Neonatal Intensive Care Unit Information Booklet

NEONATAL INTENSIVE CARE UNIT

INFORMATION BOOKLET

AREA MAP 28 T H P L AC E A N D F O R R E S T G E N E R A L H OS P I TA L Hardy Street

O’Ferral Street Augusta Street DIRECTIONS: From 28th Avenue, turn on 28th Avenue Parking Garage Ramp.

On the 4th Floor of the Parking Garage, you will see the entrance to The Family Birthplace.

W. Arlington Loop

Ca

mp

St

ree

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Emergency Entrance

Hattiesburg Clinic Medical Boulevard 28th Place

Hattiesburg Clinic Obstetrics & Gynecology

28th Place Parking

Forrest General Hospital

Main Hospital Entrance

Family Birthplace Entrance (4th Floor) 28th Avenue Parking Garage 4th Floor Parking Garage Entrance (Ramp) Adeline Parking Garage

Hillendale Drive

Adeline Street

Welcome to

THE FORREST GENERAL HOSPITAL NEONATAL INTENSIVE CARE UNIT A baby’s birth is an exciting event in every parent’s life. However, complications sometimes occur which require special care in the Neonatal Intensive Care Unit (NICU). This is often unexpected and can be overwhelming for families, but you are not alone.

As many as 15 percent of babies born in the United States each year are treated in NICUs across the country.

We want to help you during this time and have designed this resource guide to help you during your baby’s stay in Forrest General’s NICU. As parents, you have many questions concerning your baby’s condition and treatment. We encourage you to read through the information as it aims to provide answers to many of those questions as well as provides places for you to record information about your baby. Please keep this guide within easy reach—you may want to refer to it throughout your baby’s stay.

After reading this material, you may have additional questions. Please feel free to talk with your baby’s doctor or any of the nursery staff. We are here to offer assistance to both your baby and you during the infant’s stay in the NICU.

WEBSITE

TELEPHONE NUMBERS

We encourage you to create a Caring Bridge website, www.caringbridge.com, to provide updates on your baby’s progress and allow family and friends to send you messages.

A computer is available in the family lounge to create and maintain your baby’s website.

We share your concerns for your baby during his/her stay.

Please feel free to call us between the hours 8:00 a.m.-6:00 p.m. and 8:00 p.m.-6:00 a.m. Please refrain from calling during 6:00 a.m.-8:00 a.m. and 6:00 p.m.-8:00 p.m. Please know that the baby’s ID number must be provided; therefore, only the two individuals that received ID bands upon your baby’s admission will be given information. Here is a list of phone numbers you can use to reach the nursery staff when you have questions or just want to check on your baby’s progress:

PHOTOS You may take pictures of your baby; however, please note that no photos can be made outside your baby’s room or of any other person or area of the NICU or hospital.

NICU PHONE #s LOCAL:

601-288-3951 TOLL-FREE:

800-848-5893

NEONATOLOGY OFFICE 601-288-3440

NICU PATIENT CARE MANAGER 601-288-4615

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CLEAN HANDS SAVE LITTLE LIVES!

IN THE FORREST GENERAL HOSPITAL NICU Washing your hands is one of the most important things you can do as a new parent! It is very important that all your baby’s guests use proper hand hygiene. Many of the common germs responsible for infections in the NICU may come from contact with an environmental source such as a cell phone or camera and/or may be transmitted from infant to infant by the hands of parents, guests, and/or healthcare professionals.

WHEN TO WASH WITH SOAP AND WATER: ◼ When entering the unit ◼ When hands are visibly dirty ◼ After any contact with body fluids ◼ When leaving your baby’s room How to Wash Your Hands Step 1: Remove jacket and wear short sleeves or roll your sleeves above your elbows.

Step 2: Remove all jewelry (watches, bracelets, rings, etc).

Step 3: Turn water on.

Step 4: Use soap and water to wash from fingertips to elbows for 30 seconds.

Step 5: Dry hands and arms with paper towels.

Step 6: Turn off water with paper towel.

All jewelry should remain off with the exception of one solid, stoneless, smooth band.

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WHEN TO USE AVAGARD OR QUIKCARE (PROVIDED AROUND SINK AREA): ◼ Upon entrance to the baby’s room ◼ After any contact with personal belongings such as cameras, cell phones, etc. ◼ Before contact with your baby or his/her medical belongings (examples: monitors, pumps, ventilators, isolette covers, isolette, etc.), even if you haven’t left the room ◼ Between contact with different babies ◼ After gloves have been removed Anyone with artificial nails or fingernails longer than ¼" will not be allowed physical interaction with the baby and will be limited to observation only.

YOUR BABY’S HEALTHCARE TEAM Many people at Forrest General are concerned about your baby and involved in the infant’s care! This is a list of various people working together to provide world class care to your baby and you.

Parent You are an important part of your baby’s team! The more you know about your baby’s condition and care, the more comfortable you will be in participating in care, asking questions, and making decisions.

Neonatologist If your newborn is premature, or has a serious illness, injury, or birth defect, a neonatologist may assist at the time of delivery and in the care of your newborn. A neonatologist is a pediatrician with specialty training and certification in handling the most complex and high-risk medical conditions of sick and premature infants. The neonatologist is the lead medical person directing the medical treatment and healthcare team for your baby.

