NICU Admissions Guidebook

Please call this number for updates on your baby.

Only parents should call to get information about their baby. You will be given a card with a special PIN to use when you call. Please do not give this number to anyone else. Anyone with the PIN will have direct access to your baby’s medical information. Parents may call the
NICU anytime during the day or night to check on their baby. When you call for an update, we will ask you:

• Your name
• Your baby’s name
• Your baby’s PIN

Please try not to call the unit during shift changes. These happen daily from 7-7:30 a.m. and 7-7:30 p.m. During this time, we update the oncoming care team on your baby’s progress. Parents are welcome to be part of the handoff if present.

You can name up to four people who may come to the unit without you at the bedside. The four people you choose should be the same people the entire time your baby is in the NICU. Designated support people:

• May not bring others to the unit with them.
• Will not ask for or receive medical information about your baby.
• May not come to the unit if they are ill.
• May not participate in care of the baby unless given permission by parents.

Siblings are an important part of your baby’s family. Brothers and sisters are encouraged to come to the NICU so they can get to know the baby. Siblings should be fully vaccinated and free from symptoms of illness to come into the unit. Be aware that there are age-based protections during flu season, which will be posted on the unit if necessary.

A good guideline for time on the unit is five minutes for every year of the sibling’s age. For example, a one-year old will be on the unit for five minutes and a five-year-old will stay for 25 minutes. If your baby cannot handle the extra noise, your baby’s nurse may ask the brother or sister to come back at a different time.

Having another adult present can be helpful when younger siblings come to the unit. If needed, there are activities near the hospital where siblings can go with a family member or friend while parents care for their NICU baby The unit clerk or parent liaison can provide a list of these locations.

It is easy for babies in the NICU to get infections. One of the most important ways to reduce the spread of infections is careful handwashing. Wash your hands and arms with soap and water, hand sanitizer or the scrub sink:

• When entering the unit
• When entering your baby’s room
• Before touching your baby
• After touching your baby
• When leaving your baby’s room
• Any time your hands are dirty
• Follow hand-washing directions:
  • Remove all rings, watches and bracelets.
  • Put jewelry in a safe place. We suggest using the provided safety pins to pin jewelry to your clothing.
  • Push long sleeves to the elbow.
  • Place hands and arms into the washing unit. It starts and stops automatically.
  • Do not put sleeves back down.
• Clean your cell phone and drinks from outside the unit with the blue wipes provided.
• Coats can be hung in the closet in your baby’s room.
• Fingernails should be clean, short and polish-free. No fake nails or gel. These carry germs that could cause infection.
• Come clean and fragrance-free. For the health of your baby, our NICU is an odor-free area. Please do not wear scented body and laundry products when on the unit. If you smoke tobacco or marijuana (cannabis) in any form, do not smoke or vape before coming to the unit. Showering before coming to the hospital is helpful to maintain a clean, odor-free environment.

• When your baby was in the womb, they could hear muted sounds. The noise that your infant hears in the NICU is much louder. Too much noise may have harmful effects on their long-term development.
• Babies need quiet time to sleep, heal and grow. A good guide is to keep your voice at the level you would use in a library.
• It is important that your baby hears your voice. When your baby is awake, talk to your baby, tell a story, read a book or sing in a low, soft voice.
• You can help to lessen the sound levels in your baby’s room by:
  • Talking softly and reminding others to talk softly.
  • Opening and closing the incubator doors gently.
  • Not tapping on the top of the incubator.
  • Turning cell phones to vibrate or to low volume.
  • Keep your voice low when talking on your cell phone.

If you have any questions regarding noise and your baby, please ask the music therapist, occupational therapist or your baby’s nurse.

A gentle touch is needed for your baby’s growth and development. Hand hugging, encircled bed holding and kangaroo care are ways of touching your baby in a kind and caring way.

Kangaroo Care

The most beneficial type of touch for you and your baby is kangaroo care. You will hold your baby skin-to-skin on your chest while you are seated comfortably in the recliner. Kangaroo care can help your baby:

• Maintain body warmth.
• Regulate heart and breathing rates, which helps save energy.
• Gain weight.
• Spend more time in deep sleep, which encourages growth.
• Spend more time quiet and alert.
• Have a better chance of successful breastfeeding and can improve the mother’s milk production.
• Have fewer episodes of apnea (pauses in breathing) and better oxygen levels.

