Neonatal Intensive Care Unit (NICU)

The Neonatal Intensive Care Unit (NNICU) is located on 3AS of Horizon’s Saint John Regional Hospital.

• Parking passes may be purchased at the Security Office (Level 2C Tower) Monday to Friday, 8 a.m. to 4 p.m. Debit and credit cards are accepted.
• You can pay for parking at the parking lot booth when exiting the main parking lot.
• You can pay for parking using “Hot Spot” parking.
• There is designated stork parking at the main entrance.
• Disabled persons parking (DPP) is available in front of the Emergency Department, in the main parking lot and in a designated parking area adjacent to the main entrance. The DPP lot is a pay upon exit system with debit and credit card only.

What to Expect

Your baby may be admitted to the Neonatal Intensive Care Unit (NICU) directly from the Labour and Birth Unit, the Postpartum Unit or a transfer from another hospital. Parents or a support person are welcome to stay with the baby at all times. The Neonatal Unit is open 24 hours a day.

The NNICU is a secured unit. To enter, parents and visitors are asked to pick up the phone mounted on the wall outside the NNICU and state their name and reason for the visit.

On arrival, a team member will explain the NNICU entry process, which includes proper hand hygiene before guiding you to your baby’s bedside.

Your involvement and presence is very important to you and your baby. Taking care of your baby will help you feel more confident in your baby’s care. Research shows that involving parents in the care of their baby in the NNICU improves the baby’s outcome and decreases the parents’ stress. The NNICU team is there to help support you.

The NNICU team is concerned not only for your baby’s well-being, but for yours as well. Emotions in the NNICU are different for each person. As a parent of a baby admitted to the NNICU, you may experience many mixed emotions. Perhaps you did not expect to deliver early, or to leave the hospital without your baby. Feelings of frustration, anger, fear and anxiety are normal, it will help if you talk about them. You may wish to talk with someone that is close to you. The NNICU team is available for you:

• Emotional support: We can provide professional counselling or a shoulder to lean on.
• Knowledge: We will help you get your questions answered by the best person.
• Financial guidance: We can provide information on social assistance and community and hospital resources.
• Fuel the Care is a program offered by Irving Oil.

Hand Washing

Proper hand hygiene with an alcohol-based hand rinse (ABHR) or soap and water is the single most important way to prevent the spread of infection.

Every time you enter the Neonatal Intensive Care Unit:

• Remove all rings, watches, bracelets and any hanging necklaces. Place outerwear such as jackets, sweaters and hoodies on the coat rack provided at the entrance to the unit. Please keep your valuables with you.
• Please wash hands and arms up to your elbows.
• Wash every part of your hands – the front, back, between the fingers and thumbs. Make sure your nails and nail beds are clean. Wash a little above your wrists and point your hands downward toward the sink so the germs can run off into the sink.

Alcohol-based hand rinse is available at each bedside for immediate use when hands are not visibly soiled.

Clean your hands before and after touching your baby, and between babies if you have more than one.

Hands should be washed with soap and water after you change your baby’s diaper, after you touch any area of your body that has a lot of germs like your nose, mouth, head and hair, and after using the bathroom.

Every time you leave the unit, wash your hands when you come back.

Remember, you are your baby’s voice, so it is always okay to ask others to clean their hands!

Other Helpful Hints for Preventing Infections:

For your baby’s protection, refrain from using nail polish or any type of artificial nails. These can promote bacterial growth and be particularly harmful for babies with weaker immune systems.

When entering the unit, clean your cell phone with an aseptic wipe. There is also alcohol-based hand rinse available at the bedside to clean your hands after each cell phone use and before touching your baby. Please put your phone on vibrate.

Cold sores are a virus. If you or your family are experiencing symptoms, it is important that a mask is worn over the affected area. Avoid touching the cold sore. If the cold sore is touched, always clean your hands with alcohol-based hand rinse.

Parents, it is okay to take a sick day!  You may call us anytime for information about your baby. Of course you want to spend as much time with your baby as possible, but when you are not feeling well, it is better to stay at home. This will help to keep your baby and all the others in the unit well. Ask your family and friends to do the same. You can always call us for advice in your decision to come in or stay home.

