19 Ways Nurses Assess Newborns In The NICU

Pregnancy and birth are miraculous. After months of anticipation, mothers can't wait to hug their little one. However, parents of newborns who need intensive medical care cannot enjoy those special first hours after birth. Infants who need special care might be transferred to the Neonatal Intensive Care Unit (NICU).

With dedicated staff and advanced technology, NICUs help babies and their families thrive. From premature birth to health issues, there are various conditions which may require intensive medical care. When it comes to premature birth, stats show that 1 in 10 pregnancies worldwide end in premature birth, or before the mother reaches 37 weeks of gestation.

Only a parent of a preemie knows the challenge that preterm birth brings. It can be tough, but there are things moms can know to make it easier. There’s hope for many families out there. So, here are 20 vital assessments NICU nurses perform to help newborns thrive.

19 The Apgar Score – The Very First Test

After months of anticipation and hours of labor pain, moms just can’t wait to hold their little one. Nevertheless, there are some medical procedures that should come first. For instance, there’s a vital test which is given at 1 minute after birth and again at 5 minutes after birth. This is the famous Apgar score.

The Apgar assessment is used to identify breathing, heart rate, muscle tone, color, and reflexes. Each area of assessment can get different scores. An active, pinkish, and crying baby means a healthy baby. According to standfordchildrens.org, infants with three or fewer points need special attention and may be admitted to the NICU.

18 Grams Matter

How big a baby is is another essential indicator which needs to be assessed. Stats show that the majority of term babies are around 7lbs (3.2kg) and may lose 5-7% of their birth mass. Small and premature babies can be admitted to the NICU, especially those who can't gain by two weeks of age.

Many factors affect birth size, though. For instance, my healthy baby daughter, who was born full term, was only 5 lbs. Nevertheless, she didn't need any antibiotics, special care or phototherapy; she even started to gain before we were discharged from the hospital.

17 Incubators vs. Radiant Warmers: Importance Of Keeping Baby Warm

Body temperature is another factor which NICU nurses and doctors check on a regular basis. When babies are too small to maintain their body temperature, they need some additional help. Incubators and radiant warmers are the two main devices used in NICUs. Radiant warmers keep the skin temperature constant. In incubators, on the other hand, air temperature can also be controlled.

Many preemies are placed in an incubator, which can help them thrive outside the womb. Although seeing your baby in an incubator is stressful, there are openings on the side which can help parents feel their baby. Skin-to-skin contact has healing properties.

16 Assessing Physical Maturity: Are All Small Babies Preemies?


Physical maturity is perhaps one of the most important areas to assess. As mentioned above, not all small babies are premature. Premature babies are babies born before the mother has reached 37 weeks of gestation, when certain organs are still developing.

According to verywellfamily.com, NICU nurses assess the development of the baby’s lungs, digestive tract, and even skin. The more premature an infant is, the more immature their organs and functions will be. Note that full term babies who suffered from oxygen deprivation during delivery may also be admitted to NICU. Nevertheless, there are many other factors that affect a baby’s development and well-being.

15 Facts About Retinopathy

Preemies need special medical care and assessments. Unfortunately, retinopathy is a common eye disorder that affects preemies, especially those under 2 ¾ pounds. According to nei.nih.gov, retinopathy occurs when abnormal blood vessels grow and spread throughout the retina. Yet, mild cases might not require laser or invasive treatment. We should mention that supplemental oxygen in incubators has been linked to retinopathy in the past. However, today’s technological advancements make incubators safe.

Interestingly, research shows that the eye starts to develop at 16 weeks. During the last 12 weeks of pregnancy, the eye develops at a rapid pace and keeps developing up to one month after birth.

14 Assessing The Brain: Cranial Ultrasound And Doppler

Brain development is another important areas to assess. Cranial ultrasound imaging and Doppler are two common methods to evaluate blood flow in the brain arteries. Note that these procedures are completely safe. They can indicate possible health issues.

