NICU 101: How Healthy Pregnancies Support Health Babies
Medical Reviewer(s): Melissa Walsh, MD
Welcoming a new baby to the world is one of life’s most exciting moments for a family. But sometimes, babies are born with health issues, and the first month of life is hardest. This is because when babies leave the safety of the womb, they have to adjust to the outside the world, and that can be harder for some babies than others. For example, some babies have trouble breathing, digesting food, and protecting themselves from getting sick on their own. Neonatal intensive care units (NICUs) play an important role in helping and healing babies who are born with serious health issues. However, the number of babies needing NICU support has been growing, and experts agree that this trend is troubling.
In the US today, about 1 in 10 babies have to stay in a NICU (CDC), and Black and Indigenous babies are most likely to need this care (Ravi, Iacob, and Profit). The differences among these racial and ethnic communities are not random. They are connected to bigger issues like unequal access to quality antenatal care and healthy food, higher levels of ongoing stress, and unfair treatment within the healthcare system. If you’ve faced any of these challenges, you are not alone—and it is not your fault.
The good news is that your baby’s health is tied closely to your health. So, keeping you healthy can help keep your baby healthy, too. In this blog, we will explain what a NICU is and how having your baby stay in a NICU can impact you. We will also explain what kinds of health conditions can lead to a baby having to stay in a NICU and share ideas for how you can help keep your baby healthy so they do not need this kind of care.
What is a NICU?
Neonatal intensive care units (NICUs), sometimes called intensive care nurseries (ICNs), are the places in hospitals and birthing facilities that provide care for babies born with health issues and babies who need a little extra help to grow strong and stay healthy. NICUs have special equipment and special staff who are trained to monitor and care for these babies around the clock.
Not all NICUs are the same, though. Some NICUs treat babies that are mostly healthy when they are born but may be at risk of getting sick. In these NICUs, the staff watch over babies and may run tests or provide basic treatments, like giving babies medicine. Other NICUs provide these basic services but also treat very sick babies, sometimes even operating on babies. The reason it is important for you to understand there are these different types of NICUs, is so you can know what to expect if your baby needs to stay in a NICU.
Are NICUs expensive?
While NICUs offer important, life-saving care for babies in need, they can also be an emotional and financial challenge for families.
The costs for a NICU stay depends on the amount of care the baby needs. Some babies only stay in the NICU for a few days to be monitored. Other babies stay in the NICU for months and need expensive treatments, like surgeries. The average NICU stay in the US is about 14 days.
The cost of NICU care in the US ranges from $4,488 to $161,929, with an average cost of $71,158 (Valencia, Sen, and Martin). Health insurance may pay for some of these costs, but parents also have to pay for part of the care. The average out-of-pocket cost for families who have insurance is $4,969, mostly for deductibles and co-insurance
(Mostafavi).
Also, babies that need NICU support often have other health issues, including potentially lifelong physical, intellectual, and social conditions—and all of these can lead to more healthcare costs. In the short-term, about 8% of babies placed in NICUs after birth need to return to the NICU within one month of when they leave and up to 38%return within one year (Feister et al.; Hebballi et al.; McCormick, Shapiro, and Starfield).
Beyond the financial costs, parents with babies in NICUs also must deal with emotional costs. For most parents, having a baby in the NICU is not how they expected to spend the first days and weeks of life with their baby. Parents may feel helpless, as they are unable to care for their baby by themselves, and they may worry about whether their baby will survive and have a healthy life. They may also need to balance caring for other children at home, and that can be stressful and also cause feelings of guilt for not being with all of their children, all of the time. All of this can lead to anxiety, depression, and stress.
It is important to know that mental health conditions, like anxiety and depression, are common during pregnancy and for new parents. If you think you might have a mental health concern, it is important to talk to your healthcare provider. They can talk to you about what you are feeling and help you get the care and support you need.
What are the reasons that babies need NICU care?
There are many different reasons why a baby may need to stay in a NICU. Many of the health issues NICU babies have, are the result of complications during pregnancy, labor, and/or delivery.
Most NICU babies are premature or preterm, meaning they are born before 37 weeks, or they have a low birthweight, meaning they weigh less than 5 pounds, 8 ounces (or 2.5kilograms). Also, many babies that are born prematurely have a low birth weight. Babies that are born premature or with a low birthweight are more likely to have challenges with basic functions—like breathing, digesting, and controlling their body temperature—and are more likely to get sick, because their organs and systems are not ready to function on their own.
