Welcome to the
Neonatal Intensive Care Unit at Mount Sinai Kravis Children’s Hospital
Patient and Family Guide
Kravis Children’s Hospital
We know that having a baby in the neonatal intensive care unit (NICU) can be stressful and overwhelming. Our goal is to support every family throughout their experience and to provide excellent, personalized care that meets the individual needs of each patient and family.
Contents
Welcome to the Neonatal Intensive Care Unit (NICU)
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Overview of the Neonatal Intensive Care Unit (NICU)
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Visiting Your Child
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Meet Your Care Team
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Daily Routine
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Preventing Infection
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Caring for Your Baby
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Preparing for Discharge and Taking Your Baby Home
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Safety and Security
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Services
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Hospital Billing Information
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Visitor Information
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Helpful Contact Information
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Notes
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Welcome to the Neonatal Intensive Care Unit (NICU) A Message From the NICU Family Advisory Council First, congratulations on the birth of your baby (or babies)! We are parents who have also had babies in the Mount Sinai Neonatal Intensive Care Unit and who now serve as advisors on the Youth and Family Advisory Council. We understand that a NICU stay can be stressful, emotional, and even scary at times. While nothing can truly prepare you, we have partnered with the NICU team to create this admission packet, which we hope will help ease your transition. The doctors, nurses, and social workers are also here to help you navigate your baby’s hospital stay and will explain things to you along the way. We encourage you to partner with your health care team, ask questions, and discuss any concerns you have. This booklet is meant to supplement the information they provide to you. Sincerely, Family Advisory Council
Access patient records with MyMountSinai
Read the Patients’ Bill of Rights and Parents’ Bill of Rights
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Overview of the Neonatal Intensive Care Unit (NICU) The Neonatal Intensive Care Unit at Mount Sinai Kravis Children’s Hospital, often referred to as the NICU, is a Level IV Regional Perinatal Center. This means that our NICU is able to treat babies with the most complex medical conditions. We provide care for more than 900 newborns admitted to our NICU every year. Some of our newborns are delivered here, and others are transferred here from other hospitals for more specialized care. Babies are treated in our NICU for a wide range of medical conditions. Your Care Team Our unit is staffed by highly skilled medical providers and specialists. Your care team will include doctors called neonatologists, who specialize in caring for premature babies or newborns with high-risk or complex conditions. Your team will also include fellows, residents, nurse practitioners, physician assistants, and nurses who will provide care for your newborn 24 hours a day. NICU Locations and Spaces The NICU includes shared patient pods and small individual rooms. The main NICU space is on the third floor of the Klingenstein Women’s and Children’s Pavilion. This is where babies are admitted either after delivery or following transport from another hospital. When babies are closer to going home, they are often moved to the NICU Annex on the fourth floor.
Staff Structure and Leadership Our staff work in multidisciplinary teams to care for each of our patients. We have three primary NICU clinical teams, each of which includes front line providers (residents, physician assistants, and/or nurse practitioners), a NICU fellow, and a supervising attending neonatologist. (You can learn more about these providers in the Meet the Team section on page 5.) The three teams care for groups of patients with different needs and are referred to as the Pink Team, Blue Team, and Short-Stay Team. The NICU has a nurse manager and assistant nurse managers who oversee nursing care on the unit and keep the unit running smoothly. The unit medical director oversees medical care and physicians working in the NICU.
On the third floor there is a parent lounge off the NICU lobby where families may eat and recharge. There is also a pumping room on the east side of the third floor where parents may pump in private.
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Visiting Your Child Each baby can have two caregivers, who each receive a visitor wristband. This wristband allows the caregivers to visit the NICU 24 hours a day, except 7–7:30 am and 7–7:30 pm (when nurses give their handoff report to the next shift). You can also call 212-241-5517 at any time to receive an update on your baby. In addition to these two caregivers with wristbands, each family can choose four additional designated visitors. These four visitors must be 18 years or older. These visitors must remain the same for your baby’s entire stay in the NICU, so we encourage you to be mindful about who you choose. Your social worker will add the four visitor names to our visitor’s log. They can visit during regular hospital visiting hours, from 9 am–9 pm, except 7–7:30 pm. Only two visitors are permitted at the bedside at any given time. No one, including parents, should visit the NICU if they are sick or not feeling well. This is very important for keeping all of our babies safe. Viruses and infections can make our babies much sicker. Please remove your coat before entering the NICU. You can hang your coat outside the family lounge. In addition, please clean your hands when you enter the unit.