Some parents are nervous about trying kangaroo care because their baby seems too fragile or sick to hold. Your baby knows your scent, touch, voice and breathing. They will enjoy feeling close to you and the benefits will help both you and your baby.

• Plan to hold your baby for at least an hour.
• Make sure you have eaten prior to holding.
• Go to the bathroom.
• Bring a covered and cleaned drink with you.
• Have a large, button-up or easily accessible shirt.
• Your nurse will help you get settled to hold your baby.

Hand Hugging

Gently cup your hands around the baby with one hand on the head and one hand containing their legs and/or arms. This is often helpful to the baby during care time as it helps the baby stay calm. Use a firm touch rather than a light touch. Try not to rub or pat the baby.

Encircled Bed Holding

Your nurse will raise the top of the incubator and lower the side door so that you can lean and encircle your baby with your arms. Make sure your skin can touch your baby’s skin for the most benefit.

Holding

As your baby gets bigger and moves into a crib, holding them while they’re dressed and swaddled is also beneficial. You and your nurse can decide together the best way for you to provide a loving touch to your baby. Even the smallest of infants benefit from touch in these ways:

• Improves bonding between you and your baby
• Decreases stress for both of you
• Helps reduce pain
• Improves your baby’s sleep quality
• Supports brain development
• May shorten your baby’s stay in the NICU

FICare is a model of care in the NICU that makes families part of the care team where they are the primary caregivers for their baby. FICare provides a structure that supports family-centered care. The parents provide care, share insights into how the baby is doing and discuss with doctors and nurses how best to care for the baby. It gives doctors and nurses a different perspective in how to care for babies and families.

Benefits of FICare include:

• Babies gain weight more effectively
• Yields higher success rates of breastfeeding
• Lowers parent stress and anxiety
• Helps give a sense of control and competence among parents
• Promotes stronger bonding between parents and their baby
• Can decrease infection rates on the unit and increase patient safety

There are many professionals who are involved in your baby’s care. They work together to give your baby the best care possible. All employees who work in Bronson Children’s Hospital have their name and picture, along with dancing children on their badges.

Most employees, including volunteers, wear specific uniforms to help identify their role. Below is a list of caregiver roles and the color uniform they wear:

• Registered nurses (RNs) wear either white or green tops and pants, unless they are wearing blue scrubs. RNs can also wear green or
  white scrub jackets. In the NICU, they can also wear child-friendly print tops.
• The transport nurses, charge nurses, occupational and respiratory therapists, phlebotomists, surgical personnel and X-ray technicians wear navy blue.
• Patient care assistants wear teal green. In the NICU, they can also wear child-friendly print tops. 
• Environmental services (housekeeping) wear maroon.

Our doctors and nurse practitioners see each baby at least once a day. They will talk with parents about the care plan, either in person at the bedside or via a phone call. Know that even when the doctors are not in the room, the nurses are monitoring your baby at the nurse’s
station and working with the doctors to provide the best care for your baby. If you have questions or are ever concerned about your baby, please ask.

At some point, your baby may move from the intensive care unit on the fourth floor to the step-down unit. The step-down unit is on the third floor. Every baby’s healthcare journey is unique, so this happens at different times for each family. This means your baby is improving. Usually your baby:

• No longer has an IV or is getting a small amount of fluid through their IV
• Needs little respiratory support
• Is at least 32 weeks

The step-down unit focuses on helping babies learn to eat and to support their growth. Some things to consider include: 

• The care times for your baby are longer. A care time can take anywhere from 20-45 minutes because a baby can sometimes practice feeding for 20-30 minutes.
• Sometimes it takes babies a long time to figure out feeding. Also, they could do very well one day, but be tired the next and not do as well. Try your best to be patient.
• The step-down unit has the same doctors and nurse practitioners as the intensive care unit. Some nurses float to all areas so parents will see familiar faces no matter where they are.

We will do our best to inform you before your baby is moved. If it happens quickly or in the middle of the night, we may not have a chance to talk before your baby moves.

It’s important to make your baby’s room feel special. Some suggested ways to personalize your baby’s room are:

• Bring in your own sheets or blankets for your baby’s bed.
• Display ornaments, books and framed pictures on the parent shelf.
• Place a limited number of stuffed animals on the parent shelf.
• Display milestones in the designated area.