Other health conditions that can cause a baby to need NICU care include: birth defects, breathing problems, infections, low blood sugar (hypoglycemia), jaundice (yellowing of the skin and eyes due to a blood condition), side effects from alcohol use, and withdrawal from drugs.
Do health complications during pregnancy cause NICU stays?
Your health before and during pregnancy plays a big role in your baby’s health when they are born. So, it is important that you know how to stay healthy during your pregnancy, and this includes knowing how to prevent or manage common pregnancy complications with the help of your care team.
Below are a few common pregnancy health issues that can affect the baby’s health and lead to a NICU stay.
High blood pressure or preeclampsia: If you have high blood pressure, also called hypertension, or preeclampsia, your baby is at risk for being born prematurely, having a low birth weight.
Diabetes: If you have diabetes before you became pregnant (pre-existing diabetes) or if you develop diabetes during your pregnancy (gestational diabetes), your baby is at risk of having low blood sugar, trouble breathing, and some birth defects, or becoming a large baby (large babies can make labor and delivery difficult).
Infections: There are some types of infection that you can pass to your baby during pregnancy, labor and delivery, or after birth through breastfeeding. And, some infections that happen during pregnancy can lead to your baby being born prematurely or with a low birth weight. Some infections, like a head cold, are common and will not affect your baby. Other infections—including some sexually transmitted infections, some reproductive tract infections, a severe flu, and the measles—can increase the chance of preterm birth or a low-birth-weight baby.
Substance use: Using alcohol, tobacco, or drugs like opioids during your pregnancy can lead to your baby being born with health issues, like fetal alcohol spectrum disorder and neonatal abstinence syndrome. Both of these health conditions can cause low birth weight and can cause your baby to have various physical and developmental disabilities.
Anemia: Having severe anemia (low red blood cell count) during pregnancy increases the risk of your baby being born prematurely or with a low birth weight.
For many of these health issues, you might not notice any warning signs. That is why it is so important to attend your antenatal care visits and to get screened and tested for these and other potential health conditions. Also, your healthcare provider can provide vaccines for some infections, like COVID-19 and the flu, lowering your risk of getting sick and having your sickness affect your baby.
Also, complications you may have during labor and delivery can also affect your baby’s health. For example, if you labor takes too long (more than 24 hours), if your baby is not positioned in a way to be delivered easily, or if you have issues with your umbilical cord(the organ that carries oxygen and nutrients to your baby and removes waste from your baby while they are in the womb), your baby may not get enough oxygen during labor and delivery. Babies that do not get enough oxygen can end up having issues breathing and can end up with damage to their brain and other organs.
Are there ways to prevent a NICU stay?
Many NICU stays can be avoided, or at least made shorter, by preventing and managing complications during pregnancy. To put it another way, many of the pregnancy health conditions that lead to NICU stays for babies are avoidable or manageable, with the help of your care team. Making healthy choices during pregnancy is the first step, and to do that, you need to know what is healthy and what is not. Being able to identify a health issue and being able to seek care quickly is the second step.
Here are five things you can do to stay healthy and keep your baby healthy:
1. Eat a healthy diet and stay active.
When you eat healthy, your body is able to give your baby the nutrients they need to grow healthy and strong. Exercising helps your body and your baby stay healthy, too. Your healthcare provider can help you figure out what a healthy diet means for you and also what exercises are safe for you and your baby.
2. Avoid alcohol, tobacco, and drugs.
When you drink alcohol or use tobacco or drugs, your body can pass these substances on to your baby. This can prevent your baby from growing and developing the way they need to in order to be healthy and strong.
3. Take care of your mental health.
Anxiety, depression, and stress are all normal. But these conditions can affect your physical health and in turn your baby’s health. If you are feeling anxious or depressed during your pregnancy, or after you give birth, share your feelings with your healthcare provider. They can help you feel better and connect you with other resources that can help you help your baby stay healthy.
4. Attend all of your antenatal appointments.
It is important that you regularly see your healthcare provider throughout your pregnancy. During these visits, your healthcare provider will monitor your health and the progress of your pregnancy. They will run tests to check for common pregnancy complications that can affect your baby, and help you manage any issues you may have. Identifying complications early is important because it can prevent them from becoming serious and even fatal.