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Visits From Siblings Under 18 Years Visits from siblings under age 18 are coordinated by our Child Life staff. Siblings must be two years of age or older and must have proof of vaccinations in order to visit. If you are interested in arranging a sibling visit, please reach out to Child Life at 212-241-6797. Siblings who are 18 and older can be added to the list of four designated visitors. These visits do not have to be arranged by Child Life.
Meet Your Care Team The Medical Team Attending Doctors Attending doctors have finished all medical training and are experts in the care they provide. An attending doctor may be a neonatal intensivist, pediatric specialist, or surgeon. There are two types of attending doctors: the primary attending and the consultant attending.
Medical Students Medical students have finished college and are now learning how to be doctors in medical school. They work with interns, residents, fellows, and attending doctors to take care of patients. Medical students always have an attending doctor overseeing and checking all of their work.
Primary Attending Doctors The primary attending doctor oversees your child’s medical care. We call them “primary” because they are the main doctor who will make decisions for your child. Your primary attending in the NICU is a neonatologist, meaning they specialize in the care of preterm babies and babies with other high-risk or complex health conditions. The primary attending doctor will often partner with consultant attending doctors to provide care for your baby.
Physician Assistants (PAs) and Nurse Practitioners (NPs) Physician assistants and nurse practitioners are licensed health care providers with advanced degrees. Both PAs and NPs, also referred to as advanced practice providers (APPs), provide direct care to patients in the NICU under the supervision of a doctor.
Consultant Attending Doctors Consultant attending doctors are doctors who give medical advice to the primary attending doctor. This advice is typically in a specialized area of medicine. Interns and Residents Interns and residents are licensed medical doctors who are in training in a particular medical or surgical area. They have completed medical school. Fellows Fellows are licensed medical doctors who have completed a residency training program in a general field (like pediatrics) and are now completing additional training to become an expert in a more specialized field (like neonatology). They have completed both medical school and their residency training.
Registered Nurses (RNs) Registered nurses have a bachelor’s degree in nursing. RNs work twelve-hour shifts, so you will have a daytime and nighttime bedside nurse. They will perform physical assessments, monitor your baby’s heart rate and breathing, check your baby’s temperature, give medications, change diapers, and feed and care for your baby. They can provide frequent updates and help the whole family understand new medications and treatments. Primary Nurses Primary nurses are nurses who come to know your baby and their medical needs well over time. Once identified, these nurses can be more consistently assigned to the care of your baby. As caregivers, you are encouraged to be involved in the process of identifying primary nurses for your baby.
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› Meet Your Care Team (continued)
Respiratory Therapists (RTs) Respiratory therapists help treat any breathing issues your baby may have. They will provide breathing support such as ventilators (breathing machines), continuous positive airway pressure (CPAP), nebulizer treatments, and oxygen. Registered Dietitians A registered dietitian, also known as a nutritionist, has specialized training in nutrition. They work with your baby’s medical team and help to determine the best way to support your baby’s growth. Physical, Occupational, and Speech Therapists These therapists help support your baby’s development. They will work with your baby on different types of skills that are appropriate for their age and stage of development. They will also teach you how to support your baby as they grow. Pharmacists Pharmacists are trained to provide any medications your doctors have ordered for your baby. They can answer any questions you may have about your baby’s medications. Lactation Consultants Lactation consultants are professional breastfeeding specialists. They are trained to teach and assist you in breastfeeding your baby. They can also help with breast pumping. Discharge Nurse The discharge nurse is an RN who focuses on helping your family with the transition from NICU to home. They will teach you important skills like how to give medications and will make sure you and your baby are ready to go home.
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The Professional Team Business Associates (BAs) Our business associates are usually at the front desk. They help with many tasks so the unit runs smoothly. BAs will let you into the unit to see your baby after asking to see your ID band and are happy to help with any questions you may have. Patient Care Associates (PCAs) Patient care associates help to keep our unit stocked with the necessary supplies and equipment. Equipment Technicians Equipment technicians are specially trained in how to clean the equipment we use to care for your baby (for example, incubators and cribs). Environmental Services Workers (Housekeepers) Environmental services workers keep our hospital clean and tidy. This means taking out the garbage, cleaning the hallways and common areas, and cleaning your baby’s room daily.
Supportive Care Team Social Workers Social workers are professionals who provide support and guidance throughout your baby’s hospital stay. Every family with a baby in the NICU is assigned to a social worker. Social workers help with a variety of issues during and after hospitalization. This includes guidance for new parents, coping with parenthood, high-risk medical needs, NICU support, and connection to community resources. Child Life Specialists Child Life specialists provide developmental and emotional support for babies and families throughout their NICU stay. Child Life specialists help celebrate milestones and holidays, support sibling bonding, support babies during procedures to minimize pain, facilitate caregiver activities and self-care, and educate families on developmentally appropriate toys and bonding activities.
