Certified Level II Nursery and Neonatal Intensive Care Unit (NICU)

About the NICU

We know that mothers delivering twins or premature babies want local high-tech services available to support the special needs of newborns at risk, and they want answers to important questions right away. We also know that mothers who are over age 35 have increased risks for complications. In the Cayuga Birthplace, we provide both routine and high-risk care for mothers and babies.

Our certified Level 2 Neonatal Intensive Care Unit (NICU) is staffed by two top notch board certified neonatologists, Srisatish Devapatla, MD and Ramesh Vidavalur, MD, who attend high-risk deliveries, provide consulting services, continuous care of NICU patients, and leadership and education for the NICU staff.

The Cayuga Birthplace also has a group of dedicated NICU Registered Nurses (RNs) and Respiratory Therapists (RTs) who provide continuous care and make daily rounds with neonatologists to develop an individualized care plan for each NICU patient.

Our Intensive Care Nursery (NICU) admits babies born up to 10 weeks early (30 weeks and above) and at a minimum weight of 1250 grams (2 pounds, 12 ounces). In collaboration with pediatric cardiologists at Crouse Hospital in Syracuse, we provide on-site ultrasounds of the newborn’s heart (called tele-echocardiograms), which are used to diagnose or rule out heart defects. This service reduces the need to transfer an infant out to Syracuse solely for the reason of immediate cardiac evaluation in an otherwise well-appearing infant.

Whether you’re having your first baby, or you’re an experienced mom, we know you’re happily preparing for this very special event and at the Cayuga Birthplace, we’re ready to welcome your baby into the world with our Neonatal Intensive Care Unit.

You can take comfort in knowing your newborn will be in experienced hands if your baby arrives early or has medical complications. Should the unexpected happen, a neonatologist is available along with a team of skilled neonatal nurses to care for your baby. It’s reassuring to know that babies requiring special care don’t have to leave the area for treatment or be separated from their mom and family.

In addition to treating premature or low birth weight newborns, our neonatologists care for twins or triplets and babies with unexpected medical complications arising during delivery.

NICU at Cayuga Birthplace provides specialized care for premature infants with conditions such as:

  • Apnea of prematurity (breathing pauses)
  • Respiratory Distress Syndrome (due to immature lungs)
  • Inability to maintain body temperature (needing an incubator)
  • Inability to take food by mouth (needing feeding by a tube placed through the nose or mouth into the stomach)

We also care for infants who are moderately ill with problems that are expected to resolve rapidly without subspecialty services. Common problems we see are:

  • Late preterm infants (between 34 and 37 weeks gestation)
  • Infants with jaundice or infection

The new NICU at Cayuga Birthplace provides continuous monitoring of the infant’s heart rate and breathing pattern, short-term ventilation, continuous positive airway pressure (CPAP), nasal cannula oxygen, intravenous nutrition and medications. We have excellent lactation support and actively promote breastfeeding for our patients. We have hospitality rooms where our families can “room in” with their infant prior to being discharged from the hospital.

Some of our smallest patients will have begun their lives far away from home in the NICU of a large city. As soon as they are medically stable, they can transfer Cayuga Medical Center to return closer to their families.

The new Special Care Nursery at the Cayuga Birthplace is fully equipped with the latest technology, including cardiac monitors, phototherapy lights for elevated bilirubin levels, warming units, resuscitation care centers, IV infusion pumps, isolettes, CPAP generators, and ventilators. It’s nice knowing that while you’re preparing for your new arrival, the Cayuga Birth Place is preparing too.

During your baby’s stay in the NICU, a team will work closely with your baby. Included in this team are nurses, doctors, respiratory therapists, nutritionists, pharmacists, infant educators, social workers, chaplains and YOU, the most important member of the health care team. We welcome your suggestions and ideas about the care of your baby. Our goal is to make sure you are well informed and feel like a partner in the care of your baby in the NICU.

