The Secret Language Of NICU Nurses, Translated For Parents
The neonatal intensive care unit (NICU) in any hospital is full of beeping machines, specialized medical professionals, and tiny babies that need a lot of extra care. To anyone on the outside, it can seem as though there's a secret language only NICU nurses know. Though they may be confusing to parents, these terms help the nursing staff effectively communicate about their patients in order to provide the best possible care.
Oftentimes, this secret language is overwhelming to parents whose baby is newly admitted to the NICU, but it's not meant to shut the family out. In fact, Lisa Osborne, RN, tells Romper that many of the terms are used "among fellow nurses, as well as with our parents, care givers, and patient siblings." However, parents of babies in the NICU are often in a sensitive emotional state, so the medical staff tries their best to be sensitive to that fact and show compassion by not translating everything right away. "We believe in family-centered care and in that vein we provide parents/caregivers with as much information as the family is ready to hear," Sharone Halperin, RN, tells Romper. How long a baby has been in the NICU and the severity of their condition can influence how much info is translated for families.
Once families are ready to start taking in information, the nursing staff will generally begin to explain the common code words and their meanings. "Information is power and health care providers should help empower parents during what could be a high stress time; one in which they may feel lost and not know how to provide care for their newborn baby," Halperin says. Some of the terms are unique to the baby's time in the NICU, while others will be applicable once the baby is home. Here are a few common phrases experts say parents will likely pick up on during their baby's stay.
1. A's, B's, and D's
There are a number of reasons a baby may be admitted into the NICU but no matter what, the medical staff will monitor for A's, B's, and D's. Halperin says this stands for "Apneas (short pauses in normal breathing pattern, Brady or Bradycardiac episodes (slowing of the heart rate), and Desats or desaturations (decrease of the percent of oxygen in the blood)." Typically, parents can also watch for these episodes using a screen that's connected to pads and wires on their baby.
2. Events or Spells
NICU babies are always hooked up to monitors that will alert staff of A's, B's, and D's so they can jump into action if there's a problem. Halperin says the staff will refer to these problems as "events or spells." Oftentimes, one of the requirements for a NICU discharge is going a certain amount of time without any events or spells.
3. Heel Stick
In addition to normal newborn screenings, NICU babies will often also go through a number of additional tests during their stay. Many times, these tests require patient blood which Halperin says is referred to as a "heel stick." Essentially, in order to get the blood the medical staff will make a "small puncture on baby's heel."
4. Kangaroo Care
When any woman gives birth to a baby, doctors encourage as much immediate skin-to-skin time as possible. For NICU babies, however, they're often whisked away to the unit before mom can hold them. This skin-to-skin time is still very important so once the baby is stable, NICU parents are often encouraged to practice "kangaroo care."
Dr. Osborne explains that "'kangaroo care' describes placing the NICU baby in direct contact with the skin of a loved one. This engages the baby with a loved one and encourages early bonding and attachment." This is especially important because a study in the medical publication Acta Paediatrica found that parents of NICU babies struggled to bond with their babies more than parents of full-term healthy babies and that "lack of physical contact between the mother and infant after birth is associated with later emotional problems in preterm infants."
Every infant goes through a newborn screening to ensure there are no underlying medical problems that couldn't be found on an ultrasound or immediately after birth. Halperin explains in the NICU they often refer to one of the tests as a "PKU" because "one of the conditions is called Phenylketonuria or PKU."
As explained by the University of Michigan, the Phenylketonuria test "is done to check whether a newborn baby has the enzyme needed to use phenylalanine in his or her body" which is necessary "for normal growth and development." If the test reveals that the baby does not have the enzyme, "the phenylalanine level builds up in the baby's blood and can cause brain damage, seizures, and intellectual disability."
Another "slang" term Halperin says NICU nurses often use is "CCHD" which refers to another newborn screening which tests for "critical congenital heart disease." About 200 out of every 100,000 babies born every year are found to have CCHD, according to the Maternal and Child Health Bureau of the Health and Resources and Services Administration. The best chance of survival for these infants is to get started with treatment right away, which may include surgery, depending on the severity of the condition.
7. Priming The Gut
When NICU nurses use the term "priming the gut" it's "a slang phrase used to describe the slow starting of feeds to get the digestive system ready to start functioning fully (also termed trophic feeds)," explains Halperin. A study published in the Italian Journal of Pediatrics found that babies who were born very early or at a very low birth weight pose "a unique challenge due to the immaturity of gastrointestinal tract." By doing this, babies in the NICU have shown "improved feeding tolerance, better weight gain, improved bone mineralization, reduced systemic sepsis, and shorter hospital stay."
The most important thing for NICU parents to remember is that their baby's medical team wants their patient to thrive and grow into happy, healthy kids just as much as they do. Dr. Osborne and Halperin both say an open line of communication with the family is important for the baby's care. The "secret language" may be confusing, but all parents need to do is ask for a translation and the nurses will be happy to give it to them.
R. Flacking, L. Lehtonen, G. Thomson, A. Axelin, S. Ahlqvist, V. Hall Moran, U. Ewald, F. Dykes, "Closeness and separation in neonatal intensive care," Acta Paediatrica, October 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468719/
E. Civardi, F. Garofoli, C. Tzialla, M. Pozzi, M. Stronati, "Trophic feeding for very pre term or very low birth weight infants," Italian Journal of Pediatrics, 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4595378/#!po=37.5000
Sharone Halperin, RN, MSN, CNL, Unit Based Education Coordinator at Montefiore’s Weiler Hospital NICU
Lisa Osborne, DNP, MSNA, CRNA, RN