Spending Time with Your Baby in the Neonatal Intensive Care Unit

Family, friends and siblings

Parents are welcome to be at their baby’s bedside anytime. Family and friends are also welcome. The following restrictions apply:

• Visitors are not permitted while experiencing cold or flu symptoms such as fever, cough, sore throat, muscle aches, nausea, vomiting or diarrhea. Babies are at risk with any illness and every effort must be taken to avoid infection.
• If you have been in contact with someone who has chicken pox, measles, or other infectious diseases or if you, or anyone you know has visited the NNICU develops infectious diseases within three weeks of being there, please tell us by calling 506-648-6390.
• Children: Must be a sibling and have up-to-date immunizations.
• All visitors must be accompanied by a parent or a support person with an identification band. Please speak with your baby’s nurse to discuss the number of family members who may visit at the baby’s bedside. This may change with your baby’s condition and the total number of babies in the unit. At times, the NNICU team may limit visiting to ensure the safety of your baby against potential infections. In these situations, every effort will be made to notify parents of this temporary change.
• We ask you to stay at your baby’s bedside, respecting other families’ space and privacy.
• Cold drinks are permitted if the outside of the container is cleaned with an aseptic wipe.
• Food and hot beverages are not permitted at the bedside.
• The family room space offers a refrigerator, microwave and table and chairs.

Developmental Care

When babies are born prematurely, they require an environment that mimics their mother’s womb. The Neonatal Intensive Care Unit mimics a mother’s womb by keeping the noise level low, dimming the lights when possible, minimizing handling and covering the open care beds to promote sleep.

As members of your baby’s health care team, the family has a very important part to play in the growth and development of their baby. The nurses in the NNICU will provide you with information booklets to help you understand some of the things that will promote growth and development of your infant, such as skin-to-skin (kangaroo care) and understanding your baby’s likes and dislikes. Your nurse will help you with your baby needs.

Skin-to-Skin Contact (Kangaroo Care)

There is nothing more important than the power of human touch. Touch begins long before a baby is born and is one of the first senses to develop as early as 8 weeks from conception. Holding your baby in the early days can have a long-term effect on their growth and development. Learn more about the benefits of skin-to-skin contact here.

Scent Free

The NNICU is a scent-free environment. Scented products (i.e. hair products, deodorant, perfume/colognes/aftershave, lotions, cosmetics, fabric softeners, essential oils, etc.) may cause unintended harm to babies, family and staff. Please refrain from wearing scented products during your time there.

Equipment

At first, the NNICU equipment and sounds may be overwhelming. Here are some pieces of equipment used in the NNICU and what they are used for:

• Isolettes/Open Care Beds – Isolettes or open care beds are used to keep babies warm in a quiet atmosphere. They also allow for close monitoring and easy access for the health care team.
• Monitors – All babies admitted to the NNICU are connected to monitors. These monitors provide the health care team with information that can include the baby’s heart rate, breathing rate, blood pressure and oxygen saturation. Alarms are set to ring if there is an increase or decrease from the normal ranges. They will also ring if a baby is active. The monitor allows for the health care team to know what the baby’s vital signs are without disturbing your baby. The monitors can be viewed from the baby’s room and from a central monitor located at the nursing station.
• Intravenous (IVs) – Babies may require an intravenous (IV) line. The IV will provide fluid, antibiotics or nutrition. All intravenous infusions in the NNICU run on a continuous infusion pump.
• Breathing Support – Babies in the NNICU may require support for breathing. This may include oxygen or a machine to help support your baby’s breathing.
• Phototherapy – Jaundice is caused by an increase of bilirubin in the blood. Bilirubin is a yellow pigment formed in the liver that causes the baby’s skin, and sometimes eyes, to turn yellow. Jaundice is treated using a method called phototherapy. Lights are placed over, below, or around your baby to break down the bilirubin at the skin level. We will cover the baby’s eyes with eye patches to protect them from the light.

Family-Centred Care

Parents are always welcome in the NNICU. Patient- and family-centred care is an approach to planning and delivery of health care that encourages family involvement in their infants’ care. Click here to find out more about Horizon’s Patient- and Family-Centred Care approach.

Communication white boards are located in each baby’s room.

Family-Integrated Care

The Family-Integrated Care (FICare) model is an extension of the principles of family-centred care. Parents are true partners in their baby’s care. FICare improves baby’s weight gain, decreases parent’s stress and anxiety and increases milk production.

Medical Rounds

Medical rounds take place each day in the NNICU. Parents are encouraged to be at their baby’s bedside during rounds to discuss the baby’s progress and to make plans for the baby’s care. Your participation is important. Feel free to ask any questions.

