Caring for Sick Neonates

Neonates who are ill or preterm are often separated from their families to receive medical care in a special care nursery or neonatal intensive care unit. This separation is often challenging for parents emotionally, logistically, and sometimes physically (eg, breast engorgement) because they may not be able to see a critically ill or preterm infant during stabilization and may be separated from the infant for more prolonged periods because of transport to a different unit or hospital or because the infant requires subsequent procedures.

Although many infants do need to be cared for in an intensive care unit, once they are stabilized, they usually do not need to remain separate from their families. Almost no infant, even one on a ventilator, is too ill for the parents to see and touch. Evidence supports not only permitting but encouraging contact between infants and their family; direct skin-to-skin contact (sometimes called "kangaroo care") has benefits for survival, physiologic stability, weight gain, and neurodevelopment (1–6).

Experts recommend that neonatal transport teams encourage physical contact between parents and their sick infant before moving the infant to a specialty care center as long as the contact does not put the infant at risk of infection. In most hospitals, parents are encouraged to interact with their sick infant as much as possible, while appropriate precautions are taken to minimize risk of transmission of infection to the infant and the infant is monitored closely for cardiorespiratory stability while being visited and held. Infants may be able to be breastfed or milk can be expressed and given through a feeding tube. Many hospitals have unlimited visiting hours for parents, and some have areas in which parents can stay for prolonged periods to be near their infant. Parents are also encouraged to provide direct care for their infant as a way to get to know their infant and to prepare for taking their infant home.

When an infant has a congenital anomaly, the parents should see the infant as soon after birth as possible, regardless of medical status. Otherwise, they may imagine the appearance and severity of illness to be much worse than the reality. Intensive parental support from pediatricians and social workers or other mental health clinicians is essential. Parents should be provided with as many counseling sessions as are needed for parents to understand their infant’s condition and the recommended treatment, to manage the emotional stress and uncertainty associated with having a child with a congenital anomaly, and to prepare to care for their child after discharge from the hospital. To balance discussion of a child's abnormalities, the physician should emphasize what is normal about the infant and the infant’s potential regarding quality of life. Contact with families who have a child with a similar condition or support groups also may be helpful.

When neonates die without having been seen or touched by their parents, the parents may later feel as though they never really had a child. Parents who have experienced the death of a neonate have reported exaggerated feelings of emptiness and may develop prolonged depression because they could not mourn the loss of a “real” child (7, 8). In general, all parents, whether they have or have not been able to see or hold their infant while alive, including after stillbirth, will usually be helped in the long term if allowed to do so after the infant has died. In all cases of neonatal death, follow-up visits with the physician and a social worker are helpful to review the circumstances of the infant’s death, answer questions that often arise later, and assess and alleviate feelings of guilt. The physician can also evaluate the parents’ grieving process and provide appropriate guidance or a referral for more extensive support if necessary.