Pediatrician A pediatrician is a medical doctor with special training in the care of infants and children.

Neonatal Nurse Practitioner A neonatal nurse practitioner is an advanced practice nurse who holds a master’s degree and certification in directing the care and management of sick and premature infants.

Neonatal nurse practitioners work under the direction of the neonatologists and assist in making decisions about the best medical treatment for your baby.

Neonatal Nurse A neonatal nurse is a registered nurse with specialized training to care for sick and premature babies. Neonatal nurses are responsible for the minute-to-minute, individualized care of your baby. The neonatal nurse will also assist you in joining in the care of your baby.

Respiratory Therapist A respiratory therapist is a licensed healthcare professional specially trained to assess, monitor, and treat your baby’s breathing problems. The respiratory therapist performs procedures and manages the operation of ventilators and other equipment.

Developmental Care Therapist A developmental care therapist is a healthcare professional specially trained in infant development through touch, positioning, and/or evaluation of your baby’s movements, motor skills, sensory development, and feeding skills. These professionals include physical therapists, occupational therapists, and educators.

Medical Social Worker A medical social worker is a healthcare professional specially trained to help families cope with the stresses of having a sick baby requiring hospitalization. Social workers can assist families with transportation, housing, financial, and other arrangements through coordination and referrals with community services.

Ophthalmologist An ophthalmologist is a medical doctor who assesses and treats your baby’s eyes.

Audiologist An audiologist is a healthcare professional who assesses and makes recommendations regarding your baby’s hearing. Forrest General Hospital partners with community audiologists to provide this service.

Patient Care Manager The patient care manager is responsible for managing the nursing staff and day-to-day operations of the NICU. Nursing Supervisors are also available on the evening and night shifts.

Someone from the nursing leadership group is always available to discuss patient care issues or help direct you to the resources you need.

Unit Secretary / Acute Care Tech The unit secretary and acute care tech are unlicensed staff members responsible for greeting you and your baby’s visitors, answering the telephone, performing administrative duties for the nursery, assisting the nurses and/or doctors when needed, and ensuring supplies are available and equipment is clean.

Chaplain A chaplain is a Forrest General employee available to family members to help provide spiritual assistance.

Support Staff Support staff includes X-ray technicians, ultrasound technicians, patient transporters, pharmacists, housekeepers, and specialty doctors, to name a few, that are integral parts of the healthcare team.

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YOUR BABY’S HEALTHCARE TEAM (continued from page 3)

WHO ARE MY DOCTORS? _______________________________________________

ADDITIONAL PEOPLE TO

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WHO ARE MY NURSES?

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WHO ELSE TAKES CARE OF ME?

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IMPORTANT INFORMATION Because Forrest General’s NICU is “family centered,” we want you to be able to stay with your baby as much as you like, even overnight. Our goal is for you to be part of your baby’s healthcare team and participate in your baby’s care during the hospital stay.

We want you to feel at home while you are at the hospital spending time with your baby. Guidelines listed below are provided to ensure an environment that encourages your baby to grow and get stronger. Limiting visitors, keeping the nursery quiet, frequent hand washing, and a clean room are important for your baby’s health.

CONFIDENTIALITY Forrest General Hospital is required by law to abide by the terms of our Privacy Notice. ◼ Respect the rights and privacy of other patients and their families.

• Do not ask questions about babies that are not your own.

• Do not enter the room of other patients.

SHIFT CHANGE Due to our high regard for patient confidentiality, only banded individuals are allowed in the room with your baby during shift change (6:30 a.m.-7:30 a.m. and 6:30 p.m.-7:30 p.m.). To protect your baby’s privacy, we ask that the band individuals be in the room with door closed during this time.

ENTRANCE To help provide our babies with a secure environment, we use controlled access doors to see that only parents and approved guest are allowed access to our unit and your baby. Everyone entering the unit must check in at the front desk upon entering the NICU. ◼ Identification must be provided upon entering the unit.

Adult visitors will not be permitted without a hospital armband or photo ID. • Parents must show their hospital armband or photo identification card before entering.

• Armbands cannot be changed from person to person or shared during NICU stay.

• Other visitors must provide a photo identification card such as a driver’s license or military ID. • Siblings will be permitted only during our “Sibling Sunday” visitation hours.

VISITATION FAMILY AND FRIENDS MAY WAIT IN THE NICU FAMILY WAITING ROOM OUTSIDE THE ENTRANCE TO THE NICU UNTIL TIME TO ENTER THE NICU. You are encouraged to submit a list of four individuals (family, friends, etc.) who are allowed to visit your baby with or without your presence.

This list may not be changed, other than to remove a name, during your baby’s stay. No individuals under the age of 18 are allowed to visit, unless they are a sibling (See Sibling Sunday below).

Visitation is daily, 7:30 a.m.-6:30 p.m. and 7:30 p.m.-10:00 p.m. During the visit, a maximum of two individuals, excluding staff, may be present in your baby’s room.