Note that head ultrasound is common in NICUs, often performed at the infant's bedside. According to radiologyinfor.org, doctors apply water-based gel and press the device they use, called transducer, against the fontanelle. It’s interesting to mention that the fontanelle is an important part of an infant’s skull. Usually, the fontanelle is soft and closes around 2 months after birth.

13 Respiratory Complications And Outcomes

Lung maturity is one of the most important factors that NICU nurses assess. Note that in high-risk pregnancies, doctors should treat the baby with medication through the placenta to speed up lung development, which sadly is not a common practice yet.

Infants having trouble breathing are placed in incubators. According to livestrong.com, oxygenation is a process in which oxygen is administered directly to facilitate breathing, through tubes, nasal cannulas or even plastic hood.

12 Gestational Assessment: The Gestational Age Explained

Pregnancy lasts nine months? No! Each pregnancy journey is unique and doctors use gestational age to assess newborns instead. Gestational age is measured in weeks and is used to assess how far along the pregnancy is. Doctors consider the first day of the mother’s last period to the current date.

Usually, pregnancies last between 38 and 42 weeks. Data shows that twins are born earlier. Premature babies, as explained above, are those born before the start of 37 weeks of gestation. There are many factors that affect premature birth and health outcomes. With the newest advancements in medicine, though, outcomes are brighter.

11 The Six Areas Of Neuromuscular Assessment

There are different examinations to ensure a baby is healthy. All babies need careful examination and care. The popular Dubowitz/Ballard examination, for instance, is vital. According to stanfordchildrens.org, assessing a baby’s physical maturity includes skin textures, lanugo (the soft hair that covers the body), plantar creases (unusual wrinkles and other abonrmalities), chest, eyes and ears, and the private areas (in boys and girls).

Neuromuscular maturity, in particular, is another important assessment. It covers six areas: posture, square window, arm recoil, popliteal angle, scarf sign, and heel to ear. Although these terms sound way too medical, assessments basically tackle a baby’s flexibility and well-being.

10 Emotional Development, According To Psychologists

A child’s development is a mixture of physical and emotional changes. Emotional well-being is as important as physical health. Unfortunately, physical complications can result in cognitive, emotional, and behavioral issues later in life.

Even babies who spend up to months in NICUs can still bond with their parents. Psychologists reveal that parent talk is vital. Bonding is a learning process which happens over time. As long as mothers and fathers provide love and understanding, there’s no doubt their little one will become a loving individual.

9 Kangaroo Care For The Whole Family

The importance of kangaroo care or skin-to-skin contact is eminent. The history of this approach is heartbreaking: due to the many issues with preterm babies in Colombia, in the 1970s, doctors started to let mothers hold their little babies.

Placing a baby on their parent’s chest is magical. Skin-to-skin contact can improve health outcomes, sleep patterns, stress, heart rates, brain development, colic, and other conditions. Nevertheless, each NICU has their own regulations, so parents must respect their protocols. Don’t worry, though - the doctors and nurses there will let you know when it is okay to start skin-to-skin care.

8 Choosing Between Breastmilk and Special Formula

Although breastfeeding is important, breastfeeding is not a priority in NICUs. Mothers of premature babies may experience high levels of stress which can lead to milk reduction. On top of that, some premature babies are extremely premature, have breathing difficulties, and problems with their digestion system. According to tommys.org, if a premature baby is mature enough, doctors may decide to give breastmilk through a tube or let the mother breastfeed her baby.

Some premature babies need extra nutrients, so they might be given special formula. After all, formula is a wonderful alternative, which provides the vitamins and nutrients a baby needs.

7 Visits: The Dos and Don'ts

We all have heard of those stories in maternity wards. Most of us have even witnessed disrespectful attitude and gender bias. Well, professionals in maternity units face high levels of stress and irregular working hours. Nevertheless, one thing is for sure: NICU doctors and nurses cannot and do not neglect their patients; they put heart and soul into helping babies survive and families thrive. In fact, I’ve seen NICU doctors crying beside their patients. So, parents should not argue with staff - doctors and nurses are there to help.