Helpful Hints for Families

• Skin-to-skin is important for you and baby.
• The NNICU may be warm so dress in layers. Wear comfortable clothes and shoes. Please leave jewellery at home.
• Your baby knows your voice before they are born so continue to talk, read and sing to your baby.
• All your questions are important. It may be helpful to write down questions to ask the next time you talk to the team.
• Get enough rest.
• Eat regularly and drink lots of fluids.
• Go for a walk.
• Talk to someone you trust about your feelings. You may want to keep a journal.
• Accept help when people offer (providing meals, drives back and forth to hospital, doing laundry, etc.)

The Baby Friendly Initiative is a worldwide program developed by UNICEF and the World Health Organization. The program supports parents in making informed choices about how they will feed and care for their babies.

Deciding how you are going to feed your baby is a very important decision and there are many things to consider.

• Learn the facts about breastfeeding and infant formula and introducing solids.
• Discuss your thoughts, feelings, concerns and questions with your family and your health care provider.

Decide what’s right for you and your family. Whatever you decide, your health care providers will give you the information and support you need.

Feeding your baby is a very important part of your baby’s growth and development. The amount of breast or bottle feeding increases as your baby gains weight, grows stronger and his/her digestive system develops. Until your baby can coordinate sucking, swallowing and breathing, a pacifier may be given to encourage sucking. This progression of feeding will vary depending on your baby’s specific needs. For more information on breastfeeding, click here.

If you are planning to breastfeed and the baby is not ready to go to the breast, it is important to express breastmilk as soon as possible, within one hour of birth. Your nurse or the lactation consultant will help establish your milk supply by first assisting with hand expression and then by demonstrating the use of an electric breast pump. Breast pumps are available for use in the NNICU and your hospital room.

Lactation consultants from the Mother Baby Clinic are available for consult and follow-up.

Intravenous (IV) – If a baby is not ready to receive feedings then an IV may be used for nutrition.

Tube feeding – When babies are ready to start feeding, they may be too small or sick to suck, swallow and breathe at the same time. Babies learn this skill when they are older and stronger. A small tube is passed down the nose or mouth into the stomach. This is called tube feeding or gavage feeding. Breast milk or formula is given slowly down the tube into the stomach.

Donor Breast Milk – The best food for a newborn is their mother’s own milk as it is specifically designed for her baby and provides unique benefits that cannot be duplicated. The Saint John Regional Hospital NNICU purchases donor breast milk from a regulated human milk bank. Breast milk is especially important for preterm or sick infants. Mother’s own milk is always preferable, but it may not always be available. When the mother’s own milk is not available, physicians may order donor human milk (with parents’ written consent) as the best alternative feeding choice for extremely premature, sick and vulnerable babies. When the mother’s own milk is not available for a prolonged time, donor human milk will continue to be fed until the infant reaches an appropriate weight and age to be switched over to the best choice of infant formula.

Horizon’s goal is to ensure the safety of everyone who receives care or service with us. We encourage you to know about and be actively involved in your baby’s care. Working together, we can ensure a safe hospital stay.

During your time in NNICU:

• Two identification bracelets will be placed on your baby after birth. You and your identified support person/partner will also receive a bracelet with the same number and information printed on it. Your identification (ID) bracelet will be checked every time you are reunited with your baby. Please keep this ID bracelet on until your baby is discharged home.
• Nurses will introduce themselves at the beginning of their shift and all staff wear Horizon Health issued photo identification (ID) badges. You have the right to see the Horizon photo ID badge of your health care providers. Before giving your baby to staff ask to see their hospital photo ID badge.
• Infants are transferred in the hall by bassinet only.
• A Parent’s Guide: Preventing Infant Abduction is given at prenatal assessment visits and information reinforced on admission to the neonatal units.
• Ask questions about any part of your baby’s care.

Newborn Procedures (with signed consent)

A Vitamin K injection is given to newborns during their first day of life to prevent unexpected bleeding which can occur within the first 24 hours of birth up to 6 months of age.

A Hepatitis B Vaccine injection is also given during the first day of life. The Hepatitis B vaccine is the best way to protect your child from Hepatitis B and its complications.

NB Immunization Program

Maritime Metabolic Newborn Screening is a blood test (heel prick) done on newborns between 24 and 48 hours of age. Early screening is completed for several serious, rare conditions that are treatable.

Infant Hearing Program Screening. We know babies start learning speech and language well before they are 6 months old. If hearing loss is not found early enough, this may cause a delay in learning to talk. We screen every baby born in the province, so we can find those who cannot hear well early.

Safe Sleep for Your Baby

There are steps you can take to help create a safe sleep environment for your baby and lower the risk of Sudden Infant Death Syndrome (SIDS).

