Behind the Beeps - Understanding Alarms in the Neonatal Unit

Sep 22

6 min read

If you’ve ever spent time in a neonatal unit, you’ll probably remember the sounds.

The beeps. The alarms. The monitors.

Sometimes it can feel as though there is always something making a noise.

For parents, especially during those first few hours or days, an alarm can be frightening. You may find yourself looking at the monitor every few seconds, watching the numbers change and wondering:

Is my baby okay?

As a neonatal nurse, I want to take you behind those beeps and explain a little about what you’re hearing — because an alarm doesn’t always mean that something is wrong.

Why are there so many alarms?

Babies in neonatal care are monitored closely because some of them are premature, unwell, or need additional support while they grow and recover.

Depending on your baby’s needs, their monitor may continuously measure things such as:

Heart rate
Oxygen saturation
Breathing rate

Other equipment around the cot or incubator may also have its own alarms, including feeding or medication pumps and respiratory support.

Each alarm is there for a reason: to alert the neonatal team when something needs checking.

But importantly, not every alarm means an emergency.

Illustration of a neonatal bedside monitor displaying heart rate, oxygen saturation and respiratory rate.

Example illustration of a neonatal bedside monitor. Displays and readings vary between babies and neonatal units.

Why does the monitor keep beeping?

Monitors are designed to alert staff when a reading moves outside the limits set for your baby.

Sometimes that happens because your baby’s oxygen saturation, heart rate or breathing rate has genuinely changed.

But alarms can also happen for much simpler reasons.

Your baby might wriggle.
A saturation probe may lose its signal.
An ECG lead might become loose.
Your baby may be crying, feeding or being handled.

The monitor can detect when a reading moves outside the limits set for your baby, but it cannot always tell us why. For example, a low oxygen saturation reading could mean your baby’s oxygen level has genuinely dropped, or it could simply be because the probe has moved and isn’t picking up the signal properly.

That’s why we don’t rely on the numbers alone — we always look at your baby too.

“Why isn’t the nurse running over?”

This is something parents sometimes wonder, particularly when an alarm sounds and the nurse doesn’t immediately rush to the cot.

It can feel strange when you’re hearing a noise that sounds urgent.

But over time, neonatal staff learn to interpret alarms alongside what they can see clinically.

We may be looking at your baby from across the room.

We may be watching the monitor trace.

We may recognise that the signal isn’t reading properly.

Or we may know that your baby frequently has a particular type of brief event and is already recovering.

An alarm gets our attention.

Your baby tells us what needs to happen next.

If your baby does need help, the neonatal team will respond according to what is happening. This might be as simple as repositioning your baby or giving gentle stimulation, or it may involve adjusting their oxygen or respiratory support. In some situations, more urgent intervention may be needed. The response will depend on your baby, the type of alarm and what the team sees when they assess them.

What are desaturations, bradycardias and apnoeas?

During your baby’s time in the neonatal unit, you may hear staff use words such as desat, brady or apnoea.

A desaturation, often shortened to “desat”, means your baby’s oxygen saturation has fallen below the range set for them. You may see the oxygen saturation number on the monitor drop and hear an alarm. Some desaturations are brief and your baby will recover by themselves, while others may need support from the neonatal team.

A bradycardia, often shortened to “brady”, means your baby’s heart rate has fallen below the range set for them. Bradycardias can sometimes happen alongside a desaturation or an apnoea, particularly in premature babies. Again, some are brief and resolve on their own, while others may require intervention.

An apnoea is a pause in breathing. In premature babies, this can happen because the part of the brain responsible for controlling breathing is still developing. An apnoea may also be accompanied by a drop in heart rate or oxygen saturation. Depending on the episode, your baby may recover by themselves or may need gentle stimulation or additional support from the neonatal team.

If you hear staff talking about a “desat”, “brady” or “apnoea”, please ask if you are unsure what has happened. These events can look and sound frightening on the monitor, but what they mean and how they are managed will depend on your individual baby.

Your neonatal team can explain what they expect for your baby and when an episode may need further attention.

The numbers aren't the whole story

It is completely understandable to become focused on the monitor.

Many parents find themselves watching the numbers constantly. But your baby is so much more than the numbers above their cot.

As neonatal nurses, we use the monitor as one part of a much bigger clinical picture. We also look at your baby’s colour, breathing, behaviour, movement and overall condition.

Sometimes the monitor will alarm while your baby looks perfectly comfortable. Sometimes we may notice a change in your baby before a monitor tells us anything.

Technology helps us care for babies, but it will never replace actually looking at the baby.

You will start to recognise the sounds

Something I often notice is how quickly parents begin learning their baby’s neonatal environment.

At first, every beep may make you jump.

Then, gradually, you may start recognising which alarm belongs to which piece of equipment. You might notice when the saturation probe has slipped off before anyone says anything. You may even begin recognising your own baby’s monitor from across the room.

You are learning too.

A little familiarity can be a good thing — but there are boundaries

As time goes on, you may become very familiar with your baby’s monitor. You might recognise certain alarms, notice when a probe has moved or even know that a particular pump is about to start beeping.

That familiarity can help the neonatal environment feel a little less overwhelming. But it’s important that parents do not silence alarms, stop pumps or adjust any of the equipment themselves, even when you think you know exactly why it is alarming.

I have occasionally had to remind parents of this. After spending weeks or even months in a neonatal unit, it is completely understandable that the constant beeping can become frustrating and that you may feel very familiar with the equipment.

But an alarm is there to alert the neonatal team, and silencing it or stopping equipment could mean that something important is missed or that your baby’s treatment is interrupted.

If something is beeping, call your baby’s nurse rather than trying to silence or adjust it yourself. Even if it turns out to be something simple, we would always rather you ask.

I’ve said this before, but I think it’s worth repeating: you are never expected to understand neonatal monitors, equipment or terminology simply because your baby is in the unit.

You are a parent, not a neonatal professional. If you don’t understand something you see or hear, please ask us. We would much rather explain it than have you sitting beside your baby feeling worried or unsure.

Behind every beep is a baby

Neonatal units can be noisy, technical and overwhelming places.

The alarms have an important purpose, but when you are sitting beside your baby, they can sometimes make an already difficult experience feel even more frightening.

So if you find yourself watching the monitor more than your baby, try to remember:

The monitor gives us information. The alarm gets our attention. But we care for your baby, not just the numbers.

And if you are ever unsure about what you are seeing or hearing, ask us. You deserve to understand what is happening with your baby and to feel informed and involved in their care.

This article is for general information and parental education only. It does not replace advice from your baby's neonatal or medical team. Alarm limits, monitoring practices and responses may vary depending on the baby, neonatal unit and equipment being used.