For the safety and well-being of all the babies in the NICU, we are not able to:

• Hang decorations on the walls, cupboards or door frames.
• Hang decorations using tape.
• Display stuffed animals on shelves above the pumping supplies.
• Have fresh plants or flowers.
• Have flashing or blinking lights (all lights must be battery-powered).

Free wireless access to the internet is available in most areas by connecting to the hotspot called Bronson.

To protect and improve the healthcare environment for our patients, family members, employees, physicians, volunteers and guests, Bronson is a smoke- and tobacco-free campus. This includes all patient rooms, buildings, grounds, parking lots and parking ramps.
All use of tobacco products, including cigars, cigarettes, pipe smoking, smokeless tobacco (chewing tobacco), electronic cigarettes, or
vaping devices and marijuana, is prohibited on all Bronson properties. Patients may not leave the unit to smoke.

As a role model to the community, our smoke- and tobacco-free setting sends a positive message about healthy choices. Family, friends and guests must leave the hospital campus to smoke. Bronson has resources to help you quit. If interested, please talk to your nurse.

Your baby is small, but they have a lot to say. Here are some ways your baby may tell you what they need.

Your baby is happy when:

• They have their eyes open and are alert.
• They are relaxed. Watch their face, arms and legs for this cue.
• They try to smile.
• They have their hands together or up by their face.

Your baby may be over-stimulated when you see them:

• Spread their fingers apart.
• Put their hand in front of their face or look away.
• Frown, grimace or grunt.
• Yawn, sneeze or hiccup.
• Arch their back or push away.

How to help your baby:

• Talk to your baby before touching them.
• Offer hand hugs when doing care.
• Move your baby slowly.
• Let your baby sleep.
• Try to contain your baby’s arms and legs when holding or moving them.
• Have a low-stimulation environment.
  • Keep the lights in the room very low.
  • Keep the room very quiet – no TV or radio, keep your phone ringer on vibrate.
  • Talk in a quiet voice to your baby and to others in the room.

An important part of the day for both parents and baby is care time. Your baby’s care times are clustered together so the baby can rest in between. These care times are a great opportunity for parents to ask questions and learn more about ways you can care for your baby, including diaper changes, temperature checks and feedings.

As a caregiver, it is important to understand what is happening with your baby. This will help you become an advocate for your baby. This may be new information and you will have questions. The NICU staff is here to help. Here are some things to think about when learning
about your baby’s care:

• You are an important part of your baby’s care team. The NICU staff provides highly specialized care for the babies. As parents, you are the most important people in your baby’s world. There are several things you can do to provide care for your baby. Being at the
  bedside and learning all you can about your baby’s care will help you become more confident in caring for your baby. It will also help your baby to grow and go home as soon as possible.
• Ask questions. Ask as many questions as needed until you understand your baby’s care. It is helpful to write your questions down as you think of them. There are journals available for every family that can be used for this. If there is a medical condition, word or abbreviation that you don’t know, keep asking questions until you understand. One way to make sure you understand what you heard is to repeat the information back to the staff member. This could prevent a misunderstanding.
• Be patient. our baby’s needs change. As they grow, their care plan will change. Sometimes things get better slowly. Sometimes things might get worse before they get better. The medical team is doing everything possible to help your baby improve and that takes time. During your baby’s NICU journey, look for support from the people around you. Family, friends, the NICU staff and other NICU families can help you through this journey.
• Ask for help. Don’t be afraid to ask for help from your support system at home or here in the hospital. The NICU staff want the best possible outcome for you and your baby. If you need help, please ask.

Bronson MyChart is a free and secure tool that gives you access to view parts of your child’s medical record from your computer or mobile phone. There are several ways that you can sign up for Bronson MyChart: 

• Use the activation code you receive at discharge.
• Use the Request Activation Code link on the MyChart login page at https://mychart.bronsonhealth.com.
• Call Bronson HealthAnswers at (269) 341-7723. Just ask for an activation code and they will provide you with one. Once you get the code, you can set up your account at bronsonhealth.com/mychart.

When babies are less than 32 weeks, they should have their beds covered at all times to protect their eyes and their sleep. This gives your baby a lot of rest time for growing. If you are holding your baby, the lights in the room should be dimmed. After 32 weeks, we begin day and night patterns. During the day, the lights are on. At night lights are off or dimmed. This helps the babies get used to the day and night pattern they need for sleep and growth. This will also help you when you take your baby home.

