumped may be given to the baby. You may hear this referred to as “NG feedings” or “OG feedings depending on where the feeding tube is (nose or mouth).” In addition to milk and formula, medication may also be given through this tube.
- PO means that the baby is able to be fed “by mouth,” either by bottle or breast. Babies who are ready may begin to try to take a bottle. For the growing premature infant, this may be introduced slowly as one or two bottle-feeding attempts a day and increased as possible. Some babies will be ready to breastfeed, but many will not have the necessary energy or coordination and will usually start on a bottle first. The nurse will test your baby’s sucking skills on the bottle to determine if he or she has the coordination needed to breastfeed. Each baby is unique and will let us know how fast to progress. Do not be discouraged if your baby cannot immediately breastfeed; breast milk provides the same advantages even if given by tube or bottle. Also, do not hesitate to ask if the baby can “kangaroo” or nuzzle. Please let your nurse know if you would like to speak with one of our lactation consultants. Having a baby is the SCN is stressful, and if the baby is premature, he or she may take some time to get used to breastfeeding.