Sibling Sunday ◼ Siblings will be allowed in for visitation every Sunday (1:00 p.m.-3:00 p.m.). ◼ Sibling visitation will be limited to 30 minutes. ◼ Siblings must be free of any illness. ◼ Banded individuals will be allowed to have two siblings at the bedside at one time. Banded individuals will be expected to supervise visiting children at all times in the NICU as well as in the NICU waiting room. ◼ Any sibling that is visiting in the NICU must remain with a parent or banded individual at all times. ◼ Visits lasting no more than 15 minutes is usually best for your newborn as well as the sibling. For this reason, sibling visits will be limited to a maximum of 30 minutes. ◼ They must not enter other rooms and should not touch equipment anywhere in the unit. ◼ They cannot be left alone anywhere in the unit. ◼ They must not be running, jumping, yelling, “horse playing”, etc. ◼ Siblings may not spend the night. ◼ Multiple-birth siblings (twins, triplets, etc.) who are discharged may return with parents to visit hospitalized infant if they are free from illness. (continued on page 8) 5

IMPORTANT INFORMATION (continued from page 7)

GUIDELINES FOR PARENTS ROOMING-IN WITH THEIR BABY Parents are encouraged to “room in” with their baby and to participate in the care of their infant. ◼ Only the two banded individuals, free of illness, may stay with their baby.

• Only one person at a time may sleep on the sleeper sofa.

The sleeper chair is provided for the second person.

• Sleeping on the ground is not permitted.

Linens (up to one set of sheets, two blankets, two sets of towels) and pillows (up to two) are provided by the hospital and should be put away when not in use and not left on the floor. Overnight guests will be responsible for preparing their sleeping quarters and ensuring linens are put away during the day. Linens will be provided around 10:00 p.m. and can be collected as needed.

Individual rooming-in privileges may be revoked at any time at the discretion of the attending physician or hospital administration.

FAMILY LOUNGE, TERRACE, CENTRAL RESTROOM/SHOWER AND RESOURCE AREA A family lounge, terrace, and resource area are available for our guests’ use.

You will be provided an area designated for your food in the refrigerator. All items should be labeled with the baby’s name and current date. Any food or drink left in the refrigerator for 48 hours or more will be discarded.

A central family restroom/shower is available for overnight guests’ use. Parents and banded individuals must check in with the unit secretary for linens for the restroom/ shower. Only one person will be permitted to use the restroom/shower at a time

Your Baby is Our Priority!

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Personal care needs or medical problems of the parents and visitors cannot be met by the neonatal nurse as their duty is to care for the medical needs of the baby and to support the family in the care of their infant.

PARTICIPATING IN YOUR BABY’S CARE As soon as your baby is stable, we encourage you to participate in your baby’s care. This is an important part of the bonding experience between your baby and you. Bonding aids your baby in growing strong mentally, physically, and emotionally. It also helps speed your baby’s recovery while in the NICU. Your baby will feel more secure knowing that you are near while you will develop a sense of confidence in caring for your new bundle of joy.

There are many ways you may participate in your baby’s care, and we are here to help. You and your baby’s healthcare team will often discuss your baby’s condition so that, together, you can decide when and how care is best provided.

(Review the flip chart in your room to see Parenting Based on Developmental Progression of Preterm Infants for more information on ways to provide care for your baby in the hospital.) While we encourage you to participate in your baby’s care, please remember to take time to rest and care for yourself, too!

As Your Baby Is Ready, Some of the Ways to Provide Care Are: ◼ Kangaroo Care ◼ Holding, Talking, Touching ◼ Bathing your baby ◼ Being with your baby when they sleep ◼ Breastfeeding ◼ Changing your baby’s diaper ◼ Feeding

BREASTFEEDING While your baby is in Forrest General’s NICU, the neonatologists, neonatal nurse practitioners, and/or the neonatal nurses will talk to you about breastfeeding. You may contact the Lactation Nurse at 601-288-3763. Breastmilk is important to all babies health, especially sick and/or premature babies. Colostrum, which is the first milk mothers produce, is rich in antibodies. These protect your baby from illness and disease. Formula cannot give your baby this protection.

Breastmilk also contains other important nutrients which will help your babies grow stronger and healthier.

We strongly encourage you to provide breastmilk for your baby. Mothers of sick and/or premature babies should pump every 2 to 3 hours for 20 minutes per session to prevent milk engorgement and breast infections. Forrest General Hospital nurses are trained and will show you how to use a breast

pump to express breastmilk that will be given to your baby in the NICU even if he/she is fed through a tube. The nurse will also show you how to store and transport your breastmilk to the hospital for your baby’s feedings. Should you be unable to pump, Forrest General Hospital’s NICU is pleased to provide donor human breastmilk from Mother’s Milk Bank of Mississippi and Mothers’ Milk Bank at Austin, Texas. Donor breast milk is similar to donor blood in that it is thoroughly screened and is safe for your baby.

How Will My Baby React to Kangaroo Care?

KANGAROO CARE

We encourage you to personalize your baby’s room with items from home as small items can make the room feel more home-like and will add to the comfort of your stay. Furniture or large items cannot be added due to the limited space in your baby’s room.

What Is Kangaroo Care?

