My top 3 evidence-based recommendations for supporting a baby in the NICU

Electromagnetic hygiene, supplemental melatonin, slowing down, and FAQs

This post is an introduction to ideas I have for navigating the NICU experience. However, I highly recommend you email me for a private consultation for more specific ideas relevant to your unique situation. Reach me anytime at nikko@brighterdaysdarkernights.com.

We all want to avoid the neonatal intensive care unit (NICU), but sometimes despite our best preparations and intentions, the NICU is where we spend the first days, weeks, or even months of life with our babies.

I experienced this when my 3rd child needed respiratory support (she was born during the height of the lockdown and after we had been evacuated due to wildfire—two very stressful situations that contributed to a highly stressful 3rd trimester, precipitous home birth, and subsequent respiratory distress, hospital transfer, and NICU stay).

Reading about NICU experiences, or even supporting someone else through them, is nothing like going through it yourself.

If you are in the midst of it, please reach out to me or for support within your community (even and especially if it feels vulnerable). Social support is one of the biggest keys to resilience and can make a world of difference for you and your family in the years following a NICU experience.

My first recommendation for the NICU: Electromagnetic Hygiene

See if you can get staff to move any machinery or electrical power sources and create at least 18 inches of distance between it and your baby. Spaces can be crowded, but most equipment is on wheels. If you own a grounding mat, you can ask to put that inside the incubator, but I only recommend this if you can do skin testing to make sure baby is getting a safe reading. By moving the equipment and doing the grounding, researchers have been able able to drop baby’s skin voltage by 95%¹, with immediate improvements in the baby’s vagal tone (an indicator of wellbeing).

“The background Environmental magnetic flux density (MFD) levels in the NICU were less than 0.5 mG and were similar to general household levels. The levels found in our incubators were lower than those reported more than 10 years ago and may reflect an improved engineering approach to incubator design. We confirmed that the MFD was very much dependent on proximity to the power source. If we position infants away from the power sources within incubators, we could reduce their exposure to ELF-EMF 8-fold.

Epidemiological studies performed during pregnancy showed increasing risks of asthma and obesity for the developing fetus when the expectant mother is exposed to a daily MFD of 2mG, and the risk of developing childhood leukemia doubles with postnatal exposure above 4 mG. Accordingly, even though more than 2 mG (>0.2 µT) is associated with negative health consequences on the growing fetus, values exceeding this value are still commonly seen within our incubators and also within 18 inches from equipment such as incubator humidifier control panels.”

Requesting to create 18 inches of space around your baby is one of the simplest things you can do to potentially help them through the difficult experience. You can learn more about why this is so important for preventing the cascade of problems that can come from jaundice in Module 6 of my newborn jaundice course. It’s normally exclusive for paid subscribers, but please feel free to email me at nikko@brighterdaysdarkernights.com if you need a scholarship to access this information:

My second recommendation for the NICU: Supplemental Melatonin

If your baby is getting tube feeding or if they have other medications coming in intravenously, ask if you can get melatonin supplemented overnight. Breastmilk peaks melatonin around 3 am and is key to baby’s mitochondrial health, but if baby is not getting to nurse because of CPAP or other circumstances (or considering that mama’s circadian rhythm is probably disrupted due to being in this 24-hour environment), supplemental melatonin is a way to support them. It may also be indicated to combat the challenges of oxidative stress, such as after hypoxia². Here’s some research on it and dosing for preterm infants:

“As sustained-release melatonin products are not available for infants, fast-release (intravenous or liquid formulations) may be used. These products are only effective for 3–4 hr because the half-life of melatonin is <1 hr. Therefore continuous nocturnal administration of 2–4 mg of melatonin through intravenous routes or feeding tubes would be ideal. Alternatively, a larger pharmacological oral dose of 2–3 mg could be given at bed time and repeated in the middle of the night. The oral dose must be larger because of poor bioavailability. However, this method of administration would be less desirable because uneven melatonin levels would be created. Our literature review shows that melatonin is not prescribed according to weight. Although premature and full-term infants have been treated with pharmacological doses, without apparent adverse effects, dose studies in neonates have not been carried out. Therefore, further research should establish the ideal therapeutic doses for use in premature infants.”³