Oral care is any experience around the baby’s mouth. In the NICU, parents can offer good oral experiences for their baby to help them work toward feeding. Good oral experiences include:

• Oral swabs
• Milk drops on the pacifier
• Breastfeeding
• Bottle feeding

Milk drops can be small drips of what your baby gets for food. If your baby is born less than 32 weeks, you will start by giving swabs of milk. Once your baby can tolerate an active suck on the pacifier, you may offer dips of milk on the pacifier instead of the swab. You can offer drops of milk on your clean finger as well. Milk drops are a good oral experience for your baby. It will help your baby learn how to safely suck, swallow and breathe with tiny tastes of milk. The staff can help you determine which type of oral experience is best for your baby.

Breast milk can begin a lifetime of good health. Providing your breast milk is one important thing that only you can do for your baby.  Research shows that there are advantages to feeding breast milk to preterm and sick infants: 

• Breast milk is the healthiest choice for your baby’s growth and development.
• A premature baby’s immature digestive system can more easily use the nutrients in breast milk. Breast milk helps the baby’s digestive system mature.
• Human milk contains special cells that help protect your baby against infections.
• The milk of preterm mothers is not the same as milk from mothers who experience a full-term pregnancy. Preterm breast milk has a higher amount of protein and other nutrients.
• Breast milk contains special fats that help your baby’s brain to grow and develop.
• Breast milk contains endorphins (feeding chemicals) that stop pain.

• A nurse can help you start pumping with a hospital-grade electric breast pump. For the best results, begin pumping as soon as possible after birth, ideally within the first six hours.
• Pump your breasts at the same time for 15 to 20 minutes per session. Try to pump at least eight times in 24 hours.
• Save any milk in syringes or bottles. Label it with the patient's name and the date and time it was pumped. Store the milk refrigerated and transport the milk in a cooler with ice packs. Refrigerated milk should be moved to the freezer 48 hours after it is pumped.
• Clean equipment is crucial to give your baby a safe supply of your milk. Wash your pump parts in hot, soapy water and let them air dry between pumping sessions. Sterilize your parts once a day.
• The lactation consultants from the Bronson Breastfeeding Center can help you. They are board-certified in breastfeeding practices. They provide education, advice and personal consulting. Call (269) 341-8849 to learn more.

Most of the milk you pump and bring to the NICU will be stored in our nutrition room, where staff refrigerate or freeze it. The oldest milk is used first to ensure freshness. In some cases, your baby may need extra calories, protein, vitamins and minerals added to your breast milk to support their growth—a process called fortification. If needed, your baby’s doctor will recommend this.

We encourage one feeding per day with your freshly pumped breast milk. This means you will pump at the bedside, and the nurse will use that fresh milk for your baby’s next feeding. There are benefits of fresh milk that has never been refrigerated or frozen. Giving one feeding per day without the fortification will not affect your baby’s growth.

There are a couple of steps to make this happen:

• Call your baby’s nurse in the morning. Let them know if you plan to come in and pump at the bedside that day. The nurse will then let our nutrition room staff know to prepare one less feed for that day.
• If you plan to come in for care and pump at the bedside every day, then you will only need to call in the morning if you cannot make it in that day. Then the nutrition room will prepare all your baby’s feedings for that day. We know that life gets busy and sometimes prevents you from coming to the NICU as often as you wish. It is also tough to build a normal milk supply by only pumping. Pumping for weeks on end is a lot of work. Please know that whatever you can do, for however long, is a wonderful gift to your baby!

• Pump at your baby’s bedside.
• Skin-to-skin contact has been shown to increase milk supply. Talk with your baby’s nurse to arrange a time for skin-to-skin contact.
• Pump as often as your baby feeds, usually every two to three hours.
• When you are not with your baby, look at pictures or videos of your baby or the camera on the unit showing your baby while you pump.
• If you are trying to make more milk, add an extra pumping session in the early morning.
• Drink plenty of fluids and try to eat a balanced diet. It is recommended to add about 500 calories to your normal daily intake when you are pumping.

Breastfeeding is often challenging for moms with healthy, term babies. When your baby is in the NICU, this creates additional challenges and stress that can make it hard to keep up with pumping and breastfeeding. The NICU nurses and lactation consultants are here to help you.

Give yourself grace. Each baby and mom are different. If breastfeeding doesn’t work for you, you haven’t done anything wrong. Some moms don’t produce a lot of breast milk no matter how frequently they pump, and sometimes pumping and breastfeeding can cause too much stress. Your well-being is important. If you feel that pumping and feeding are wearing you down, talk with the nurses or doctors about supplementing with formula or donor breast milk.

