When baby arrives early, parents often need additional support

For families spending time in a NICU, it brings an added layer of complexity to adjusting to life with baby, and how and when to return to work. Dr. Nina Zelazny, Cleo Clinical Lead in Neonatology, outlines key milestones.

November 12, 2021

In the U.S. each year, 1 in 10 babies is born preterm, and upwards of 15% spend some time in the Neonatal Intensive Care Unit (NICU) following birth. For their families, this brings an added layer of complexity to managing parental leave, adjusting to life with a new baby, and the calculus of how and when to return to work. A holistic family benefit like Cleo becomes most critical in moments such as these, when parents inevitably encounter the unexpected and unknown.

Like all Cleo members, parents who have a child in the NICU can look to their Guide for the support they need when they need it. Cleo Guides help connect our NICU families with mental health specialists, feeding and lactation consultants, sleep specialists, and child life specialists to ensure parents have the support needed to navigate caring for their child and themselves, and to successfully return to work.

While there is no template for how preterm birth may impact a family’s experience, Dr. Nina Zelazny, Cleo Clinical Lead in Neonatology outlines key NICU milestones that determine an infant’s readiness for discharge. Having a baby admitted to the NICU is a particularly stressful experience for parents. The large team of specialists within the hospital will help provide support while there, but Cleo is ready to pick up where the healthcare system leaves off, providing a different and invaluable level of support that extends well beyond discharge.

When baby requires intensive care

People often associate the NICU with prematurity, but babies are admitted to the NICU for a variety of conditions including infections, congenital abnormalities, and birth trauma. Based on prenatal testing or concerns, a plan might be made before birth for an automatic transfer to the NICU, and sometimes something happens soon after birth that requires further evaluation or treatment in the NICU.

Respiratory milestones: the goal is for baby to breathe on their own without the need for oxygen or other assistance.

For a variety of reasons, babies may need help with breathing. For some, their lungs are not yet ready to do that on their own. For others, their brain is not sending an appropriate signal to stimulate breathing.

There are a variety of ways to assist babies with breathing. Some require oxygen through a small tube under their nose or a tube placed in their airway and connected to a ventilator that helps deliver the breaths as needed. As the baby’s status improves, the use of assisting devices will diminish. Some babies do go home while still using some supplemental oxygen or other breathing assistance, and in those cases, families receive special training and equipment to continue care at home.

Feeding milestones: the goal is for baby to eat all they need to grow from either the breast or bottle.

Some babies admitted to the NICU are able to do this right away but for others, it is a process with a series of steps and stages. Initially, a baby may receive their nutrition through an IV line directly to their bloodstream. As they are stabilized and ready to receive food into their stomach, that will be fed through a tiny tube into their nose that is passed into their stomach. Once they are mature enough to suck, swallow, and breathe all at once, they can start working on oral feeding by breast or bottle. Occupational therapists and lactation consultants often play important roles in helping with this transition.

“When my eldest spent her first full week in the NICU, the hospital staff was wonderful caring for her, but my own recovery suffered. I’ve since had the opportunity to join Cleo, and the support from my Guide is invaluable. I often think about how different that time may have felt if I had this support then.”
Cleo member

Temperature stabilization: The goal is for baby to keep their temperature stable without an external heat source

When babies are admitted to the NICU they are typically placed in an isolette (incubator) or under a warmer. This is done so that their temperature can be regulated and maintained. In some cases, for larger babies who could otherwise maintain their temperature with the normal amount of bundling, they may still be put under a warmer so that they can be undressed and have continuous assessment and monitoring which is difficult to do in a fully bundled baby. Prior to going home, a baby should be able to be bundled with the normal amount of clothes and maintain a normal temperature.

Readiness for discharge

When a baby can breathe, eat, and keep their temperature up on their own, they are often ready to head home. Some infants may continue to need some support in these areas, and once the family is trained and comfortable handling care at home with special equipment, they can likewise head home.

Although eagerly anticipated, discharge to home can be scary. Leaving the relative safety and security of the hospital is a significant transition for most parents, and especially for those who’ve received more intensive care. It’s helpful to prepare by talking with your NICU team about what to expect and meeting with your baby’s pediatric provider to discuss your concerns, how often you can expect to see them, and how to get in touch for both urgent and non-urgent matters. It’s also a good opportunity to ensure that they have or will be receiving the medical records from your baby’s time in the NICU.

Spending time in the NICU can be an emotional and exhausting journey for anyone. But the support of a Cleo Guide, bolstered by our team of specialists, can make a meaningful difference to any parent, and especially to those whose path includes added twists and turns.

Note: This content has been reviewed by Dr. Nina Zelazny, Cleo’s Clinical Lead in Neonatology. Cleo aims to give the most accurate information, but details and recommendations may have changed since this piece was published. For the latest information, please check out resources from the World Health Organization, U.S. Centers for Disease Control, and local public health departments.