Kangaroo Care, or skin-to-skin care, is a special way of holding your baby. It allows you to share warmth and natural closeness with your baby. It involves holding your baby against you in full skin-to-skin contact.

Why Kangaroo Care?

Forrest General’s NICU is very high-tech, with machines, monitors, noises, and equipment which separate you from your baby. Kangaroo Care gives you the chance to give the loving touch that only you, the parents, can provide and helps relieve much of the stress of this high-tech environment.

What Are the Benefits of Kangaroo Care?

Kangaroo Care has been shown to: ◼ Help premature infants grow ◼ Help premature infants move from an isolette to a crib sooner ◼ Increase restful sleep ◼ Increase breastfeeding mothers’ milk production ◼ Help parents become more comfortable caring for their infant How Do I Provide Kangaroo Care?

Both mothers and fathers can provide Kangaroo Care.

You will need to wear a loose-fitting, button-up shirt and plan to stay with your baby for a minimum of one hour. The neonatal nurses will help prepare your baby and you for this bonding experience. The nursery staff will help you pick up your baby and position him/her on your chest in an upright position as you sit comfortably in a recliner. Your baby will be dressed in only a diaper to allow for as much skin-to-skin contact with you as possible. Your body heat will help keep the baby warm.

Your baby’s reaction to Kangaroo Care may vary from visit to visit. Once in your arms and resting on your chest, your baby may fall asleep or remain awake. The neonatal nurses will help you to understand your baby’s behavior and responses which will provide your infant the most benefit from Kangaroo Care.

PERSONALIZING YOUR BABY’S ROOM

BULLETIN BOARD A framed bulletin board is provided for your use. We encourage you to place family-friendly photos, drawings, letters, and anything else you find meaningful on this board to personalize your space. Family photos placed in clear plastic sleeves may be taped to your baby’s bed.

CLOTHING AND BLANKETS FOR YOUR BABY Although it is not necessary, you may bring infant clothes and/or blankets once your baby’s health improves. We understand dressing your baby and his/ her crib can help normalize the experience and make your baby’s bed feel more like home. It is best to bring clothes that are easy to get on and off your baby because changing clothes can make babies tired! We also ask that you do not bring in white linen. White items are easily lost if they get mixed in with the hospital linen.

TOYS Once your baby’s health improves and it gets close to time to go home, your baby may seem to want to look around more. Although babies prefer to look at people, plastic or rubber infant toys (toys that can be wiped clean) may be brought into the NICU. We ask that you bring no more than two toys and that you show the toy(s) to your baby’s nurse before giving it to your baby.

Expensive and/or valuable blankets, clothing, gifts, toys, and the like are not recommended as Forrest General Hospital is not responsible for lost or stolen personal belongings.

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GOING HOME Parents often ask when their baby will be able to go home.

Our goal throughout your baby’s stay is to prepare the baby and family to do just that—to go home! A good sign that your baby is nearing discharge is when you see your baby doing more and the nursery staff doing less, a sign that your baby is progressing. As the time nears for you to go home, there will be several important things for you and the nursery staff to do.

BIRTH CERTIFICATE If your baby was born at Forrest General Hospital, you should complete a form while on the postpartum unit and return it to the birth certificate clerk who will process the form. Your baby’s Social Security card should arrive within 5-6 weeks. Once you receive the social security card, you may request a birth certificate by contacting the Mississippi State Department of Health via mail or phone: 601-576-7981. If you have any questions, Forrest General’s birth certificate office phone number is 601-288-4575.

Before your baby goes home, the nursery staff will arrange for your baby to have a hearing screening while at the hospital.

CAR SEAT STUDY NICU staff will help ensure your baby has a safe ride home. Your baby’s nurse will tell you when it is time to bring the car seat to the NICU for the car seat test. During the test, the neonatal nurse will assist you with positioning your baby in the care seat in a semi-reclined position and ensure the position does not cause low heart rate, low oxygen levels, or other breathing problems. Ultimately, the car seat test will determine whether or not your baby has any special transportation needs.

CPR TRAINING To ensure you and your family have life-saving skills in the event of an emergency after discharge, all parents must review the CPR (cardiopulmonary resuscitation) training video and return demonstration before your baby goes home. NICU staff will schedule a time with you for the CPR training and demonstration toward the end of your baby’s stay.

BACK TO SLEEP

FOLLOW-UP APPOINTMENT

Your baby needs to start sleeping more and more on his/her back. This is the safest way to sleep once your baby goes home.

Please choose a pediatrician for your baby before the day of discharge. NICU staff will schedule a follow-up appointment for your baby with the pediatrician.

Once your baby is discharged, you should contact your regular pediatrician for questions concerning your baby’s health.

NOTHING IN THE BED All equipment and positioning supplies needed to help your baby should be moved out of the NICU bed before your baby goes home. Sometimes there is a need for equipment in the bed, but this is rare and short-term. Infants may not be put in the bed with parents to sleep.

NEWBORN SCREENING All babies in the NICU will have a blood test called a newborn screen which tests for metabolic disorders.

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HEARING SCREENING

DEVELOPMENTAL CLINIC Some babies will be scheduled to return the Forrest General Hospital Developmental Clinic for specialists to see how your baby is growing and changing. Babies in the NICU are at higher risk for later developmental differences.