Chaplains Trained chaplains support families during the unique challenges and uncertainties of having a child in the NICU. However you define your spirituality, the team’s multi-faith staff is always available to address your emotional and faith-related needs with sensitivity, respect, and inclusivity. Chaplains offer services such as religious ceremonies, prayers, blessings, rituals, baby namings, access to religious literature, and connection with community-based religious leaders. Music Therapists Music therapists are musicians who provide music therapy services for babies and families in the NICU. Through sound and music, our certified music therapists support your baby’s care by promoting brain development and helping to sooth and calm your baby.
Creative Arts Therapists Creative arts therapists provide developmental and emotional support for patients and their families. Creative arts therapists help families process their NICU experience by providing art therapy interventions that allow them to express their thoughts and feelings through art.
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Daily Routine Nursing Shift Change Our nurses work either the day shift from 7 am–7:30 pm, or the night shift from 7 pm–7:30 am. Each shift begins with a nursing huddle from 7–7:30 (am or pm, depending on the shift). Nurses will conduct patient hand-offs at your baby’s bedside. Morning Huddle Every day in the NICU begins with a team huddle. Members of the medical team review important information and discuss planned events such as admissions, discharges, procedures, or radiologic studies. The huddle helps promote awareness and safety on the unit. Daily Rounds NICU rounds begin just after the morning huddle at around 8:45 am. They typically last until around 12:30 pm. During rounds, the team reviews important information related to your baby’s health and makes plans for the day. Consulting doctors (like surgeons or cardiologists) will either round with the primary team or separately depending on the baby’s needs. You are welcome to join rounds and participate in the medical care for your baby if you choose.
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Nursing Care and Feeding Times The NICU team tries to coordinate all “touch times,” which are the times we provide hands-on care. This helps minimize over-stimulation and stress for your baby. During these times, babies are assessed, their temperature and vital signs are taken, their diapers are changed, they may be fed, and any other necessary care is completed. Touch times typically occur every three hours at 2 am, 5 am, 8 am, 11 am, 2 pm, 5 pm, 8 pm, and 11 pm. For some of our more vulnerable babies, touch times occur less frequently. We encourage you to play an active role in the care and development of your baby as they progress through different stages of their NICU stay. Your nurse can help guide and support you. Speak with your nurse about your plan for the day, including your goals for spending time with your baby and participating in their care.
Preventing Infection Keeping Your Baby and All Babies Safe Cleaning Your Hands Cleaning your hands is one of the most important things you can do to keep your baby safe and healthy. • All visitors should clean their hands when they enter the NICU. Visitors should either wash their hands with soap and water for 30 seconds or use alcohol-based hand sanitizer. • It is important to also clean your hands before entering and exiting your baby’s room or pod and before and after touching your baby. This helps keep your baby and their environment clean and safe. Please always wash your hands before and after handling your phone. Cell phones and other personal electronic devices are dirty. You are also encouraged to wipe your phone with an alcohol wipe when you enter your baby’s room or pod. • Your baby’s health care team will also clean their hands before coming into your baby’s room or pod. If you do not see them clean their hands, we encourage you to remind them.
Colds, Coughs, and Other Illnesses Babies can get colds and viruses very easily. Do not visit if you have a fever, cold, runny nose, cough, diarrhea, vomiting, or have been exposed to a very contagious disease like chickenpox. If you are not feeling well, please contact a member of your baby’s medical team for guidance about when you can return to your baby’s bedside. We know how important it is to be with your baby, but our top priority is to keep your baby and all babies in the NICU healthy. Vaccines Your baby’s care team will discuss newborn vaccinations with you when your baby is able to receive them. Please speak with your own primary care doctor to discuss vaccinations that you and other caregivers can receive to help keep your baby safe. These may include vaccinations for TDAP, influenza, and COVID-19.
• Please remind all your baby’s visitors to wash their hands.
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Caring for Your Baby Providing Breast Milk Breast milk and breastfeeding have many wonderful benefits for both babies and their parents. When NICU babies receive their parent’s breast milk, they gain additional protection against infection. They also have a lower risk of necrotizing enterocolitis, a disease of the intestines that affects some premature infants. These benefits are among the many reasons to consider breastfeeding or pumping breast milk for your baby, if you are able. Our board certified lactation consultants are available to support you during every stage of your baby’s stay in the NICU. They can help you and your baby learn to breastfeed, help establish a breast milk supply if your baby is not yet able to breastfeed directly and support your baby’s transition from tube feeding or bottle feeding to breastfeeding.