Seeing your healthcare provider early in your pregnancy, before you are 10 weeks, is also important. This is the time when your healthcare provider can talk to you about your personal risk factors for common pregnancy conditions and help you create plans to prevent those health issues from happening.
5. Understand warning signs and seek help quickly.
Many pregnancy health issues have signs and symptoms that you can watch for. Here are some common symptoms that could be warning signs of a health issue:
- Really bad headaches that last for more than a day
- Vision problems that do not go away or that get worse, for example, if everything looks blurry or if you are seeing spots or flashes
- Dizziness that does not go away or that gets worse
- Really bad stomach pain, feeling sick to your stomach, or vomiting a lot (more than four times i n a day) and not being able to eat or drink
- Trouble breathing or shortness of breath, especially when you are resting or relaxing
- Being really tired all the time, no matter how much sleep you get
- High blood pressure (>140/90)
- Rapid heartbeat, or feeling like your heart is pounding or your pulse is racing
- Baby kicking less than 10 times in two hours
- Gaining a lot of weight quickly, like in a week or two
- Swelling in your hands, feet, and/or face
If you have any of these issues, you should contact your healthcare provider immediately. Having a symptom does not always mean there is something to be concerned about, but your healthcare team can determine if you have a health issue or are if you might be at risk of developing a health condition. And, if needed, they can help you prevent or manage that health issue.
How can BobiHealth help?
Eating a nutritious diet, exercising, avoiding alcohol and drugs, and taking care of your mental health can help you stay healthy and help your baby grow healthy. Seeing a healthcare provider early in your pregnancy and at regularly scheduled visits is also vital. And, knowing how to identify a health concern and seeing your healthcare provider when you first start having the issue is key to managing health issues before they become dangerous for you and your baby. BobiHealth can help you with all of these things.
BobiHealth is an app that can help you keep track of your health at home during your pregnancy. Unlike other pregnancy trackers that focus on only a few health signs, like weight gain and baby’s kicks, BobiHealth offers a broad range of tools and resources to help you stay on top of your health and your baby’s health. For instance, you can log your vital signs in the app and then easily see changes in your health over time. Here are a few vital signs you can track that could signal a health issue:
- Blood oxygen levels: Low blood oxygen levels can be a warning that you are anemic or have preeclampsia.
- Blood pressure: High blood pressure (>140/90) can lead to preeclampsia.
- Fetal kicks: Once you are 28 weeks pregnant, your baby will be moving a lot. If your baby kicks less than 10 times in two hours, they may be in distress.
- Pulse: If you feel like your heart is racing, skipping beats, or beating irregularly, you may have anemia or an infection, or your blood sugar or blood pressure may be too low, or you may be dehydrated.
- Temperature: A fever (a temperature higher than 100.4°F or 38°C) may be a sign of an infection.
You can also track many other pregnancy symptoms, such as bleeding, different types of pain, and mental health concerns. Also, you can pair the app with wearable products, like smartwatches, to make tracking even easier. The app will remind you to track these vitals and symptoms regularly so you can easily notice when there are changes. The app will also alert you if it notices changes. But it is important that you enter your vitals and symptoms regularly and correctly in order for the app to be able to identify these changes. You can also can set goals and reminders in the app to help you remember to practice healthy behaviors, like getting your steps in or taking vitamins.
Your body goes through a lot of changes when your pregnant, so some of the changes you may notice are just part of being pregnant, but others may be warning signs of a health issue. If you notice changes and have concerns, it is important to talk to your healthcare provider. They can help figure out if what you are seeing is a sign of a health issue and then provide the care and support you need to address the issue. You can share all of the health information in the app with them, too. Having that information will help your healthcare provider make the best decisions for how to help you avoid or manage a health issue that could lead to your baby needing NICU care. When you contact your healthcare provider as soon as you have a concern, they can help prevent that concern from becoming serious.
Being able to track this information at home is particularly helpful if you are not able to get to your healthcare provider easily, for instance if the nearest health facility is very far away or if you have trouble taking time off work or finding transportation to the health facility. But this does not replace the need to attend regular antenatal care visits or the guidance your healthcare provider can offer. Use the app in addition to your regular health appointments so that together, you and your care team can make the best decisions for you and your baby.
Help yourself stay healthy, for you and your baby.