Developmental screenings are recommended to watch your baby’s development and provide information to you on ways to encourage your baby to learn the next skills. If needed, your baby’s nurse will schedule this appointment before you leave the hospital.

ID BAND The Forrest General Hospital ID band that you were given upon your baby’s birth or admission to the NICU should be kept and brought to the hospital at the time of discharge. This band matches your baby’s band and is the best way to identify you as your infant’s parent.

Although you are probably eager to hear that your baby can go home, you may also feel anxious and fearful about your ability to care for your baby once you are away from the support of the nursery staff. These feelings are normal! That is why it is important to participate in your baby’s care and learn as much as you can before you leave. The nursery staff is here to help you with any concerns you may have about caring for your baby once at home. We want you to feel comfortable and have the proper knowledge of your baby’s needs. Please keep a list of any questions you may have so the neonatologists, neonatal nurse practitioners, and/or neonatal nurses can discuss them with you. If you have questions once you are home, please call the neonatal nursing staff. We are here 24 hours a day to help.

IRIS—YOUR ONLINE PATIENT PORTAL Iris is an internet application that allows you to have secure, convenient online access to your health information and your baby’s health information, such as test results and other details from your hospital visit. This tool also allows you to engage in certain online communications with your health care provider. Iris is a service provided to you by Forrest General and other Forrest Health providers and the Hattiesburg Clinic. Only one log-in and password is needed if you are a Forrest Health and Hattiesburg Clinic patient. To create an account for your baby, please speak to the NICU secretary, and she will walk you through the process. To sign up for Iris or for more information, contact the Iris Help Desk by calling 601-579-5432 or ask a staff member. Brochures are located throughout the hospital.

WIC WIC (Women, Infants, and Children) provides supplemental foods, healthcare referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.

For more information, contact your local Health Department.

SYNAGIS® Synagis is an FDA-approved medication to help protect high-risk babies from severe RSV disease. Synagis® is given as a shot and provides a dose of virusfighting substances called antibodies that help prevent severe RSV disease from infecting your baby’s lungs. There are enough antibodies in one Synagis® shot to help protect your baby’s lungs for about 28-30 days. For this reason, it is important to get every single shot on schedule during RSV season. Missing or delaying just one shot could put your baby at increased risk for severe RSV disease. For more information, ask your baby’s doctor. ®

The ABCs of Safe Sleep ALONE in

their own bed.

Placed on their BACK. Sleep in their

CRIB, CRADLE or Bassinet.

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Good

h i ng s t o T

Know!

Forrester’s Food Court Hours Forrester’s Food Court is open for breakfast, lunch, and dinner. Although snacks are available in the Canteen on the first floor, we ask that meals be eaten in Forrester’s dining area. Call 601-288-1750 for a listing of what’s being served on the menu in Forrester’s Food Court. A menu is also included on the patient hospitality TV channel. ◼ Subway Open: Sunday-Friday Closed: Saturdays, Thanksgiving Day, and Christmas Day ◼ Chick-fil-A Open: Monday-Saturday Closed: Sundays ◼ Java Moe’s

Forrest General’s specialty coffee service, Java Moe’s, features a variety of baked goods, as well as coffee, beverages, hot chocolate, Breve, tea, and several frozen drinks. Java Moe’s is located in Forrester’s Cafeteria.

Open: Sunday-Saturday ◼ Canteen

Snacks and cold foods are available. The Canteen is located on the first floor by the Surgery/ICU elevators.

Parking Forrest General Hospital is pleased to offer free parking to our customers. For your convenience, parents and visitors of our NICU are encouraged to park on the top floor of the parking garage located off of 28th Avenue.

Public Safety Officers Forrest General’s Department of Public Safety is recognized by the State of Mississippi as a law enforcement agency and may be reached 24 hours a day, seven days a week by calling 8-4345 (or 80 for an emergency). Public Safety officers provide many

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services for customers, including escorts into and out of the building upon request. Public Safety also investigates property loss, thefts, and vehicle accidents, as well as assisting hospital staff with disruptive patients, employees, or visitors.

Televisions Each patient room is equipped with a color television for the family and visitors’ viewing pleasure. Headphones may be purchased in the gift shop. A listing of the television channels is provided. Due to your baby’s need for a quiet environment, all audio for the television is available only through headphones that plug into the jack on the back wall. If you have any questions or problems with your television, feel free to ask any available staff member for assistance.

Translation Services Communication between patients and caregivers is part of a successful healthcare experience. If there are specific needs regarding language, hearing, or vision, translation services are available. Please notify the NICU nursing staff and they will work to accommodate all interpretation needs, verbal or written.

Tobacco-Free Policy Effective July 4, 2008, Forrest General Hospital joined the City of Hattiesburg, Pine Grove Behavioral Health, and more than 30 other Mississippi hospitals which had already become tobacco-free. Forrest General cares about the health of our patients, families, guests and employees. Providing a tobaccofree campus supports a healthier environment for everyone at Forrest General.