Each baby has a different story and learns at their own pace. When babies are sick or need support to help them breathe, it’s not safe for them to eat by mouth. Many preterm babies are ready to start oral feeding around 33 to 34 weeks of gestation if they do not require respiratory support. Whether you choose to breastfeed or bottle feed, both will help your baby grow. The nurses and occupational therapists will help you look for signs that your baby is ready to be bottle-fed or breastfed. Signs include:

• Baby wakes on their own before care time.
• Baby stays awake during care time.
• Baby can suck on a pacifier for 5-10 minutes.
• Baby shows they are hungry by bringing their hands to their face and opening their mouth for the pacifier.
• Baby has a respiratory rate of less than 70 breaths per minute.

Your nurse and lactation consultant can help you with breastfeeding.

How can I help my baby learn to eat?

• Your baby can use the pacifier to practice sucking. They can do this even before they are old enough to start eating from the breast or bottle.
• Your baby can use the pacifier while getting tube feedings.
• Ask your baby’s nurse to show you the signs that your baby is ready to eat.
• Your baby should suck for no more than 20–25 minutes at a feeding to save energy for the next feeding.

How long will it take for my baby to eat well enough to go home?

• A baby born early needs a lot of time to learn how to suck, swallow and breathe.
• Every baby is different. Some babies take several weeks and may be close to term before they eat well enough to be able to go home.
• Some babies with breathing or stomach problems take longer to learn how to eat.

Why is it so hard for my baby to eat?

• Your baby’s muscles are weaker.
• Your baby needs extra sleep and may tire quickly.
• Your baby needs time to learn to coordinate swallowing and breathing.
• Your baby needs a lot of energy to eat.

Why isn’t my baby eating as well as yesterday?

• Your baby may not have enough energy to eat well every day.
• Infection or illness can also affect how much your baby can eat.
• A busy day with family interactions or procedures makes your baby tired.
• Being out of the incubator takes more energy and may affect eating.

Why don’t we try to feed my baby at every feeding time?

• Some babies don’t have enough energy to eat every feeding in the beginning.
• Your baby may need more rest breaks if they have breathing problems.

• Fourth floor: Bathrooms are located near the family kitchen by the elevators and greeter’s desk.
• Third floor: Bathrooms are located just past the elevators.

To keep infection rates down, food is not allowed at the bedside. You can find designated areas for eating within the hospital, including:

• Terrace Café (North Campus) – Located on the first floor of the North Pavilion, the café serves specialty coffees, muffins, desserts, sandwiches, salads and other light fare. It is open 24 hours/day, seven days/week.
• SkyCourt Café (South Campus) – Located on the Garden Level of the Medical Office Pavilion, the café is open 24 hours/day, seven days/week and serves freshly prepared, hot entrees during the following times:
  • Breakfast 7 a.m. – 10:30 a.m.
  • Lunch: 11 a.m. – 2:30 p.m.
  • Dinner 5–7 p.m.
  • Late night: 10 p.m. – 3 a.m.
• Water Street Coffee Joint (South Campus) – Located on the Garden Level next to the SkyCourt Café, it serves specialty coffees and food. Hours are 6:30 a.m. to 5:30 p.m. daily.

• Fourth floor: Water and ice are in the NICU Family Kitchen by the elevators and the greeter’s desk.
• Third floor: Water and ice are in the step-down unit near the hand-washing station.

A mini kitchen is available on the ground floor with a refrigerator and freezer, microwave, washer and dryer. NICU staff can show you where this area is located.

Our most comfortable overnight option for family members of patients is the Hospital Hospitality House. It is located close to Bronson and provides lodging for out-of-town families of our patients. It is also open to parents and families who are not overnight guests, but who wish to use its shower or kitchen. Ask your nurse or the social worker for more information. There is no charge to stay at Hospital  Hospitality House. Donations are welcome.

The Bronson Breastfeeding Center is located in the North Pavilion. Lactation consultants are available by appointment only. Call (269) 341-8849 for more information. 

The North Campus Gift Shop specializes in new mother and baby items. It is located on the first floor of the North Pavilion. Hours are Monday through Friday, 9 a.m. - 3:30 p.m. 

There is a private Facebook group for Bronson NICU families and staff. Connect with other families who have had babies in the NICU and keep in touch with the staff who have cared for your baby.