• Provide a smoke-free environment before and after your baby is born.
• Breastfeeding can protect your baby.
• Always place your baby on his or her back to sleep, at nap time and night time.
• Provide your baby with a safe sleep environment that has a firm surface and no pillows, comforters, quilts or bumper pads.
• Room sharing for the first 6 months (when the risk of SIDS is highest) helps your baby sleep safely and lowers the risk of SIDS.
• Place your baby to sleep in a crib, cradle or bassinet next to your bed.

Infant Car Seats

Before you leave the hospital, you must have an approved car seat in place for your baby. The Loving Care 0-6 months book and Child Safety Link has information and helpful links on installing car seats.

Dental Care

Healthy baby teeth are important for overall health. Good dental health starts even before baby teeth come in. Baby teeth are worth taking care of! Start early to keep your baby cavity free for life. For more information, Loving Care.

Registering Your Baby

You will be given forms to complete to register your baby’s birth. These forms are:

• Registration of Birth Package
• Medicare

While in Hospital

A vaginal birth usually requires a hospital stay of up to 48 hours. A Caesarean section birth usually requires a stay of up to 48-72 hours. In preparation for your discharge we will ensure all your questions have been answered and follow-up care is in place before you leave the hospital.

If your baby requires special care, you may be discharged before your baby. In this event, your health care team will discuss hostel room availability.

Follow-up

Upon discharge, you will be offered an appointment at our Mother Baby Clinic.

It is very important that you and your baby have follow-up appointments:

• Newborn: 24 to 48 hours after you leave the hospital by a primary health care provider or Mother Baby Clinic, and
• 1 week after discharge by your primary health care provider (family physician or nurse practitioner)
• Babies discharged from Neonatal Intensive Care Unit will have their follow-up appointments arranged.

Mother:

• 6 weeks after birth with health care provider

Public Health

Healthy Families, Healthy Babies Program offers a variety of services fostering the health and development of young children from the prenatal stage to age 2 years old. A Public Health nurse will visit you in hospital and assess your need.

Emotional Adjustments

Having a new baby is an exciting time but sometimes life with a new baby is not always what you expect. Most women will go through a period of the ‘baby blues’ as they adjust to their new role and their body adjusts to the hormonal changes of the post-partum period. This is a common and completely normal part of new parenthood, and not the same as post-partum depression.

Post-partum depression is a serious illness that can occur any time after birth but typically appears in the first few weeks after birth. Symptoms include feelings of hopelessness, extreme sadness and frustration. You may feel overwhelmed and have low self-esteem, reduced libido and problems sleeping or eating. You could experience increased anxiety or panic attacks and have little interest in your baby. It is important you receive help, so notify your caregiver as soon as possible. They will connect you with support and counselling services.

Transfer or discharge planning begins at the time of your baby’s admission to the NNICU. We practice family integrated care, which means that we promote your involvement in your baby’s care. The goal of your health care team is to decrease your stress and anxiety, and to provide you with the knowledge and skills needed to care for your baby.

You are encouraged to participate in “preparing for discharge milestones” discussions.

Planning for discharge includes:

• The baby is discharged by the doctor.
• The baby’s screening tests, including hearing, maritime newborn screening and oxygen saturation, are complete.
• You are comfortable with baby’s care including feeding, bathing and giving medications if required.
• You are comfortable with securing baby in a car seat.
• A family physician appointment has been made. If you do not have a family physician on admission to the hospital, a doctor will be assigned to the baby.
• A card is given with any other follow-up appointments.

Hostel Room/Care by Parent Room

Two hostel rooms are available for parents and are prioritized by babies’ medical needs. Meals are provided for one person. A refrigerator and microwave are available for personal use in each room.

Preparation at Home

• Painting and decorating of the baby’s room, if needed, should be done before discharge.
• Purchase a car seat, crib, clothing, diapers, etc. as soon as possible before discharge.
• Complete registration for baby equipment so you will receive notice if there are any issues.

Please refer to the following Loving Care books for additional information on caring for your baby:

• Loving Care: Birth to 6 months
• Loving Care: 6 to 12 months
• Loving Care: 1 to 3 Years
• Loving Care: Parents and Families

• Family Integrated Care
• Canadian Premature Babies Foundation
• About Kids Health Life in the NICU
• Canadian Pediatric Society
• Caring for Kids
• Child Safety Link
• Baby Friendly Initiative
• Donor Breast Milk
• March of Dimes
• Government of NB – Public Health
• Public Health Agency of Canada
• Cannabis and Pregnancy