For the purpose of this policy, “tobacco products” includes, but is not limited to, cigarettes, cigars, herbal tobacco products, pipe tobacco and any smokeless tobacco such as chewing tobacco or snuff. Also, for the purpose of this policy, “e-cigarettes” are treated as tobacco products.

NICU DISCHARGE PATHWAY Congratulations on the birth of your baby! While no parent intends for their infant to be in the NICU, every parent quickly asks, “How long will my baby be here?” That answer differs for every infant, but below is a pathway that will lead to your baby’s discharge. As your baby accomplishes the goals listed below, place an “X” through each circle to mark it as complete. After the milestones are complete, your baby will be ready to go home.

Maintain temperature in open crib and gaining weight

Parents able to give home meds

Congenital heart defect screen or heart echo

Only bottle or breastfeeding for at least two days

Discharge videos

Hepatitis B vaccine

Safe sleep

Circumcision, if desired

Breastmilk/formula preparation

Parents choose a pediatrician

Hearing screen

Wean to room air or adjust to home oxygen setting

Car seat evaluation study

Clear for discharge at physician’s discretion

Consistently alarm free

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G LOSSA RIE S

TERMS

COMMONLY USED IN FORREST GENERAL HOSPITAL’S NICU CENTRAL LINE An intravenous line inserted into a vein, often in the arm or leg, and threaded from there into a larger vein in the body closer to the heart. A PICC (peripherally inserted central catheter) line is a type of central line commonly used in the NICU. CHEST TUBE A tube placed in the baby’s chest to remove air or fluid.

ENDOTRACHEAL TUBE (ETT) A breathing tube placed through the nose or mouth into the windpipe that allows oxygen to be delivered to the lungs by a ventilator. It is used when needed to help keep the baby’s airway open.

HEMATOCRIT (CRIT) The percentage of red blood cells in the blood.

INTRAVENOUS LINE (IV) A thin, plastic tube placed in a vein in the head, hand, or foot. It is used to deliver blood, fluids and nourishment.

MECONIUM The baby’s first stool which is dark green and tarry in appearance.

MUCOUS The fluid secreted by the membranes of the nose, trachea, and lungs.

NASOGASTRIC (NG) OR OROGASTRIC (OG) TUBE A small plastic tube placed in the stomach through the nose (nasogastric) or mouth (orogastric) that is used to feed a baby, give medicines, or remove air from the stomach.

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NEONATE A newborn infant.

NITRIC OXIDE Therapy for respiratory disease in the neonate.

OXYGEN A clear, odorless gas that makes up 21 percent of the air we breathe. Sick or premature babies often need extra oxygen.

PREMATURE INFANT A premature infant is a baby born before 37 weeks gestation.

SUCTION CATHETER A small tube used to remove mucus from your baby’s nose, throat, or endotracheal tube to help the baby’s breathing.

SURFACTANT A medication that is delivered directly into the lungs through the breathing tube which prevents the air sacs in the lungs from collapsing.

PARENTAL NUTRITION (TPN) AND LIPIDS Special nutrition which is given through a vein. TPN and lipids are used with infants who cannot be fed breastmilk or formula, or as a supplement until full milk feedings can be given by mouth or tube.

UMBILICAL ARTERIAL CATHETER A tiny tube inserted into the baby’s naval cord so that small amounts of blood can be taken for tests without disturbing the baby. This tube can also measure blood pressure and can be used to give your baby fluids or medication.

VITAL SIGN An indication that a person is alive. Vital signs include temperature, heart rate, breathing rate, and blood pressure.

COMMONLY USED IN FORREST GENERAL HOSPITAL’S NICU During your baby’s stay, the neonatologist or neonatal nurse practitioner will likely order various tests to determine what, if any, your baby’s problems may be and how they should be treated. Tests may also be ordered to monitor your baby’s progress. The neonatologist or nurse practitioner will inform you of any tests your baby may need and will have you sign consent before any major tests are done. The neonatologist or nurse practitioner will also inform you of the results. Below is a list of tests commonly done in the NICU. Some babies may need additional specialized tests, depending on the infant’s condition.

BLOOD GAS A test done on a small amount of blood to measure the amount of oxygen, carbon dioxide, and acid in the baby’s blood. These measurements are taken frequently, as they are needed to make adjustments in how much oxygen the baby should receive.

LUMBAR PUNCTURE A sterile procedure in which a needle is inserted into a space between the vertebrae below where the spinal cord ends.

Fluid is removed and sent to the lab to test for infection.

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TESTS

HEEL STICK A method of obtaining blood samples by pricking the baby’s heel.

MAGNETIC RESONANCE IMAGING (MRI) A specialized procedure that uses powerful magnets and computers to create an image that is more detailed than even a CT scan. This painless procedure is performed in the Radiology Department.

RETINOPATHY OF PREMATURITY (ROP) EXAMINATION An examination provided by an ophthalmologist at the baby’s bedside to determine whether the blood vessels in the baby’s eyes are developing normally. If there are any signs of ROP, the ophthalmologist will repeat this examination regularly to see if the condition is clearing up on its own or whether treatment is necessary.

BLOOD WORK Samples of blood sent to the lab to test for a variety of conditions.