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Donor Breast Milk The best food for most NICU babies is their parent’s breast milk. When a parent’s milk is unavailable, we may provide donor milk. Donor milk is offered to all babies born at less than 32 weeks and/or born at less than 3.3 pounds, as these babies are at the highest risk for necrotizing enterocolitis. Donor breast milk is obtained from a milk bank, which has a careful screening and pasteurization process to keep the milk safe. We always request permission from a parent or guardian before a baby is given donor milk. Infant Formula Sometimes formula is the best choice for your baby. We have many formula options for infants who are not feeding breast milk or donor breast milk. Infant formulas are designed to meet the nutritional needs of your baby. Formulas intended for preterm infants provide especially needed nutrients and additional calories. Other specialized formulas are available for babies with different medical needs. Your medical team includes registered dietitians who help determine what feeding plan is right for your baby and they are a great resource for when you may have questions about formula and feeding options.
Skin-to-Skin or Kangaroo Care Skin-to-skin care, also known as kangaroo care, is a way of holding your baby where your skin and the baby’s skin are touching. It has many benefits for both you and your baby. It’s normal to feel nervous or scared to hold your baby when they seem small or fragile. Skin-to-skin care is safe for most babies, even the smallest ones. We encourage starting skin-to-skin care as soon as it is safe for your baby. You can do skin-to-skin care even if your baby is connected to a breathing machine or intravenous (IV) tubes. When you want to hold your baby skin-to-skin, please ask the nurses and they will let you know if your baby can be held that day. The nurse will then schedule a time for you to hold your baby and help you and your baby into a comfortable and safe position. Self-Care It is important for all caregivers to take time for themselves to rest and decompress. We encourage you to take care of yourself by doing things like going to have a meal or taking a walk. We want you to feel comfortable knowing your expert team of medical specialists is caring for your baby when you are away. NICU parents are welcome to use the parent lounge located off the NICU lobby or the Caregiver Relaxation Area on the first floor of Mount Sinai Kravis Children’s Hospital in the building next door (1184 Fifth Avenue).
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Preparing for Discharge and Taking Your Baby Home The transition home may feel both exciting and overwhelming. The NICU team is here to support you and help you feel prepared to take your baby home. Feeding A registered dietician will meet with you before your baby is discharged. They will make sure you understand and feel comfortable with the plan for feeding your baby at home. They will also make sure you are confident in how to mix formula or breast milk preparations. Medications If your baby is prescribed medications to take at home, you will need to fill the prescriptions and bring the medications to the NICU before your baby is discharged. The team will check the medications and make sure you have the correct instructions. CPR Training Parents are offered CPR training before discharge. It is unlikely you will ever need to use it. It may, however, make you feel more confident and prepared in case of an emergency.
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NICU Nesting Room When a baby has more complex medical needs, the nesting room is available for parents to spend a night caring for their baby in a home-like environment, while still within the NICU. For some patients, like those going home with tracheostomy tubes or central lines, this overnight stay is required. For parents of children with moderately complex medical needs, this overnight stay is encouraged to help build confidence in your ability to take care of your baby outside of the hospital.
Safety and Security Security personnel are stationed at all entrances and throughout the hospital. Security officers patrol the grounds and provide directions and other helpful information. Should you have any security concerns, your child’s nurse will alert the appropriate staff and/or call the Security Department at 212-241-6068. NICU Identification Wristbands Each family is issued two infant and two adult identification wristbands. Your baby will wear the two infant bands. Parents or designated caregivers will wear the adult wristbands. Your wristband links you to your baby, and you must wear it at all times. If you need new bands, please ask the business associate (BA) at the front desk. For the safety of your baby, the BA and nurse will ask to see your band before giving you information about your baby. You cannot give the ID band to anyone else. The ID band lists your baby’s medical record number (MRN). You will be asked to provide this number when you call the unit. Photography You are allowed to take pictures of your baby. However, please do not take pictures of any other babies or staff on the unit. Our Child Life specialist and creative arts therapist are available to capture milestones upon request.
Video Personal video cameras and video calls on personal cell phones or devices are not allowed at any time on the unit. We want to protect the privacy of every family. If you would like to have a video call, a Child Life specialist or creative arts therapist can arrange it using hospital equipment. Phones Phones are allowed on the unit. Please, however, make sure to wash your hands after using any phone. Please also be respectful of other families and take calls away from the bedside. Valuables Please do not leave anything of value unattended. All clothes, bottles, and pumping supplies should be labeled and kept in the designated caregiver or patient storage areas in your baby’s room. Lost and Found If you have lost something, please notify a nurse. Missing items are often turned in. If something of value was stolen, we can help you file a security report.