Parenting in the NICU

Before your child was born, you probably did not expect your baby to arrive early or with medical problems. Having a premature or sick newborn can be a shock to families. You may feel helpless and powerless to help your baby. You may feel scared, depressed, guilty, worried, exhausted, or stressed-out.

You may have these questions:

  • Will my baby survive?
  • What is really wrong with my baby?
  • Will my baby grow up normally?
  • How will all this care be paid for?
  • How can I be both with my baby in the hospital and with my other children?
  • What about all of my other responsibilities?

Almost all parents who have had an infant in the NICU have expressed these thoughts and feelings. We encourage you to talk about these feelings with someone.

The NICU staff will be available to help you. Small or sick babies are easily stressed. We know some ways to make babies more calm or comfortable. Your baby will like certain kinds of touching and holding. Ask your nurse to share this information with you.

You can continue to learn about your infant’s special personality while they are very small or sick in the NICU. Babies can continue to learn about their very special relationship with their parents, too.

Often parents enjoy taking pictures and videos of their infant, bringing booties, blankets, clothes, and even family photographs and toys for their baby. Your baby knows you by your smell and the sound of your voice. Babies need your love and your personal touch. Your visits are very important.

As your infant’s condition stabilizes, the baby might be moved into a patient room near the nursery where mom and baby can both stay (usually with the baby on electronic monitoring), or the baby’s care may be transferred to one of the pediatricians and the baby deemed “regular nursery care”, meaning the baby stays with mom all the time in a regular room and the neonatologist is no longer the care provider. The neonatologist will discuss your baby’s progress with you frequently and help you to know when changes such as these may be expected.

Below is a list of some of the ways parents can participate in their baby’s growth and development:

  • Visit your baby daily. Depending on your baby’s condition and gestational age, daily needs may vary. The nurse will let you know how you may participate in your baby’s care, which may include diaper changing, temperature taking, bathing and holding.
  • Hold your baby and include “Kangaroo Care”, which is also called skin-to-skin contact. “Kangaroo Care” is the practice of holding your preterm infant, wearing only a diaper, against your chest, skin-to-skin. During “Kangaroo Care”, the baby receives stimulation due to the physical closeness and the familiarity of parental touching. “Kangaroo Care” provides an opportunity for you to develop that special bond with your infant that can be difficult to attain in the NICU. Ask your nurse for additional information.
  • Talk to your baby. Your baby will recognize your voice and will be comforted by it. Newborns are calmed by a soft, monotone voice.
  • Make your baby’s isolette like a little nursery. Bring in receiving blankets, a blanket to cover the isolette and keep light out, a music box or a tape player with lullabies, and family photos. You may bring in T-shirts and sleepers when your baby is big enough – ask your nurse when it is appropriate.
  • Breastfeed your baby. If you plan on breastfeeding your baby, you should begin pumping your milk during your hospital stay. (The postpartum nurse will give you a pump kit.) Milk transported to the NICU should be on ice. You will be directed on how to label and store the milk for your baby. If you’ll need a pump for more than several days, we encourage you to rent.
  • Encourage visitation. At the NICU, we encourage families to visit their baby. Visitation allows parents time to bond with their baby and also gives the staff opportunities to teach the skills parents need to know to care for their baby at home.

Most premature babies are unable to breastfeed right away because they are not able to coordinate sucking and swallowing.

New moms who already are dealing with the stress and anxiety of having a child in the NICU may find it stressful to build their milk supply by pumping. Our lactation staff (health care professionals trained to help mothers with breastfeeding issues) offer special help to mothers so they can provide breast milk for their NICU babies.

Our consultants can help new moms establish feeding at the breast as soon as the baby is medically able, find a quality breast pump, educate on how to pump breast milk and offer emotional support.

In the Cayuga Birthplace Neonatal Intensive Care Unit (NICU), we have many different kinds of equipment to help us care for your baby. All the machines have different types of alarms that the staff recognizes by tone.

Our staff is well-trained and recognizes the importance of each alarm and will respond appropriately – including communicating to the parents what the alarm signifies. Your questions and concerns are important to us and we are here to help.