ULTRASOUND A method of taking pictures of the baby’s organs (brain, liver, kidneys, etc.) using sound waves. This painless procedure is done at the baby’s bedside and is often done to determine if a baby has any bleeding in the brain.

COMPUTED TOMOGRAPHY (CAT OR CT SCAN) An advanced radiology procedure that produces a more precise picture of tissue than an X-ray or ultrasound.

This painless procedure is performed in the Radiology Department.

X-RAYS Pictures of your baby’s lungs and other internal organs that are painless and taken at the baby’s bedside.

ECHOCARDIOGRAM (ECHO) A specialized form of ultrasound examination that is used to study the heart. It can detect structural problems (heart defects) and problems with how the heart works. This painless procedure is performed at the baby’s bedside.

Notes 13

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MEDICAL PROBLEMS

COMMON WITH PREMATURE OR SICK BABIES ACIDOSIS A build up of acid in the baby’s blood and body tissues which decreases the pH balance of the blood.

ANEMIA A blood problem that occurs when there are not enough red blood cells to carry oxygen to all tissues of the body.

It is a common condition in premature babies and is treated with vitamins and iron to build up the baby’s blood. Severe anemia is treated with blood transfusions.

APNEA A long pause in breathing common in preterm babies. Babies with apnea are connected to monitors to help nursery staff detect when the baby’s heart rate slows due to the apnea.

Some babies are also given medication or put on a ventilator to treat this condition.

BAGGING A procedure used to temporarily help the baby breathe.

A small mask is placed on the baby’s face and an air bag is pumped by hand to give the baby air.

BRADYCARDIA (BRADY) A heart rate that is slower than normal. This usually goes along with apnea. Heart monitors alert nursery staff when this occurs. Bradycardia is treated the same as apnea since they often occur together.

BRONCHOPULMONARY DYSPLASIA (BPD) A chronic lung disease that may include fluid in the lungs, scarring and lung damage.

CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) Helps the baby maintain necessary pressure in the lungs and is usually delivered through the nose.

CYANOSIS A bluish coloration of the skin, lips, or nails that happens when there is not enough oxygen in the blood.

DESATURATIONS (DESATS) An oxygen level that is lower than normal.

14

EDEMA The presence of too much fluid in the body causing a swollen appearance.

EXTUBATE Removal of the endotracheal tube.

GESTATIONAL AGE The age of a baby, in weeks and days, starting from the beginning of pregnancy.

GLUCOSE Sugar in the blood used for energy.

HYPERBILIRUBINEMIA Too much bilirubin in the blood which may lead to jaundice.

(See jaundice.)

HYPOGLYCEMIA Low blood sugar level. This can be treated simply by feeding the baby (if the newborn is on feeds) or treated with glucose in the IV. INTRAUTERINE GROWTH RESTRICTION (IUGR) A condition in which a baby grows more slowly than usual in utero and is smaller than normal for the infant’s gestation age at birth.

INTUBATE Placement of an endotracheal tube through the baby’s mouth or nose into the windpipe. This tube is then attached to the ventilator which assists breathing.

INTRAVENTRICULAR HEMORRHAGE (IVH) A condition which sometimes occurs in the smallest premature babies referring to bleeding in the brain.

JAUNDICE A yellowing of the skin due to a buildup of a substance called bilirubin in the blood. Jaundice is treated with phototherapy lights to break down the bilirubin.

NECROTIZING ENTEROCOLITIS (NEC) A condition in which the baby’s bowels are damaged. Blood supply is decreased, and bacteria that are normally present in the bowel invade the damaged area, causing more damage.

PATENT DUCTUS ARTERIOSUS (PDA) A common heart problem in premature babies that may be treated with medication or surgery.

PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN (PPHN) A condition creating high blood pressure in their lungs leading to a lack of oxygen in the blood. The baby may be put on a ventilator and given a gas called nitric oxide through a tube in the windpipe.

PNEUMONIA An infection that causes a baby’s lungs to fill with fluids making breathing difficult. An antibiotic is given to stop the infection. The baby may be given oxygen or put on a ventilator to help with breathing.

RETINOPATHY OF PREMATURITY (ROP) Damage to the back of the eye, called the retina.

This condition often needs special treatment by an ophthalmologist.

REFLUX A condition where the acid contents from the stomach come back up into the esophagus (like heartburn) and cause discomfort to the baby.

SEPSIS A problem caused when infection gets in the baby’s blood and affects the whole body. It is treated with antibiotics.

RESPIRATORY DISTRESS SYNDROME (RDS) A common problem in premature babies caused when tiny air sacs in the lungs collapse and the baby has trouble breathing. Babies with RDS are put on a ventilator or under an oxyhood until they can breathe on their own. This is also called Hyaline Membrane Disease (HMD).

EQUIPMENT

COMMONLY USED IN FORREST GENERAL HOSPITAL’S NICU

CARDIOPULMONARY MONITOR A monitor that records the baby’s heart rate and breathing rate through tiny wires, referred to as “leads,” attached to the baby’s skin. The monitor displays information on the screen and alarms if the baby’s heart rate, breathing rate, or oxygen levels are higher or lower than the normal range.

CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) A method of respiratory support used to get oxygen to the baby through small tubes in the nose and make it easier for the baby to breathe. The baby does all the breathing on his or her own.

