Understanding NICU Rounds: What to Listen For and How to Speak Up

The neonatologist stood at my daughter's bedside flanked by nurses, residents, and respiratory therapists. They talked over her isolette, referencing numbers I didn't know, medications I'd never heard of, and terms that sounded more like alphabet soup than actual words.

I nodded along. I tried to follow. And when they finished and moved to the next baby, I had no idea what had just happened.

Nobody told me that was normal. Nobody told me I was allowed to stop them and ask what things meant. Nobody told me that the NICU team didn't expect me to understand everything — or that asking questions was not just okay, but encouraged.

So I'm telling you now.

Rounds are when the medical team gathers at your baby's bedside to discuss their condition, review their progress, and make decisions about their care plan for the day.

Depending on your NICU, rounds typically happen twice a day — once in the morning for the day shift and once in the evening for the night shift. These are structured check-ins where doctors, nurses, nurse practitioners, respiratory therapists, and sometimes specialists all come together to talk through what's happening with your baby.

If you've never experienced medical rounds before, it can feel overwhelming. There are a lot of people. There's a lot of jargon. And it all happens quickly because they're moving from baby to baby across the entire unit.

But here's the most important thing I can tell you: you are part of that team. You belong in that conversation. And the best NICU teams know that.

I'm not going to sugarcoat it. The first few times you sit through rounds, you're going to feel lost.

The team will reference lab values, medication dosages, ventilator settings, and feeding volumes using abbreviations and shorthand that you've never heard before. They'll say things like "we're weaning her FiO2" or "her bilirubin came back at 8.2" or "let's increase her TPN" — and if you're new to the NICU, none of that will mean anything to you yet.

That's okay. You're not supposed to know this language on day one.

What helped me was realizing that my NICU team wanted to explain things in terms I could understand. They just didn't always know I needed them to slow down until I asked.

Once I learned it was okay to say "I don't know what that means" or "can you explain that in a different way" — everything changed. The doctors and nurses would pause, back up, and walk me through it. Sometimes they'd pull out a diagram. Sometimes they'd use an analogy. Sometimes they'd just explain it three different ways until I nodded and said I got it.

You have to remember: the NICU team sees a lot of parents. Some are deeply engaged. Some are overwhelmed and struggling just to show up. When they encounter families who are actively asking questions, who want to be informed and involved, most of them will go the extra mile to talk it all through with you.

But you have to speak up first.

The more rounds you attend, the more it starts to make sense.

I couldn't be at every round. My wife couldn't be at every round. We had jobs, we had our older daughter, we had life pulling us in different directions. But the more rounds we made, the more familiar the rhythm became. We started recognizing terms. We started understanding what the numbers meant. We started knowing which changes were good and which ones meant setbacks.

Sometimes we'd miss rounds entirely and come in after the fact. When that happened, we'd ask for the nurse practitioner or the neonatologist to come bedside and give us the rundown. They always did. A quick two-minute summary of what was discussed, what changed, and what the plan was moving forward.

That's another thing nobody tells you: you don't have to be physically present at rounds to get the information. If you can't make it — because of work, because of traffic, because you needed to sleep — you can ask for a recap. The team expects this. They understand.

Once you start attending rounds regularly, here's what you should pay attention to:

"Going up" or "going down." These are the phrases that signal change. When the team says they're "going up" on something — oxygen support, feeding volumes, medication doses — or "going down" on something, that's your cue to ask clarifying questions.

Is going up good or bad in this context? Is going down progress or a setback? Sometimes it's obvious. Sometimes it's not. Ask.

Trends, not single numbers. The NICU isn't about one good day or one bad number. It's about patterns over time. Listen for phrases like "trending in the right direction" or "we've seen improvement over the last few days." That tells you more than any single lab value.

The plan for today. Rounds always end with a plan. What are we watching for today? What are we trying? What's the goal? Write it down if you need to. This becomes your roadmap for the day.

Your baby's name. This one sounds small, but it matters. When the team uses your baby's actual name instead of "the patient" or "baby in bed 4," it means something. It means they see your baby as a person, not just a case. And it usually means you've built a relationship with a team that genuinely cares.

Here's what I wish someone had told me on day one: the NICU team does not expect you to fully understand what they're talking about.

They know you're not a doctor. They know you didn't go to medical school. They know this is a foreign language to you. And the best teams — the ones who truly value family-centered care — will slow down and explain things if you ask.

So ask.

"Can you explain that in simpler terms?" "What does that mean for her today?" "Is that good news or bad news?" "What should I be watching for?"

These are not stupid questions. These are the questions every engaged NICU parent asks. And when you ask them, you're not slowing the team down or wasting their time. You're participating in your baby's care. You're advocating. You're doing exactly what you should be doing.

If you're worried about interrupting, wait until they finish their summary and then say, "Can I ask a few questions before you move on?" They'll stop. They'll answer. And they'll respect you more for asking.

There will be times when you still don't understand even after they've explained it.

That's okay too.

Ask again. Or ask a different member of the team later. Your baby's nurse has often been there all shift and can break things down in a way that makes sense. The nurse practitioner can walk you through lab results or medication changes. The respiratory therapist can explain ventilator settings.

You're not expected to understand everything immediately. You're just expected to keep asking until you do.

And here's something I learned the hard way: don't pretend you understand when you don't. It's tempting to nod along because you don't want to seem like you're not paying attention or because you feel embarrassed that everyone else seems to get it. But pretending doesn't help your baby. Asking does.

If you need to pull out the NICU glossary after rounds to look up terms you heard, do it. If you need to write down questions to ask before the next round, do it. Whatever helps you stay informed and engaged — that's the right approach.

If someone hasn't told you when rounds happen at your NICU, just ask.

Most NICUs follow a predictable schedule — morning rounds between 8-10 AM and evening rounds between 6-8 PM, though times vary by unit. Knowing the schedule means you can plan to be there when the team discusses your baby's care.

But life happens. You'll miss rounds sometimes. You'll be at work, or stuck in traffic, or exhausted and sleeping after being up all night. When that happens, don't panic.

Ask your baby's nurse for a summary. Ask the nurse practitioner to stop by. Send a message through the patient portal if your hospital has one. The information doesn't disappear just because you weren't physically there when it was discussed.

The team wants you informed. They just need to know you want the update.

One of the most important things I learned during my time in the NICU is this: I belonged in that conversation.

Not as an observer. Not as someone passively receiving information. As a participant. As my daughter's parent and advocate. As someone who had every right to understand what was happening and every right to ask questions when I didn't.

It took time to find my voice in those conversations. It took practice to get comfortable speaking up when I didn't understand something. But once I did, everything about the NICU experience changed.

I wasn't just hoping for the best anymore. I was actively engaged in the plan. I knew what we were working toward. I knew what the numbers meant. I knew when to celebrate small wins and when to brace for setbacks.

And that knowledge — that active participation — made me a better advocate for my daughter. It made me a true partner in her care.

That's what rounds can give you. Not just information, but empowerment. The ability to show up at your baby's bedside not as a confused bystander, but as a parent who knows what's happening and why.

So speak up. Ask questions. Ask them again if you need to.

Your baby needs you informed. And the NICU team is there to help you get there.

You just have to let them know what you need.

— Louie

Two-time NICU dad. Still learning to ask better questions.

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Between Beeps does not provide medical advice. Always follow your NICU team’s recommendations.