COVID-19 has complicated the already daunting process of having a baby—simply walking into the hospital can be stressful. For parents of babies admitted to the neonatal intensive care unit (NICU) during a pandemic, the stress level can be off the charts. Going back and forth to the hospital for weeks, possibly months, is probably not how you imagined spending your first weeks after birth. You may be worried about virus exposure on top of all the usual stress and emotions of having a baby in the NICU. And the NICU itself may have additional rules about visitors to help keep everyone safe, which can seem like another layer of challenges.

As hard as this time is, especially for NICU mamas, as a neonatologist I want you to know that your NICU care providers are right there by your side, and we want to provide you and your baby with the best care possible.

Here’s what we want you to know about navigating the neonatal intensive care unit (NICU) during a pandemic:

1. Prepare for the NICU environment

You can expect to find the NICU quiet and dimly lit to decrease stimulation and stress for your baby. Your infant may be placed in an isolette (a small temperature-controlled enclosure) and connected to several wires that continuously track their temperature, heart and breathing rate, blood pressure and oxygen saturation.

Next to the isolette, you may find different types of machines assisting your baby to breathe. Hanging next to the baby’s bed may be pumps administering IV fluids, medications and/or feedings. All of these pumps and monitors may emit an alarm if they fall out of range. Try not to be frightened, as these alarms may go off when your baby is just fine. They serve to alert the caregiver on the status of your baby.

Don’t let the equipment and activity in the NICU keep you from interacting with your little one. Bonding is important for all newborns, and perhaps even more so for a premature baby. Check with your baby’s caregivers to decide how best to spend time with your baby. Ask about the possibility of “kangaroo care,” or holding your baby skin to skin.

Finally, know that most NICUs have restricted visitation. Many only allow parents, some only one at a time, and have limited visiting hours. You will want to make sure you’re clear about any rules or restrictions surrounding your visits.

2. Understand your baby’s nutritional needs & your options

Ask your NICU care provider about your baby’s feeding options and nutritional needs. You may be able to breastfeed your baby in the NICU, or your baby may be given your pumped breast milk (or donor breast milk or formula) as well as supplemental nutrition through a feeding tube—or both.

Breast milk is important for all babies, especially premature infants because it supports your baby’s developing immune system and helps protect against infections. Many NICUs make donor breast milk available if your supply is not ready or you’re unable to breastfeed, so be sure to inquire about this option.

Premature infants also have specific nutritional needs that breast milk alone can’t meet. Requiring up to 40% more calories and protein than a full-term baby, premature infants need to make up for the growth they missed in your womb. To provide the added calories and protein, NICUs often add a “human milk fortifier” to your breast milk or to pasteurized donor breast milk for premature babies born weighing 3.3 lbs (1500 g) or less.

There are two types of “human milk fortifiers” available in the NICU: cow milk–based and donor breast milk–based. As both are labeled “human milk fortifier,” be sure to ask which type your baby is receiving in the NICU. Cow milk–based fortifiers have been in use for many years, and they have been linked to an increased risk of complications. Meanwhile, donor breast milk-based fortifiers can help reduce the complications of prematurity, resulting in better health outcomes and shorter hospital stays in the NICU.

3. Ask for help when you need it—and delegate when you can

As a new parent, remember that you don’t have to do it all. Give another person (such as your partner or another family member) the responsibility of sharing updates about your baby’s progress with your friends and family. That way you can focus on being present with your baby.

You may also find the Peekaboo ICU app helpful. Peekaboo ICU supports parents through the NICU journey with a family-centered focus and approach to care.

Remember to take care of yourself too. Don’t feel guilty if you can’t stay with your baby every day or night in the NICU. Your good health and well-being will be important to care for your infant. You deserve time to heal and rest after birth, and your baby has the best possible medical care team taking care of them while you’re away.

4. Keep records & don’t be afraid to advocate for your baby

Record information about your baby, such as daily stats on growth (weight, head circumference, length), medications or treatments received, complications, names of medical staff and any questions you may have (you can use the Peekaboo ICU app to do this). Also, don’t forget to trust your instincts. If your baby seems agitated for reasons other than what you are used to or seems to be acting differently, tell your doctor or nurse about your observations.

5. Closely follow public health guidelines to protect yourself & your family

Expectant and new parents should follow the recommendations from their health care providers as well as the Centers for Disease Control and Prevention to prevent exposure to COVID-19. Wearing a mask whenever you are in a public space, practicing good hand washing and avoiding crowds are some of the most important things new parents can do—whether their newborn is in the NICU or not.

When the time arrives to take your baby home from the NICU, you’ll likely have many friends and relatives anxious to meet your precious new arrival. When deciding how, when, and who to allow for visits, be sure to ask your doctor for advice. It may be important to first determine with your doctor if the baby’s immune system is strong enough to consider some safe visits. Keeping interactions brief and/or outdoors with healthy visitors and ensuring lots of hand washing can limit exposure for both you and your infant. Be your baby’s advocate and ask any potential visitors whether they have been protecting themselves, have been exposed to anyone with COVID-19, or have any symptoms of illness (cough, fever, loss of smell, muscle aches, upset stomach). If they have not been following recommended guidelines for protection, or have any exposures or symptoms, kindly tell them they will have to wait to see the baby.

The NICU journey can be an incredibly stressful time. Take a deep breath. Take comfort in the fact that you are not alone, and that your baby has an entire care team doing everything in their power to keep you and your baby safe. Research tells us that most premature babies not only survive, but thrive. You will get through this!