COOLING BLANKET A water-filled “blanket” that works to lower and constantly monitor your baby’s temperature.

ELECTRODE An adhesive patch placed on the baby’s chest and belly to measure the heart rate and breathing rate.

INCUBATOR/ISOLETTE A heated, insulated bed make of clear plastic to keep the baby warm. The “Giraffe” is a common isolette used in Forrest General Hospital’s NICU.

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PNEUMOTHORAX Condition that exists when air collects around the baby’s lungs causing them to collapse. A tube may be inserted to remove the air and/or fluid and reinflate the lungs.

TRANSIENT TACHYPNEA A condition which causes the baby to breathe with quick, shallow breaths. It is the result of fluid in the lungs and usually improves as the fluid is absorbed by the lungs.

IV PUMP A pump that sends fluids such as medications to the baby through a tiny catheter inserted into one of the infant’s veins.

IV stands for intravenous, a word which means “into the veins.”

NASAL CANNULA OR NASAL PRONGS Small plastic tubes which fit into the baby’s nostrils and deliver oxygen. They are often used with a treatment called CPAP (continuous positive airway pressure).

OSCILLATOR VENTILATOR A high-frequency, highly specialized ventilator OXYHOOD A plastic dome or box which fits over the baby’s head. An attached tube delivers warmed and humidified oxygen. The oxygen hood is for babies who can breathe on their own but need extra oxygen.

PHOTOTHERAPY LIGHTS Special lights (called bili-lights) that help cure the baby’s jaundice. The baby’s clothes are removed so much of the skin is exposed to the light rays while the eyes are covered for protection.

PULSE OXIMETER (PULSE OX) A medical device that monitors the oxygen saturation of a baby’s blood through a small probe wrapped around the baby’s hand or foot.

VENTILATOR (RESPIRATOR) A machine that helps the baby breathe by sending oxygen to the baby’s lungs through a slender tube placed in the infant’s nose or mouth.

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LOOK HOW BIG I AM! It is common for all babies to lose up to 10 percent of their birth weight in the first week of life. Babies who are premature or sick may lose weight for a longer period of time. In fact, your baby may gain weight one day and lose weight the next, or even stay the same weight for a few days. This is normal and shouldn’t cause you much concern. Babies in Forrest General’s NICU are measured in grams.

The chart below is provided for your convenience to convert your baby’s weight to pounds and ounces.

WEIGHT (MASS) POUNDS AND OUNCES TO GRAMS EXAMPLE: To obtain grams equivalent to 4 pounds, 6 ounces, read “4” on top scale, and “6” on side scale; equivalent is 1985 grams.

OUNCES

POUNDS 0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

0

0

454

907

1361

1814

2268

2722

3175

3629

4082

4536

4990

5443

5897

6350

1

28

482

936

1389

1843

2296

2750

3204

3657

4111

4564

5018

5472

5925

6379

2

57

510

964

1418

1871

2325

2778

3232

3686

4139

4593

5046

5500

5954

6407

3

85

539

992

1446

1899

2353

2807

3260

3714

4167

4621

5075

5528

5982

6435

4

113

567

1021

1474

1928

2381

2835

3289

3742

4196

4649

5103

5557

6010

6464

5

142

595

1049

1503

1956

2410

2863

3317

3771

4224

4678

5131

5585

6039

6492

6

178

624

1077

1531

1985

2438

2892

3345

3799

4253

4706

5160

5613

6067

6521

7

198

652

1106

1559

2013

2466

2920

3374

3827

4281

4734

5188

5642

6095

6459

8

227

680

1134

1588

2041

2495

2948

3402

3856

4309

4763

5216

5670

6124

6577

9

255

709

1162

1616

2070

2523

2977

3430

3884

4338

4791

5245

5698

6152

6606

10

284

737

1191

1644

2098

2552

3005

3459

3912

4366

4819

5273

5727

6180

6634

11

312

765

1219

1673

2126

2580

3033

3487

3941

4394

4848

5301

5755

6209

6662

12

340

794

1247

1701

2155

2608

3062

3515

3969

4423

4876

5330

5783

6237

6691

13

369

822

1276

1729

2183

2637

3090

3544

3997

4451

4904

5358

5812

6265

6719

14

397

851

1304

1758

2211

2665

3119

3572

4026

4479

4933

5386

5840

6294

6747

15

425

879

1332

1786

2240

2693

3147

3600

4054

4508

4961

5415

5868

6322

6778

NOTE: 1 pound = 453.59237 grams; 1 ounce = 28.349523 grams; 1000 grams = 1 kilogram. Gram equivalents have been rounded to whole numbers.

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Date: ________________ Weight:________________

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Information for this family guide was developed in part thanks to materials from: Footsteps

by Ann L. Wilson

NICU Family Support March of Dimes Foundation

Neonatal Intensive Care Nursery Parent Handbook Kosair Children’s Hospital’s NICU

In Great Hands Methodist Children’s Hospital of South Texas

Neonatal Parent Info New York Weill Cornell Center, Department of Pediatrics

6051 Highway 49 • Hattiesburg, MS forrestgeneral.org Revised 9/7/23