In the NICU - step-down care
Most babies leave the neonatal intensive care unit (NICU) and grow into normal, healthy children. Some leave the NICU with temporary or chronic medical conditions that may require special attention from their parents or care givers.
When a NICU baby is better and stronger, he will graduate from the NICU. That means he is:
• Probably breathing on his own
• Possibly starting to feed from the breast or bottle
• Gaining weight
• Getting stronger
This little guy is almost ready to go home—but not quite. He is now ready to move to the “step-down” or intermediate-care nursery for some additional recovery time. The step-down nursery may be in the same hospital as the NICU, although not every NICU has one. Sometimes babies are transferred to a community hospital closer to home. That process is often referred to as back-transport. The baby’s doctors will discuss any transfer plans with his parents in advance. If they and the baby’s doctors decide this is right for him, the baby probably will be moved in an ambulance. It may take a few days for the baby to adjust to a transfer.
Although parents are happy their baby is getting better, they may be more than a little nervous about leaving the familiar staff and routines of the NICU. A visit to the step-down nursery before their baby is moved may help ease their concerns. The step-down nursery will get parents to become more directly involved with their baby’s care, while still having staff expertise readily available when needed. It can be a very reassuring experience.
The step-down nursery is usually quieter and a lot calmer than the NICU. There are fewer machines because these babies no longer require the type of intensive care the NICU provides. Babies need fewer tests now. But they still need a lot of care and rest to continue to grow and recover. The transition made in the step-down unit is a rehearsal of sorts. It brings a family to the point of being ready to go home.
Tags: Baby, hospital care, neonatal intensive care unit, newborn, NICU, premature baby, step-down care
August 26th, 2010 at 11:09 am
My daughter spent four months in the NICU and even though there was a “step-down” nursery in the hospital doctors felt that she was strong enough to come home even though her condition of liver failure is not at 100% well, but my daughter is eating, gaining weight, growing and most important breathing on her own. I can never repay the entire staff for all they did for my 27wks baby. God Bless them ALL.
August 26th, 2010 at 11:17 am
Arleth, thanks for your comment. I’m SO glad to hear that your daughter is doing well. I agree that the staff in the NICU are amazing people.
August 26th, 2010 at 11:31 am
My little boy is still in the NICU 3 months 2 weeks 1 day after he was born, our original due date was August 2, 2010. He got very sick & put us back for a few more months. His doctors & nurses are amazing. I couldnt have asked for a better staff, just wish it wasnt 1400 miles from home. We’re in the talks of having him transfered to a hospital close to home once he is better. Thank you for this wonderful information!
August 26th, 2010 at 12:21 pm
My daughter Grace, spent 3 1/2 months in the NICU, but she was transfered after 16 days to our local hospital’s NICU. So, she just went from one NICU to the other. However, the local hospital’s NICU was more private, Grace had her very own room, it was more quiet, and I was allowed to spend the night. There was much more interaction with her medical staff, and we made lasting relationships in those 3 months. She did contract a virus while staying there, and it turned into viral meningitis, almost taking her life multiple times in a two week period, and causing a “stroke” in the right hemisphere of her brain. She now has mild Cerebral Paulsey. (sp) I’m not sure if this would have happened had she stayed in the NICU at OHSU in Portland, but there were other aspects of her care at our local hospital that were excellent and she wouldn’t have gotten had she stayed in the big NICU. It was hard enough not being able to take my baby home with me for over three months, pumping all the time and not being able to nurse her, having PTSD and PPD, and dealing with all of her and my health issues at our local hospital; I don’t know if we would have made it had she stayed at the big, cold, impersonal NICU. Even though she has lasting effects from contracting CMV at our local NICU, I will still be forever grateful that she was transfered there and that we got to meet all the excellent people who cared for us there.
August 26th, 2010 at 12:25 pm
My daughter, Addisyn, was born at 26 weeks 2 days gestation, and was an identical twin with TTTS, and was the smaller of the two at 2 lbs. Her sister passed away at 8 days of age. Even though she was small, she progressed well to the point that they moved her to Satellite, and then to a less acute care hospital, which was closer to home. Addisyn was in the hospital for a total of 81 days. NICU staff at both hospitals were amazing and very helpful to our needs and concerns. Our daughter is now 4 months, 1 week & 3 days old, over 10 lbs and doing very well.
August 26th, 2010 at 12:40 pm
Jennifer, I can only imagne how hard it is for you to be so far from home. But it is great to know that your son is receiving excellent care where he is. That’s what is most important. Hopefully it won’t be too long before he is strong enough to step-down to a closer hospital where you will have family and friends around you. You’ll be able to get him started with his pediatrician and introduce a routine to your lives. Glad you found this post helpful.
August 26th, 2010 at 12:50 pm
Shannon and Leslie, it sounds like your girls received excellent care despite many difficult challenges. Having them close to home can be such a relief. It often makes it possible for you to spend extra time with your baby, something that benefits you both.
August 26th, 2010 at 7:09 pm
My nephew was born with Gastroschisis, a condition where the stomach has a hole and his intestines were on the outside of his body. His survival rate was very low. Immediatley after he was born (via C-section) at 26 weeks, he went into his first of several surgeries. The NICU at Rockford Memorial Hospital in Rockford, IL was absolutley wonderful!! Prayer helped and the comfort of knowing he was being taken care of. He came home around Thanksgiving. We celebrated his 6th birthday last Sunday. Although he will always be small -and has about a 10 inch scar down his stomach - he is healthy and no one would ever know how much of a fight he had to put up!!
August 26th, 2010 at 8:16 pm
My daughter was 28 weeks preemie - she spent a total of 8 weeks in the NICU; 6 in the NICU, 2 in the CCU. I remember feeling really unsure what the rules were (visiting hours, procedures, etc), but also being really excited about how much more we could do with her (dress her, try to nurse, etc). She is now almost 4 years old, with mild cerebral palsy.
August 26th, 2010 at 8:26 pm
My daughter was in the hospital 3.5 months. She was transferred to 3 different hospitals and I live in a big city with great hospitals.
When she made it to her permanent hospital she was in a critical care section, then the regular NICU and then the step down nursery. I also roomed in with her for 48 hours before taking her home.
September 10th, 2010 at 12:53 am
My son Mario was born at 27 weeks and 4 days. The hospital i delivered at was not adequate to accomadate his needs so he was helicopter lifted to UCSF a few hours after birth, my heart was broken when he was literally ripped out of me and i knew nothing about his condition or what was going on. I suffered a placenta abruption and had no idea whether he was going to make it or not. For the first 2 days of his life he was on the C-PAP and then was moved down to the nasal canulla. He had such a rough start and the ICN at UCSF was beyond amazing. Having such helpful nurses and doctors who are comforting are a MUST in times like these. I am a 20 year old mom who just had no idea that things like these go on all the time. I met so many families while at ucsf. Mario was in the NICU the entire stay but he did go to the east wing afer about 3 weeks of being at the hospital. This wing was considered the “step down” wing. We stayed at the hospital for 8 weeks and took him home at 35 weeks gestation. We were lucky enough to stay at the Ronald McDonald house in San Francisco and just so blessed by all the help w recieved from complete strangers. Now mario has been home for 2 months and he is just truly a blessing that i couldn’t be any more thankful for
September 10th, 2010 at 9:49 am
Amanda, I’m so glad to hear that Mario is home and doing well.