Below is a list of some commonly used equipment and a brief description of what the equipment is used for.

Bili Lights

Bili Lights are used for a condition called jaundice, a yellowing of the skin due to a substance that collects in the blood of many newborns.

A Bili Blanket is also used to treat jaundice. It is placed under your baby or between your baby’s skin and clothes. The baby is placed under the lights wearing a diaper and eye patches to protect them from the bili light.

Cardiac Respiratory Monitor

A cardiac respiratory monitor has small wires, or chest leads, placed on the baby’s chest. These leads monitor the baby’s heart rate, rhythm and respiration. The monitor will sound an alarm if the baby’s heart rate or respiration are below or above the normal range.

CPAP (Continuous Positive Airway Pressure)

Through the use of a ventilator and nasal prongs, babies can be given pressurized air mixed with oxygen to help them breathe and to keep their lungs expanded. A hat is used to keep the nasal prongs in place. A small feeding tube is placed in the baby’s mouth. The tube extends into the baby’s stomach to help keep air from accumulating in the stomach.

Endotracheal Tube (ET Tube)

An endotracheal tube is a very small plastic tube inserted in a baby’s windpipe. The tube is attached to a ventilator to keep the airway open and to deliver air and oxygen to the baby.

Feeding Tube

A feeding tube, or OG, NG or gavage tube, is a tiny tube inserted into a baby’s nose or mouth and down into the stomach. Formula, breast milk and medicine can be given through the feeding tube, and it is how babies are fed until they are strong enough to suck from a breast or bottle. It may also be used to remove air from the stomach. A feeding tube is not as uncomfortable for a baby as it seems since babies do not have a strong gag reflex.

Isolette (Incubator)

An isolette, or incubator, is a specially heated bed with transparent plastic. The isolette provides a controlled warm environment for maintenance of normal core temperatures. Air temperature is controlled by a sensor attached to the baby’s skin. Babies stay in an isolette until they are 1,650 grams (3.6 pounds), and stable.

IV Pump

An IV pump is attached to a pole by the baby’s bed. The pump sends fluids into the baby’s IV at an exact rate and if the baby is unable to eat, provides the nutrients needed.

Nasal Cannula

Nasal cannula is plastic tubing with two little prongs that go just inside a baby’s nose to provide extra oxygen when needed.

Radiant Warmer

A radiant warmer is a bed that helps regulate a baby’s temperature. A probe secured to the baby’s skin tells the bed how much heat to use, which in turn allows the NICU staff to constantly monitor the temperature.

Saturation Monitor

A saturation monitor gauges how much oxygen is in the baby’s blood. It is connected to a baby by a probe that is wrapped around the foot or arm and has a glowing red sensor light.

Suction Catheter

The suction catheter helps keep a baby’s airway clear by using a thin soft tube to suction out mucus.

Umbilical Catheter

An arterial or venous umbilical catheter allows the NICU staff to draw blood by going into an artery or a vein in the baby’s belly button. The catheter can also be used to give fluid or blood to the baby, if needed.

Ventilator (Respirator)

The ventilator is used for infants who do not have sufficient vigor to breathe independently. It delivers oxygen and breaths per minute via a tube (endotracheal tube or ET Tube) placed in the infant’s trachea or airway.

As your baby gets close to discharge, you may experience many different emotions – ranging from elation to be leaving the hospital to anxiety as you assume responsibility for your baby’s care.

Remember that these feelings are normal. The more involved you are in holding, feeding, diapering and bathing your baby prior to discharge, the more comfortable you will feel with your baby at home.

Caring for Your Baby

Before taking your baby home, try to visit him or her in the Cayuga Birthplace Neonatal Intensive Care Unit (NICU) for long periods of time so that you will feel more comfortable in providing the care your baby needs. The NICU staff will work with you one-on-one with discharge instructions for the care of your new baby.

