Parents navigate specialized care during premature infant's NICU stay

Lyndsay Gardner’s pregnancy proceeded normally until her water broke at 31 weeks. Although her son was due around Christmas in 2023, he arrived just before Halloween instead. Born nine weeks early, Maximus Coelho could not immediately return home to Lititz with his parents and three older siblings. He spent nearly four weeks in the neonatal intensive care unit (NICU) at Golisano Children's Hospital at Penn State Health Milton S. Hershey Medical Center.

"He needed help breathing, eating, fighting off infections and developing before he could come home with us," Gardner said. The realization that a newborn requires extra hospital care can be frightening. The NICU offers specialized support for infants' health and development, staffed by doctors, nurses, occupational therapists, physical therapists, and other experts who assist parents through this stressful period.

Reasons for NICU Admission

Premature birth is the most common reason for NICU admission, according to Dr. Dennis Mujsce, a neonatologist at Penn State Health Golisano Children's Hospital and interim chief of neonatal-perinatal medicine at Penn State College of Medicine. A typical pregnancy lasts about 40 weeks. Early-born babies require additional support as their lungs, digestive systems, and other organs mature. NICUs also treat full-term newborns with complex medical conditions.

The majority of premature infants admitted to the NICU are born between 34 and 37 weeks. However, level IV NICUs can care for infants born as early as 22 weeks, some weighing less than a pound. Earlier births necessitate more medical support. "One of the first things somebody has to do when they are born is start breathing," Mujsce said. "A very preterm baby's lungs are underdeveloped and usually not ready to do the work of breathing."

NICU teams assist breathing using tubes, ventilators, or medication. Care may include incubators to maintain body temperature or intravenous (IV) nutrition if an infant cannot safely eat or digest food. These units also treat critically ill infants with intestinal abnormalities, urinary tract problems, narrowed airways, heart defects, fluid buildup in the brain, nutrient breakdown issues, birth injuries, and infections.

Levels of Neonatal Care

Intensive care units provide four distinct levels of newborn care:

• Level I, Newborn nursery: Basic care for healthy infants.
• Level II NICU or Special Care Nursery: Care for stable or moderately ill newborns, often born between 32 and 40 weeks.
• Level III NICU: Advanced care for smaller babies born under 32 weeks and newborns with medical conditions.
• Level IV NICU: Highest level of care for the most critically ill newborns, including advanced specialists and surgical care.

Parental Expectations and Support

Hospital stays in the NICU involve significant emotional uncertainty. Many facilities offer psychologists, social workers, and care coordinators to help parents navigate the experience. Gardner and Maximus's father, Nate Coelho, spent as much time as possible each day with their son while balancing work and home responsibilities.

"We definitely felt the push and pull of having three kids at home who needed us and a premature infant who needed us," Gardner said. When doctors manage conditions requiring NICU care, they meet with parents to address common questions regarding duration, feeding, bonding, and discharge preparation.

Duration and Feeding Questions

The average NICU stay is about three weeks, though some infants require care for three to six months, Mujsce noted. Before discharge, babies must maintain body temperature, breathe with little or no support, and feed well enough to continue growing.

Regarding breastfeeding, Mujsce stated, "The baby's mother's milk is one of the best sources of food and nutrients for the baby." If an infant cannot suck or swallow normally, mothers can pump milk for tube feeding. Lactation consultants assist with feeding inquiries. The NICU at Penn State Health Golisano Children's Hospital features a Milk Lab where parents drop off pumped breast milk for safe storage.

Bonding and Home Preparation

"We encourage parents to be involved in the care of their infant," Mujsce said. "A lot of parents are afraid to touch their babies if they're in incubators or have IVs, so we guide them toward the best way to interact with their child for their development." Skin-to-skin contact, reading, talking, singing, and participating in daily care strengthen parent-child bonds.

Gardner highlighted the role of the hospital's Child Life team: "They not only supported us, but they embraced our three older children and helped them read to Maximus, bathe him and make crafts for him. They made it special and helped our bigger kids bond with their brother."

Many hospitals provide transition rooms for parents and babies to stay together before discharge. Care coordinators schedule follow-up appointments and provide instructions for home care, including contacts for questions or concerns.

Long-Term Development Outcomes

Maximus returned home on Thanksgiving Day. For the subsequent two years, his parents visited the NICU Neurodevelopmental Follow-Up Clinic to monitor his progress. Now 3 years old, he is a healthy boy who loves fire trucks; this Halloween, he chose a firefighter costume.

"He has no chronic health problems and is just as perfect as perfect can be," Gardner said.