And more recent recommendations for infants suffering from HIE:

“While the pharmacokinetic profile of melatonin has been clearly documented in adults, in infants, the dosage of melatonin and the frequency of its administration may differ than those in adults. The exact dosage of this metabolite needed for neuroprotection is still unknown. In global or focal hypoxia-ischemia models, melatonin doses vary from 1 mg/kg to 50 mg/kg.”⁴

Ordinarily, I am all for supporting endogenous production of melatonin, but three situations I think the research indicates the use of exogenous supplementation are: newborns who are not able to breastfeed or who have experienced adverse events (as described above), mothers who are getting pitocin to induce⁵ or augment labor, and pregnant or postpartum women presenting with symptoms of preeclampsia⁶.

My third recommendation for the NICU: Slow down

Don’t be afraid to ask for specific timelines for decision-making. In some cases, there is life & death urgency, but in many situations, even though it may feel very immediate and hurried, it’s okay to ask for time to decide about which treatment plans you embark upon. The worst that can happen from asking for more time is a provider will let you know if there isn’t any time available. However, it may be that you can take 10 minutes, 20 minutes, an hour, or even more to read through the informed consent materials, do your own research, and/or go to the hospital chapel to pray for guidance.

All doulas are taught to help their clients use the BRAIN acronym:

Benefits: what are the benefits of this treatment?

Risks: what are the risks of this treatment?

Alternatives: what alternatives exist for treating this condition?

Intuition: what does your intuition say?

Nothing: what will happen if we do nothing?

Another helpful tip is to anchor yourself in the present. With all the emotions flying, if you can bring yourself back into your body, into your breath, into your extremities it’s possible you may be the only person in the room who is fully present and not lost in fear or imaginings. This is an invaluable asset to your baby and the situation.

FAQS:

What do you think about photobiomodulation in the NICU?

This is one of the most common questions I get about ICU/NICU stays.

My response is that Nature and tradition always offer the gold standard.

Traditional postpartum care features a warm, dark, restful environment for the first 6 weeks or so of life. Lighting would have been ambient natural light and fire light. For more about what this should look like in Summer or Winter, read my Circadian Postpartum post.

Obviously, the NICU at present does not have circadian lighting installed, and bright white light is needed for handling emergency situations.

Photobiomodulation devices offer a limited amount of frequencies compared to natural light, but could potentially augment NICU treatments. These ideas are in fairly early stages of research, with results being speculated from adult and animal models.

For example, currently, hypothermia is one of the main tools for neonatal hypoxia⁷, as well as adult events around cardiac arrest. In adults, photobiomodulation has been shown to be a potential alternative to hypothermia that may carry fewer risks⁸. And photobiomodulation has been tested in a rat model for neonatal hypoxia with good success⁹.

Is it safe to give baby sunlight through window glass?

A: Ordinarily, I never recommend sunbathing through a window.

However, for a baby needing light to break down bilirubin and reduce newborn jaundice, filtered sunlight through a window is actually perfect.

This kind of filtered sunlight has been tested in resource-poor settings and has proven equally effective for moderate to severe newborn jaundice with fewer risks to babies compared to intensive phototherapy¹⁰.

Can you consult with me on a 1-1 basis?