Yet, be an expert on your baby, mama! Do not be shy to ask questions or get involved with diapering and feeding.

6 Common Problems and Treatments

There are many reasons why a baby might be transferred to a NICU. From high-risk pregnancies and diabetes to  premature birth and oxygen deprivation during labor, factors vary. Yet, there are some common problems parents need to be aware of: heart problems, retinopathy, hearing loss, and so on and on. Bronchopulmonary dyslpasia can lead to the worst case scenario, unfortunately, which was the case with my brave nephew.

Here, we should talk about problems that parents may face. NICU nurses are be too busy to explain all the mysterious tests and challenges your little might be dealing with. However, ask questions during your visits. As neonatologist Pursley said, "It provides [parents] an opportunity to ask why certain tests and treatments are being done."

5 NICU Practices Worldwide: Babies On Display

NICU practices vary, so do costs. In the US, for instance, healthcare is unbelievably expensive. Interestingly, NICUs didn’t appear in America until 1922.

According to nicuawareness.org, Pierre-Constant Budin was one of the pioneers in the care of premature babies. He introduced the method of feeding a baby through a tube. In France, his colleague Tarnier created an isolette – a wooden box with a glass lid to keep babies warm, which became the first incubator. Nevertheless, hospitals didn’t allow incubators in their facilities. So, it was Dr. Couney who started displaying babies in a sideshow at Coney Island. The admission fee supported the development and acceptance of incubators worldwide.

4 Stay Informed About Possible Issues

Being informed about possible risks and complications is crucial. As mentioned above, the obstetric gestational age is vital to determine how premature a baby is. Generally speaking, there are five groups: late preterm (34-36 weeks), moderately preterm (32 to 34 weeks), very preterm (26-32 weeks), and extremely preterm (less than 25 weeks).

Each baby is unique, though. While there are many factors that can affect the mother and the baby , nobody can predict outcomes. Nevertheless, mothers and fathers should stay positive and loving – with the newest advancements in medicine, things are really much more hopeful.

3 Managing Withdrawal In infants

It’s not a secret that addicted mothers face numerous challenges and prejudices. It’s a fact, though, that substances can pass through the placenta to the fetus and lead to  withdrawal in the baby. Neonatal abstinence syndrome is quite common. Symptoms vary and may last up to 10 days.

Even if a baby is born full-term, they might be admitted to NICU where doctors can monitor possible problems. IV fluids can help babies cope with dehydration, which is a common symptom. Note that meds can also be required to treat withdrawal symptoms.

2 Bilirubin: The Cause Of Jaundice

Testing for bilirubin is another common assessment which NICU nurses perform. Note that bilirubin is a yellow pigment which comes from the breakdown of red blood cells. High levels of bilirubin, though, can cause jaundice. Mild jaundice in newborns is a common condition. According to preganncybirthbaby.com, it happens in 60% of full-term babies and 80% of preemies. Newborn jaundice causes yellowing of the skin and the eyes.

Jaundice is treatable and disappears within 2-3 weeks. At the same time, high levels can indicate a problem. Therefore, testing for bilirubin is crucial.

1 The Power Of The Color Purple: Parents Also Need Support

Pregnancy and birth can be a lot to handle, so mothers need lots of support and rest. However, if their little one is accepted to NICU, things get more complicated, stressful, and upsetting. Doctors, nurses, babies, and parents form a powerful relationship in which each party needs support.

Doctors should understand that parents need emotional support to cope with their family tragedy. Psychologists need to battle the stigma that surrounds premature birth. Purple butterfly stickers in NICUs, on the other hand, can celebrate babies who are part of a multiple loss. In the end, World Prematurity Day, observed on November 17, can help families raise awareness.

You are not alone, mama!

Sources: Baby Center, Live Strong, Pregnancy Birth Baby, Radiology Information, Stanford Children, Very Well Family,

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