NICUs are lifesaving resources for families that need them. But ideally, you want to prevent health issues that could lead to your baby needing to stay in a NICU if you can. And, while sometimes a NICU stay is unavoidable, making healthy choices throughout your pregnancy can often help reduce the length of the NICU stay. Following the health tips explained earlier in this blog is important and BobiHealth is hereto help you do that.
Download the BobiHealth app today to get started. Make pregnancy health easier for you, so your baby can have a healthy start to life.
Useful Terms
Here are definitions of a few terms we use in this blog. It may be helpful to read these definitions so you know what they mean if your healthcare provider uses these terms with you.
Anemia: Red blood cells carry oxygen from your lungs to the rest of your body and your body uses that oxygen to function. Anemia happens when either there are not enough red blood cells or the red blood cells do not have enough protein to give the rest of your body the oxygen it needs. This can make you feel weak or tired, make it hard to breathe, make you feel dizzy or unsteady, cause you to have pale skin, and/or make your hands and feet cold. Anemia is usually treated with medication(iron supplements) but very serious cases may need blood transfusions.
Birth defect, or congenital anomalies: Birth defects, also called congenital anomalies, happen when the baby’s organs and systems do not develop the way they should. Birth defects can be minor or major, and they can affect how the body looks or works. One example of a minor birth defect is a birth mark, which is usually harmless. One example of a major birth defect is a heart condition that requires surgery to fix.
Diabetes, pre-existing and gestational: Diabetes is a health condition that occurs when your body does not process sugar the right way. When your body doesn’t process sugar correctly, the sugar can stay in your blood and make you sick. If you have diabetes before you get pregnant, it is called pre-existing diabetes. When this happens during pregnancy, it is called gestational diabetes.
Fetal alcohol spectrum disorder (FASD): If you drink alcohol during your pregnancy, your body will pass the alcohol from you to your baby. This affects how your baby’s brain develops and can result in different health complications, including physical defects, learning disabilities, and behavioral issues.
High blood pressure, hypertension: High blood pressure, also known as hypertension, happens when your blood pushes too hard against the walls of your blood vessels. This can happen if the blood vessels get tighter or less flexible, and this can lead to severe health problems, like a heart attack or a stroke.
Hypoglycemia, or low blood sugar: Hypoglycemia happens when the amount of blood sugar you have is too low. Blood sugar, also called glucose, is your body’s main source of energy. So, when your blood sugar is too low, it can be hard for you to think clearly or you may feel tired or sluggish. In really bad cases, it can lead to serious and even fatal health complications, like seizures or coma.
Jaundice: Jaundice is common condition in babies that causes the eyes and skin to look yellow. Jaundice happens when the baby’s liver is not developed enough to clean the baby’s blood right and remove a yellow-colored substance called bilirubin. The buildup of this yellow substance in the blood causes the eyes and skin to look yellow. Treatment depends on the seriousness of the jaundice. The most common treatment is light therapy (placing the baby under special blue lights) but for a serious case, a blood transfusion may be needed.
Low birth weight: Babies that are born weighing less than 5 pounds, 8 ounces (or 2.5 kilograms) are called low birth weight. Compare this to the average weight of a newborn, which is about 7 or 8 pounds (or 3 to 3.5 kilograms).
Neonatal abstinence syndrome (NAS): If you use drugs like opioids during your pregnancy, your body will pass the drugs from you to your baby. Your baby will get used to having drugs in their systems and then when they are born and no longer getting the drugs, they will go into withdrawal. This can make your baby very sick and unhappy.
Neonatal intensive care units(NICUs): NICUs, also known as intensive care nurseries, are special areas in a hospital or birthing center that provide extra care for newborns with serious health conditions.
Preeclampsia: Preeclampsia is a health condition that can happen during pregnancy and up to 6 weeks postpartum. Preeclampsia happens when your blood pressure is too high and can lead to dangerous complications. Read our blog, What You Need to Know About Preeclampsia, to learn more.
Preterm birth: A preterm birth is a birth that takes place earlier than it should, usually before the 37th week of pregnancy. Read our blog, Avoid Having Your Baby Too Early: Your Guide to Preterm Labor and Birth, to learn more.
Umbilical cord: The umbilical cord is a tube-like organ the organ that forms in the womb. It connects the placenta to the baby and carries oxygen and nutrients to your baby and removes waste from your baby.