Visitors at Home and Taking Your Baby Out in Public

Many friends and family members will want to visit you after you bring your baby home. Remember that babies may become fussy when handled too much or when their sleep and feeding schedules are disturbed. Try to limit visitors and make sure they wash their hands prior to touching or holding your baby. Also, keep your baby away from people (including their brothers and sisters) who have colds, coughs or sniffles. When taking your baby out, avoid places with large crowds, especially during the first several months, and always protect your baby from cigarette smoke.

Choosing a Pediatrician

If you have not already chosen a pediatrician, it is important for you to do so immediately. You should interview several doctors to determine if you are comfortable with them and their sensitivity to the “ups and downs” of parenting. Inform your baby’s nurse as soon as you make this decision.

Car Seat Test

Babies born at or before 37 weeks will need a car seat test before going home to see if they can safely sit upright. The test will be conducted by the NICU staff just after the baby is fed. Your nurse will tell you when to bring the car seat in for this test.

Hearing Screening

All babies leaving the NICU will receive a hearing test close to the time of discharge. You will be informed if your baby does not pass this test and what follow-up is necessary.

CPR (Cardiopulmonary Resuscitation)

A CPR class is highly recommended for all parents. Classes are held at Cayuga Birthplace at various times each month.

Concerns After Discharge from the NICU

Baby’s Sleeping Habits

In the Cayuga Birthplace Neonatal Intensive Care Unit (NICU), the continuous lighting, beeping from monitors and talking make it difficult for your baby to learn the difference between day and night, which may lead to erratic sleeping patterns.

When you get home, try to establish structure and routine so that your baby’s day has some predictability. For example, develop a routine in which you give your baby a bath at the same time every day.

You may, for the first week, need to keep the light on at night in your baby’s room. Gradually turn the lights off after the last night feed so your baby learns night from day and to make night a quiet time in your house.

Remember, babies must sleep on their backs in their beds.

Other ways to make your baby’s sleep environment safe is to:

  • Place the baby in his or her own crib on a firm mattress with tight-fitting sheets
  • Have no soft, fluffy bedding in the crib
  • Have no bumpers in the crib
  • Do not overdress your baby

Baby’s Development

Most parents of premature infants worry if their baby will develop normally. While the doctors and nurses are unable to tell you exactly how your baby will develop, they will teach you ways to help your baby grow and learn new skills. Your baby’s first year is a time of great change. A child’s development is a complex, ongoing process, and no two children mature at the same rate or in the same way.

Child Passenger Safety

More than 85 percent of car seats are incorrectly installed and yours may be one of them. Have your child safety seat inspected by a certified child passenger safety technician. You may also visit the National Highway Traffic Safety Administration, call (888) 327-4236, or visit Safe Kids USA.

The neonatology team provides high quality, safe newborn intensive care to all infants born at the Cayuga Birthplace, striving to keep babies and families close to home whenever possible. We work closely with the obstetricians to transfer mothers when necessary, but occasionally an infant who needs a higher level of care available only at a Level 3 NICU is delivered at the Cayuga Birthplace. In this situation, the infant is thoroughly assessed and stabilized by our team and then transported to the Level 3 NICU at the Crouse hospital, Syracuse, or Arnot Ogden Medical Center, Elmira, or Strong Memorial at Rochester.

In general, the following infants will be transferred to a Level 3 facility:

  • Infants who are less than 30 weeks gestation
  • Infants weighing less than 1,250 grams
  • Infants who have severe lung disease (needing long term or high frequency ventilation), pulmonary hypertension, neurologic problems (needing complex imaging, EEG), or other problems requiring pediatric surgical or pediatric medical subspecialty consultation, such as pediatric cardiology

When an infant from our region no longer requires Level 3 or subspecialty care at Children’s Hospital, they are often transferred back to the Cayuga Birthplace for convalescent care and to be closer to home.

To understand the some of the common diagnoses made in NICU, please visit this link: http://www.nlm.nih.gov/medlineplus/prematurebabies.html.

Frequently Asked Questions

When is my baby going home?

The neonatologist determines when your baby will be discharged. The decision depends on your baby’s diagnosis and length of treatment.