A: Yes, absolutely. I offer intellectual, emotional, and social support (non-medical) and am extremely well-versed in the available treatments & the latest research for health concerns surrounding maternal-fetal health. I am a pre-med Biology/Psychology graduate of the University of Oregon and have have completed certifications and trainings from the Childbirth and Postpartum Professional Association, The Institute of Applied Quantum Biology, Doula Training Center, Indie Birth Midwifery School, Pacific Birth Institute, and other institutions. I’ve been dedicated to better understanding how we can improve outcomes for families for the past 17 years, and I am more than happy to help you find the support & answers you need to feel safe & secure in the decisions that need to be made for the challenges you are facing. If I can’t help you myself, I’m also able to refer you to other professionals who can provide the guidance you need. I am also available to help you and your family process what you have been through and to serve as a sounding board for any questions, concerns, or feelings still lingering after your NICU experience, no matter if it just finished up or happened many years ago. Please email me at nikko@brighterdaysdarkernights.com to let me know your situation and how I can help.

1. Passi, R., Doheny, K. K., Gordin, Y., Hinssen, H., & Palmer, C. (2017). Electrical Grounding Improves Vagal Tone in Preterm Infants. Neonatology, 112(2), 187–192. https://doi.org/10.1159/000475744

2. Robertson, N. J., Faulkner, S., Fleiss, B., Bainbridge, A., Andorka, C., Price, D., Powell, E., Lecky-Thompson, L., Thei, L., Chandrasekaran, M., Hristova, M., Cady, E. B., Gressens, P., Golay, X., & Raivich, G. (2013). Melatonin augments hypothermic neuroprotection in a perinatal asphyxia model. Brain : a journal of neurology, 136(Pt 1), 90–105. https://doi.org/10.1093/brain/aws285

3. Jan, J. E., Wasdell, M. B., Freeman, R. D., & Bax, M. (2007). Evidence supporting the use of melatonin in short gestation infants. Journal of pineal research, 42(1), 22–27. https://doi.org/10.1111/j.1600-079X.2006.00398.x

4. Paprocka, J., Kijonka, M., Rzepka, B., & Sokół, M. (2019). Melatonin in Hypoxic-Ischemic Brain Injury in Term and Preterm Babies. International journal of endocrinology, 2019, 9626715. https://doi.org/10.1155/2019/9626715

5. Swarnamani, K., Davies-Tuck, M., Wallace, E., Mol, B. W., & Mockler, J. (2020). A double-blind randomised placebo-controlled trial of melatonin as an adjuvant agent in induction of labour (MILO): a study protocol. BMJ open, 10(2), e032480. https://doi.org/10.1136/bmjopen-2019-032480

6. Hobson, S. R., Gurusinghe, S., Lim, R., Alers, N. O., Miller, S. L., Kingdom, J. C., & Wallace, E. M. (2018). Melatonin improves endothelial function in vitro and prolongs pregnancy in women with early-onset preeclampsia. Journal of pineal research, 65(3), e12508. https://doi.org/10.1111/jpi.12508

7. Arnautovic, T., Sinha, S., & Laptook, A. R. (2024). Neonatal Hypoxic-Ischemic Encephalopathy and Hypothermia Treatment. Obstetrics and gynecology, 143(1), 67–81. https://doi.org/10.1097/AOG.0000000000005392

8. Wang, R., Dong, Y., Lu, Y., Zhang, W., Brann, D. W., & Zhang, Q. (2019). Photobiomodulation for Global Cerebral Ischemia: Targeting Mitochondrial Dynamics and Functions. Molecular neurobiology, 56(3), 1852–1869. https://doi.org/10.1007/s12035-018-1191-9

9. Tucker, L. D., Lu, Y., Dong, Y., Yang, L., Li, Y., Zhao, N., & Zhang, Q. (2018). Photobiomodulation Therapy Attenuates Hypoxic-Ischemic Injury in a Neonatal Rat Model. Journal of molecular neuroscience : MN, 65(4), 514–526. https://doi.org/10.1007/s12031-018-1121-3

10. Slusher, T. M., Vreman, H. J., Olusanya, B. O., Wong, R. J., Brearley, A. M., Vaucher, Y. E., & Stevenson, D. K. (2014). Safety and efficacy of filtered sunlight in treatment of jaundice in African neonates. Pediatrics, 133(6), e1568–e1574. https://doi.org/10.1542/peds.2013-3500