Common Neonatal Care Procedures

Neonatal Intensive Care Unit (NICU) care may include continuous monitoring, respiratory support, blood tests, vascular access, feeding support, medication, treatment for jaundice, and newborn resuscitation. The procedures used depend on the newborn’s gestational age, condition, medical history, and level of medical support needed. Some procedures are routine, while others are performed when a specific concern or change in condition occurs.

Assessment and monitoring

Neonatal assessment: A clinical evaluation of a newborn’s breathing, heart rate, temperature, color, movement, feeding, and other signs of health.
Vital signs monitoring: Ongoing or repeated measurement of temperature, heart rate, breathing rate, blood pressure, and oxygen saturation.
Cardiorespiratory monitoring: Continuous monitoring of heart rate, breathing, and heart rhythm, often with sensors attached to the newborn’s skin.
Pulse oximetry: A noninvasive measurement that estimates the oxygen level in the blood using a sensor placed on a hand or foot.
Blood pressure monitoring: Measuring blood pressure with a small cuff or, when needed, through an arterial catheter.
Blood gas analysis: Testing a blood sample to measure oxygen, carbon dioxide, and acid-base balance.
Heel stick: Using a small puncture on the heel to collect a capillary blood sample for testing.
Blood glucose testing: Measuring the amount of glucose in the blood to identify and manage low or high blood glucose levels.
Newborn screening: Testing a small blood sample for certain inherited, metabolic, endocrine, or other conditions that may not be apparent at birth.
Reassessment: Repeating an evaluation to determine whether the newborn’s symptoms, vital signs, laboratory results, or response to treatment have changed.

Temperature and supportive care

Incubator or isolette care: Providing a controlled, enclosed environment that helps maintain a newborn’s body temperature and supports safe care.
Radiant warmer care: Using an overhead heat source to help maintain body temperature while allowing healthcare professionals access to the newborn.
Skin-to-skin care: Holding a newborn directly against a parent’s bare chest, with appropriate monitoring, to support temperature regulation, bonding, and feeding.
Developmental care: Adjusting light, sound, handling, positioning, and caregiving to support a newborn’s development and comfort.
Pain assessment: Evaluating signs of pain or discomfort and using age-appropriate comfort measures or medication when indicated.

Vascular access and blood products

Peripheral intravenous (IV) access: Placing a small, flexible catheter into a vein to provide fluids, medication, nutrition, or blood products.
Peripherally inserted central catheter (PICC): Placing a long, flexible catheter into a vein and advancing it toward a larger central vein for longer-term medication, fluid, or nutrition support.
Umbilical venous catheter (UVC): Placing a catheter through an umbilical vein to provide fluids, medication, nutrition, or blood products.
Umbilical arterial catheter (UAC): Placing a catheter through an umbilical artery to obtain blood samples, monitor blood pressure, or provide selected treatments.
Blood sampling: Collecting blood through a heel stick, IV access, or catheter to evaluate blood counts, infection, glucose, electrolytes, organ function, or other concerns.
Blood transfusion: Giving red blood cells, platelets, plasma, or another blood component to treat blood loss or a blood-related condition.
Medication administration: Giving medication by a route such as IV, injection, mouth, or feeding tube according to the newborn’s condition and care plan.

Respiratory support procedures

Oxygen therapy: Providing supplemental oxygen through a nasal cannula, oxygen hood, CPAP system, or breathing machine when a newborn needs additional oxygen.
Nasal cannula: Delivering oxygen or breathing support through small, soft prongs placed at the entrance of the nose.
Continuous positive airway pressure (CPAP): Providing a steady flow of air, with or without extra oxygen, through nasal prongs or a mask to help keep the airways and lungs open while the newborn breathes.
Noninvasive ventilation: Providing breathing support through the nose or a mask without placing a breathing tube in the trachea.
Airway suctioning: Removing mucus, fluid, or other secretions from the mouth, nose, or breathing tube to help maintain a clear airway.
Intubation: Placing an endotracheal tube through the mouth or nose into the trachea to support the airway and breathing.
Mechanical ventilation: Using a machine to assist or control breathing through an endotracheal tube when a newborn cannot breathe adequately without support.
Surfactant administration: Giving surfactant medication into the lungs, usually through a breathing tube, to help keep the small air sacs open and improve breathing in selected newborns.
Extubation: Removing an endotracheal tube when a newborn can breathe safely with less support or another form of respiratory support.
Chest tube insertion: Placing a tube into the space around a lung to remove air or fluid and help the lung expand when clinically necessary.

