Cedars-Sinai Blog

Demystifying the NICU

Kurlen Payton, MD, interim director of the Ahmanson Pediatric Center's Neonatal Intensive Care Unit

No parent wants to hear that their newborn needs to be in the Neonatal Intensive Care Unit (NICU). It's often the most stressful period of their lives, so taking care of a newborn means taking care of their families, too.

With clear communication, expertise and compassion, Dr. Kurlen Payton, interim director of the Ahmanson Pediatric Center's Neonatal Intensive Care Unit, helps put parents at ease while making sure their little ones are getting the best care available. We asked him to demystify the NICU for us, too. Check out his answers below.

"Our NICU social workers are truly experts in anticipating needs and supporting families."

What's the most common misconception about the NICU?

Dr. Kurlen Payton: That it's a place where bad things happen. While it's frightening to learn that your newborn needs intensive care, the vast majority of families leave the NICU with a healthy infant after overcoming the fears and challenges of having a sick newborn. There is a unique joy in seeing parents take their healthy baby home after a NICU stay.

Headshot for Kurlen Payton, MD

Kurlen Payton, MD

Peds - Neonatology
Guerin Children's

Kurlen Payton, MD

Peds - Neonatology
Guerin Children's
Guerin Children's

When you know an infant will need the NICU as soon as they are born, how do you prepare parents?

KP: The most important part of preparing parents is listening. I can't go in and guess what is most important to a specific family. I can't go in with a script and expect to meet their needs. I have to let them guide the discussion. 

Regardless of the medical situation facing their infant, families have different needs—different concerns, fears, preconceptions and priorities. Having their baby in the NICU is a stressful and anxiety provoking experience, and sometimes parents don't really know what to ask. It takes time and patience to make sure we've met their needs.

Can parents come see the facility ahead of time?

KP: Yes! This is important. Any added uncertainty adds to the stress. Parents often tell me that they feel much better after visiting the area where their baby will be. Seeing the equipment and understanding what it's for can help make the NICU a less intimidating place.

What other services do you offer parents whose newborn is in the NICU? Is there emotional support?

KP: Parents have access to a network of support providers and services. Our NICU social workers are truly experts in anticipating needs and supporting families. We're also always figuring out how to be better.

For example, we are currently trying to innovate in the area of parent education when a newborn is expected to stay in the NICU for many weeks. That includes making sure we are crystal clear about expectations and details, such as the range of care the infant may require, and then evaluating how well we did in supporting the family.

As a specialist, what is the main challenge in communicating with parents whose baby needs the NICU? What are some of the ways you deal with those challenges?

KP: We function in a high stress and fast paced environment, so time is always an issue. Good communication is key but talking isn't enough. I've found that using visuals are very helpful, so I supplement my discussions with sketches and diagrams as much as possible.

Using verbal communication alone is like limiting a two-lane highway to a single lane. There's only so much information that can flow through a single lane. At some point there's a bottleneck and this is a huge barrier to effective communication.

I've had parents pull out a piece of paper that I started sketching on weeks prior. I'll keep adding details and updating the graphics as we go. One family sent me a picture of the paper on their refrigerator diagramming the steps on the journey home for their twins. Moments like that are so rewarding.

Can parents visit their newborn in the NICU for skin-to-skin contact?

KP: Parents can visit the NICU 24 hours a day! We prioritize skin-to-skin contact whenever it's safe to do so. During the pandemic, we have had to make challenging decisions, but we view parents as essential caregivers as opposed to visitors.

What's the most common medical problem that leads to the NICU?

KP: Our most common patient is a full-term or near-term newborn who has breathing issues just after birth. Those babies have an average NICU stay of 2-5 days. The smallest babies who are born earlier can be in the NICU for 3 to 5 months. We do see lots of babies born premature. The vast majority of newborns in our care are not facing life-threatening situations, and even then, there is so much we can do for them.

What else would you like people to know?

KP: When babies are in the NICU at Cedars-Sinai, they have access to the best care available, with a team of compassionate professionals who are totally dedicated to making sure your little one is safe and comfortable. We do everything we can not only to help the infants, but to keep families informed and engaged as essential members of our team. We are there for them every step of the way.

Kurlen Payton, MD, inside the NICU