As a nurse, what are my biggest care concerns for a NICU baby?
Although neuro is very important, as a NICU nurse of 15 years i would have to choose belly. Tummy issues are very frequent with babies that are premature. The younger they are, the more often it happens. Figure a 28 weekend is 12 weeks premature.....EVERYTHING is premature, brain, vessels, and digestion. Consider that tummy is not supposed to see food for 12 more weeks.....but we cannot NOT feed the baby.....we must introduce food slowly to train it. Breast milk is best, but even that doesn't work sometimes. Their tummys reject it and blow up like a balloon...and if you are not watching them closely, they can perforated and need immediate surgery. If surgery isn't fast enough, the baby could die. There is also NEC necrotising enterocolitis...and infection they can get that kills the intestines at a very fast rate. I have seen many babies die from NEC.....they blow up like a Macy's day balloon. I knew one that survived after having 75 percent of her intestines removed, but she just died last year. Same goes with fortifying the milk....giving it extra calories by mixing in some fortifier.... they generally don't tolerate that either. I always hate when the doctor says we are increasing calories....I know I have about a 60 percent chance that tummy is going to blow up....and it can happen within 3 hr....the time between care.preemies tummys are thebworst.
I second neurological. Skin integrity is a HUGE factor too. Constantly be checking your pressure points, tape, IV sites, where lines are draped, moisture on skin (sweat or drips from meds/any fluid such as a flush or cleansing wipe), nasal cannulas and ventilator prongs/masks, diaper chafing and urine/feces causing rashes. You need to rotate NICU babies constantly to not only prevent skin breakdown but also to help keep their muscles from shortening, even bigger babies who are in the step down have to be rotated because they tend to only turn their necks one way (out towards the room) so you have to switch which direction they lay frequently.
Skin breakdown can cause massive issues in NICU care as the skin is so thin and has less layers than adults or even fully mature newborns. It can cause infections and even a slight bit of pressure for a few hours can cause babies to lose toes/fingers!
My other would be that you HAVE TO for the sake of your license and for the safety of your patient double and triple check dosages of meds/feeds/ANY fluids that go into your baby. This is life or death and a small miscalculation can be everything. YOU are ultimately responsible as you are the one administering eveything. You are your patient’s last line of safety.
I've worked as an NNP for 33 years in a Level 4 NICU- what I would be most concerned about is mother/baby relationship. Mom's need to feel very confident, comfortable, and take the lead. Encourage kangaroo care at the very earliest....know what is NORMAL and ABNORMAL when it comes to your assessment.....each baby is different, so it is all about the breathe, breathing, respiratory status at the beginning for a premie....do your best to keep family updated, involved and in the loop.
Neurological development is of major concern. A micro premmie's brain needs to be protected from a bleed and damage from how they are handled.
making sure baby gets all the care they require while...also getting enough sleep and rest periods.and dim the lights!!!! soft music on low when you want just a little noise/helping them relax.AND when possible... love baby hold and snuggle!!!!
These are critical tiny ones who are very frail. They should be warm. They should have adequate oxygenation. Medications should be titrated exactly for their weight or it could result in an adverse event. Ensure they are positioned well for feeding, and last but not least, they need to feel tender human touch as often as possible, and hear a caring voice.
I am sure I may have left some important suggestions out, so someone else please feel free to add.
The younger the gestation, the more critical and numerous the concerns. It’s difficult to compare the needs of a 23-week gestation newborn versus a 32- week gestation newborn; it may be beneficial to look up care concerns based on gestational group (extremely preterm, very preterm, and late preterm). Don’t forget you also need to consider what mom’s history was before and during the pregnancy; although not as common, a fraction of yerm babies have complications, too. If I had to make a top 3 list, I would say the more general concerns overall are cardio-respiratory, GI/ nutrition, and infection.