Feeding and nutrition procedures

Feeding assessment: Evaluating a newborn’s ability to coordinate sucking, swallowing, and breathing safely during oral feeding.
Nasogastric (NG) tube placement: Passing a soft tube through the nose into the stomach to provide breast milk, formula, medication, or drainage.
Orogastric (OG) tube placement: Passing a soft tube through the mouth into the stomach for feeding, medication, or drainage.
Gavage feeding: Providing breast milk or formula through an NG or OG tube when a newborn cannot safely or adequately feed by mouth.
Oral feeding support: Assisting with breastfeeding or bottle-feeding while monitoring breathing, swallowing, fatigue, and feeding tolerance.
Parenteral nutrition: Providing nutrients, fluids, vitamins, minerals, and other required components directly into the bloodstream when feeding through the digestive system is not sufficient or appropriate.
Feeding-tube verification: Confirming that a feeding tube is in the correct position before using it, according to NICU policy and the care plan.
Weight and intake monitoring: Tracking weight, feeding amounts, urine output, and other measurements to evaluate growth, hydration, and nutritional needs.

Diagnostic and infection-related procedures

Blood culture: Collecting a blood sample and sending it to a laboratory to check for bacteria or fungi in the bloodstream.
Urine collection: Obtaining a urine sample for testing when a urinary infection or another condition is suspected.
Lumbar puncture: Inserting a needle into the lower back to collect cerebrospinal fluid for testing when clinically indicated.
Chest X-ray: Using an imaging test to evaluate the lungs, heart, breathing tube, feeding tube, or other structures in the chest.
Ultrasound: Using sound waves to create images of organs or tissues, such as the brain, heart, kidneys, or abdomen.
Retinopathy of prematurity (ROP) screening: An eye examination for eligible premature or medically vulnerable newborns to check for abnormal development of the blood vessels in the retina.
Antibiotic therapy: Giving medication to treat or prevent selected bacterial infections when prescribed by the neonatal care team.
Infection-control precautions: Using measures such as hand hygiene, protective equipment, or separation from other patients to reduce the spread of infection.

Treatment for jaundice and blood conditions

Phototherapy: Using special light to help break down bilirubin so the newborn’s body can remove it more effectively. The newborn’s eyes, temperature, feeding, hydration, and bilirubin levels are monitored during treatment.
Bilirubin testing: Measuring the bilirubin level in a blood sample or with a device placed on the skin to assess jaundice and guide treatment.
Exchange transfusion: Replacing some of a newborn’s blood with donor blood in severe cases of elevated bilirubin or certain blood-related conditions.
Electrolyte replacement: Giving fluids or medication to correct an imbalance of substances such as sodium, potassium, calcium, or other electrolytes.

Newborn resuscitation and emergency procedures

Neonatal resuscitation: Immediate care to support a newborn’s breathing, circulation, temperature, and transition after birth or during a life-threatening change in condition.
Positive-pressure ventilation: Providing breaths with a bag and mask or another device when a newborn is not breathing adequately.
Chest compressions: Delivering coordinated compressions to the chest during neonatal resuscitation when the heart rate remains critically low despite effective ventilation.
Umbilical cord access: Using the umbilical vessels for emergency or ongoing access to fluids, medication, blood sampling, or monitoring when appropriate.
Emergency medication administration: Giving time-sensitive medication during resuscitation or another serious change in condition according to neonatal protocols.

Care after a procedure and transition planning

Post-procedure monitoring: Observing a newborn after a procedure for changes in breathing, heart rate, temperature, blood pressure, pain, bleeding, or other signs of complications.
Comfort measures: Using developmentally appropriate approaches such as facilitated positioning, swaddling, nonnutritive sucking, skin-to-skin care, or prescribed medication to reduce stress and discomfort.
Family education: Teaching parents or caregivers about equipment, feeding, medications, warning signs, and care that may be needed after discharge.
Discharge readiness assessment: Evaluating whether a newborn meets the medical, feeding, temperature, breathing, and caregiver-education requirements for leaving the NICU.
Transfer: Moving a newborn to another unit, hospital, or specialized service for a different level of care or a specific treatment.
Follow-up: Additional medical evaluation after NICU care, such as appointments with a primary care professional, neonatologist, specialist, or developmental service.

The exact procedures performed in a NICU vary according to the newborn’s condition, gestational age, available services, and clinical judgment. The neonatal care team should explain the purpose, expected benefits, possible risks, and aftercare for a procedure whenever the situation allows.