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Services Centers for Spirituality If you would like emotional, spiritual, or religious support, chaplaincy services will be available to you regardless of your religion. • The Peck Jewish Chapel: Guggenheim Pavilion, Second Floor (Chesed Room is located next door) • Hatch Interdenominational Chapel: Guggenheim Pavilion, First Floor • Muslim Jummah Services: Friday in the Hatch Interdenominational Chapel You may ask your health care team for a meeting with a chaplain or call 212-241-7262.
Patient Service Center/Patient Representatives 1468 Madison Avenue Guggenheim Pavilion First Floor, West Tower Walk-ins welcome Monday–Friday, 8 am–5 pm T 212-659-8990 Patient representatives are available to: • Answer questions about hospital policy and procedures • Provide information about the New York State health care proxy and patients’ rights • Assist patients and family members with care issues that other Mount Sinai staff are unable to answer • Arrange an appointment with notary services; appointments are available Monday through Friday 10:30 am–4 pm, free of charge Language Assistance We offer language or sign language interpreter services to make it easier for you to communicate. Services can be provided by phone, video, or in person. Please ask a member of your care team for assistance at any time.
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Hospital Billing Information Insurance Insurance providers have varying policies and many require charges to be pre-authorized or pre-certified. It is your responsibility to confirm insurance coverage for a planned hospital stay. If you need help understanding the coverage for your plan, please contact Patient Financial Services at 212-731-3600. Patient Financial Services The Mount Sinai Hospital offers financial assistance to patients who do not qualify for government programs. Eligibility is determined based on income and assets. For more information, contact Patient Financial Services at 212-731-3100 or 866-682-9380. The Financial Screening Department can be contacted if you do not have insurance coverage and you think you may be eligible for Medicaid. Please call 212-731-3600 or 212-731-3800. Hospital Charges Patients are responsible for deductibles, copayments, and any unpaid portion of the hospital services bill. The fees for professional services rendered by your primary doctor, anesthesiologist, radiologist, and any other consulting doctors will be billed separately from your hospital services.
Medical Records If you would like to request a copy of your hospital medical records, please review and complete the Hospital Release of Information Authorization form in full and either mail it or bring it to the Medical Records Office. This form is available on the hospital’s website, or you may pick it up from the Patient Service Center located on the first floor of the Guggenheim Pavilion. There is a per-page fee for all records. Mailing address: Attn: Medical Records Department 1468 Madison Avenue Box 1111 New York, New York 10029 Drop-off location: Medical Records Department Annenberg Building B-2 Level, Room 20 Monday–Friday, 8 am–5 pm
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Visitor Information Food and Dining Plaza Cafeteria Serves a large selection of hot and cold dishes. 1468 Madison Avenue Guggenheim Pavilion, First Floor Monday–Friday, 6:30 am–7:30 pm, Saturday, Sunday, and holidays, 7 am–3 pm. Starbucks Serves Starbucks coffee and an assortment of pastries. 1468 Madison Avenue Annenberg Building, West Lobby Monday–Friday 6:30 am–6:30 pm, Saturday, Sunday, and holidays, 7 am–6:30 pm
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Parking Garage 1292 Park Avenue (Entrance is on 99th Street, between Madison and Park Avenues) 212-241-5125 Open 24 hours a day ATM Chase ATM 1468 Madison Avenue Guggenheim Pavilion, First Floor
Helpful Contact Information For Patient Care: Hospital Main Number (Hospital Operator)
212-241-6500 or 212-590-3300
NICU Front Desk
212-241-5517
Patient Service Center
212-659-8990
Admissions
212-241-1900
Department of Pastoral Care
212-241-7262
Child Life
212-241-6797
Emergency Room
212-241-6639
International Patients
212-241-1100
Language Assistance Program
212-241-2700
Patient Representatives
212-659-8990
Patient Rooms
212-241-6500
Schedule an Appointment
800-MD-SINAI (637-4624)
Sexual Assault and Violence Intervention Program
212-423-2140
Sign Language Interpreters and Telecommunication Devices for the Deaf (TDD)
212-241-7778
Social Work Services
212-241-6800
For Business Offices: Billing
212-731-3100 or 866-682-9380
Community Relations
212-731-7888
Financial Screening
212-731-3600
Health Education Medical Records
212-241-6831 212-241-7607
Radiology Associates
212-241-8333
Surgical Scheduling Office
212-241-2273
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Kravis Children’s Hospital