The birth of a baby is a wonderful yet very complex process. Many physical and emotional changes occur for mother and baby.

A baby must make many physical adjustments to life outside the mother's body. Leaving the uterus means that a baby can no longer depend on the mother's circulation and placenta for important physiologic functions. Before birth, breathing, eating, elimination of waste, and immunologic protection all came from the mother. When a baby enters the world, many body systems change dramatically from the way they functioned during fetal life:

- The lungs must breathe air.
- The cardiac and pulmonary circulation changes.
- The digestive system must begin to process food and
  excrete waste.
- The kidneys must begin working to balance fluids and
  chemicals in the body and excrete waste.
- The liver and immunologic systems must begin functioning
  independently.

Your baby's body systems must work together in a new way. Sometimes, a baby has difficulty making the transition to the world. Being born prematurely, having a difficult delivery, or birth defects can make these changes more challenging. Fortunately for these babies, special newborn care is available.

What is the neonatal intensive care unit?
Newborn babies who need intensive medical attention are often admitted into a special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced technology and trained healthcare professionals to provide specialized care for the tiniest patients. NICUs may also have intermediate or continuing care areas for babies who are not as sick but do need specialized nursing care. Some hospitals do not have the personnel or a NICU and babies must be transferred to another hospital.

Although about 9% of all newborn babies require care in a NICU, giving birth to a sick or premature baby can be quite unexpected for any parent. Unfamiliar sights, sounds, and equipment in the NICU can be overwhelming. This information is provided to help you understand some of the problems of sick and premature babies. You will also find out about some of the procedures that may be needed for the care of your baby.

Which babies need special care?
Most babies admitted to the NICU are premature (born before 37 weeks of pregnancy), have low birthweight (less than 5.5 pounds), or have a medical condition that requires special care. In the US, nearly 12 percent of babies are born preterm, and many of these babies also have low birthweights. Twins, triplets, and other multiples often are admitted to the NICU, as they tend to be born earlier and smaller than single birth babies. Babies with medical conditions such as heart problems, infections, or birth defects are also cared for in the NICU.

The following are some factors that can place a baby at high risk and increase the chances of being admitted to the NICU. However, each baby must be evaluated individually to determine the need for admission. High-risk factors include the following:

Maternal Factors:
- age younger than 16 or older than 40 years
- drug or alcohol exposure
- diabetes
- hypertension (high blood pressure)
- bleeding
- sexually transmitted diseases
- multiple pregnancy (twins, triplets, or more)
- too little or too much amniotic fluid
- premature rupture of membranes (also called the amniotic sac or bag of waters)

Delivery Factors:
- fetal distress/birth asphyxia (changes in organ systems
  due to lack of oxygen)
- breech delivery presentation (buttocks delivered first) or
  other abnormal presentation
- meconium (the baby's first stool passed during pregnancy
  into the amniotic fluid)
- nuchal cord (cord around the baby's neck)
- forceps or cesarean delivery

Baby Factors:
- birth at gestational age less than 37 weeks or more than
  42 weeks
- birthweight less than 2,500 grams (5 pounds, 8 ounces)
  or over 4,000 grams (8 pounds, 13 ounces)
- small for gestational age
- medication or resuscitation in the delivery room
- birth defects
- respiratory distress including rapid breathing, grunting, or
  apnea (stopping breathing)
- infection such as herpes, group B streptococcus,
  chlamydia
- seizures
- hypoglycemia (low blood sugar)
- need for extra oxygen or monitoring, intravenous (IV) therapy, or medications
- need for special treatment or procedures such as a blood
  transfusion

Who will care for your baby in the NICU?
The following are some of the specially trained healthcare professionals who will be involved in the care of your baby:

- Neonatologist - a pediatrician with additional training in the care of sick and premature babies. The neonatologist supervises pediatric fellows and residents, nurse practitioners, and nurses who care for babies in the NICU.

- respiratory therapists
- occupational therapists
- dietitians
- lactation consultants
- pharmacists
- social workers
- hospital chaplains

The members of the NICU team work together with parents to develop a plan of care for high-risk newborns.