When will my son be circumcised?

The neonatologist must determine that your baby is medically stable prior to having a circumcision. Some are done after discharge.

Can my baby stay in my room?

Initially, NICU babies need to be under constant, direct care. Once they are stabilized, they progress to being able to be cared for in a Family NICU care room, with electronic monitoring. The neonatologist will explain the criteria used to determine when the baby is ready to “graduate” to a different level of observation and care.

When can I breastfeed?

Breast milk is very important to your baby’s recovery. If your baby is not able to breastfeed yet, we will assist you with pumping. Babies who are premature may take longer to learn to breastfeed. This is normal. Skin-to-skin contact may help baby when she/he is ready. We have lactation consultants who can help you.

Why can't I hold my baby whenever I want to and even when my baby is sleeping?

Sick babies need quiet, uninterrupted sleep to conserve energy and to reduce stress. Parents are encouraged to visit at “touch times” when they are able to participate in their baby’s care and to hold and/or “Kangaroo Care” their baby.

What time will the doctor be here and when can I speak with him or her?

The neonatologist usually begins the day at 7:00 a.m.; you may request to speak with the neonatologist during the day. The doctor will be happy to speak with you when he or she is not with another baby.

Did I do something wrong?

It is common for a mother to feel like she did something wrong to cause her baby to be admitted to the NICU. Prematurity, respiratory difficulties, low blood sugars and infections are not caused by anything you did. We encourage you to talk about these feelings with a family member or a caregiver.

Why is my baby losing weight?

It is a normal adaptation for premature babies to lose 10 percent to 15 percent of their birth weight and full term babies to lose 7-10% of their birth weight in the first week after delivery.

How long will my baby have to be on antibiotics?

This depends on the results of the laboratory work, as well as any signs and symptoms of infection that your baby shows. Typically, babies are on antibiotics for 48 to 72 hours, or until their lab work comes back negative for an infection. If babies have an infection, they will be treated for a minimum of 7 days.

How long will my baby need phototherapy?

The amount of time your baby needs phototherapy varies, depending on blood type, age, size and hydration status. All of these factors affect your baby’s bilirubin level.

Why is there an IV in my baby's head?

Due to the limited access and fragility of a baby’s veins, your baby may require an IV to be placed in a scalp vein. A scalp vein is the same as any IV site. The catheter is inserted superficially into the vein and does not come into contact with the brain.

Why does my preemie have to be fed with a tube?

Depending on how early your infant is, the ability to coordinate sucking, swallowing or breathing may be difficult. During this time, your baby will be fed with a tube to ensure proper nutrition, digestion and weight gain. As your baby matures, the ability to feed without the tube will develop.

Does my baby feel pain when an IV is inserted?

Yes. However, appropriate measures are taken to alleviate discomfort during procedures. Some interventions include swaddling, providing support and containment, using a sucrose solution and allowing the baby to suck during the procedure. Please feel free to discuss comfort measures with the nurse.

Will there be a problem transitioning my baby from the bottle to breastfeeding?

Most infants adapt without much difficulty. The NICU staff will provide the support you need to succeed with this transition.

Can children visit?

Visits for siblings of the NICU baby can be arranged with the NICU staff, providing that the siblings are healthy, of course. Timing and length of visits will be dependent on the condition of the baby and the presence and situation of other NICU patients.

What are my chances of having another premature infant?

Please speak to your obstetrician, who will be glad to address your concerns.

How long will my baby be on a ventilator/CPAP or oxygen?

There are many factors that determine the length of time, including gestational age, diagnosis, signs and symptoms, and blood gas results.

My baby is not feeding or the feedings are being limited; how is my baby getting the required nutrients?

IV nutrition, also called total parenteral nutrition (TPN) is used to supplement or replace feedings by mouth and is monitored closely by the NICU staff. The nutritional needs of each infant are assessed daily.

As your baby becomes healthier, the amount of IV nutrition will decrease and the amount of food your infant can eat will increase.

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