Charlotte Boatwright, R.N., Ph. D.
The Neonatal Intensive Care Unit (NICU – pronounced “NICKEW”) is a world that most people do not know exists unless they, their friends or family have a baby that goes there. Most people assume that they will have a healthy baby, deliver it and go home from the hospital within a couple of days. They do not anticipate going for a doctor’s visit when he will look them in the eye and give them bad news about the pregnancy. No one expects that to happen. In such cases, the NICU staff is prepared to take care of the baby after delivery, but they are also prepared to take care of the family. “Our mission is to take care of the whole family. You can’t just take care of the baby and not take care of the mom, dad and grandparents,” says Terri Woodruff, Nursing Director for the unit. “Everyone in the family is anticipating this baby. They want it and they already love it. They want this baby to be born even if it means challenges. Unfortunately, it can be a roller coaster ride in NICU, because the babies have some good days and some tough days. That is a part of prematurity. We laugh with the parents, we rejoice for the days that go well and sometimes we cry with them. We invest a lot of time, energy, knowledge and caring in taking care of those families. We really become a part of their families, so much that they bring their babies back to us when they come for follow up care. They send us pictures at Christmas and we put them on our board of NICU Stars so that everyone can see them. There is nothing more rewarding that helping a family through the NICU journey,” Woodruff remarks.
Neonatal care units were initiated in the 1970’s. The unit at T. C. Thompson Children’s Hospital was opened when the hospital was relocated from Glenwood to the Erlanger Campus in 1973, so it was one of the earliest units to open. Designated a level III unit, the highest possible designation, it is equipped to care for the smallest, sickest infants and is the only level III unit in the region. “The real advantage of T.C. Thompson is the availability of pediatric sub specialists in such areas as surgery, cardiology and neurology which enable us to provide care above and beyond level II,” says Liz Kennedy, M. D. Medical Director. “We get babies from Tennessee, Georgia, Alabama and North Carolina. We often transport babies from outlying areas. The best way to transport babies is inside the mom, but if the baby is born in an outlying facility, we will send our transport team to bring them here. We currently have 48 beds and are in the process of expanding to another 8-bed pod.” she says.
Care has really evolved over the years. In early years, adult ventilators and other equipment were used for the babies. Since babies’ lungs are much smaller than those of adults, there were many complications. Now the technology is specifically designed for the smallest babies. “An example of that is our smallest baby that weighed 14.5 ounces,” Woodruff notes. “That is two ounces larger than a can of Coke. She would fit in your hand somewhat like a flip cell phone. Survival rates of such small babies have increased as technology and medical knowledge have improved. Babies now survive that would have died 10 to 15 years ago. We have ventilators and beds that provide oxygen, heat and humidity in the exact amount that each baby needs. Even the design of the unit is created to promote neonatal development. High ceilings lift noise up and away from the babies. Muted colors are used to provide a calming environment. The other important piece in survival is the perinatologists who take care of the mom if she has complications during pregnancy. They monitor the moms and the babies so closely that if a pregnancy is compromised, they can deliver the baby so that both mom and baby have an optimal chance of survival.”
There are 130 nurses in the NICU, 15 neonatal nurse practitioners and 7 neonatologists. Staff also includes case managers, social workers, respiratory therapists and physical therapists. Physical therapists play a big part in the unit, teaching families how to position the child, exercises to help the baby develop and overcome some of the problems of being premature. Often the baby’s associations are not positive as it may have had a ventilator or feeding tube in its mouth, so the physical therapist helps it to associate positive things with its mouth and hands. The staff practices cluster care, planning all care at one time, completing care and leaving the baby to rest. “The baby needs to get to deep REM sleep in order to secrete growth hormone,” says Woodruff.
The staff is passionate about the care they provide. “They give while they are at work, but many of them go above and beyond,” Woodruff explains. “They make hats, blankets and clothes for the babies and keep in touch with them after they go home. Sometimes they baby sit with the babies so that the parents can go out. You can imagine that you would not want to leave your baby with just anyone, so this enables the parents to feel their baby will be safe. Everyone in the unit is committed to continuing education to keep us aware of the newest research so that we can give our best to the babies. Throughout Children’s Hospital, we practice family-centered care, and it starts in the NICU.”
Parents are encouraged to help take care of their babies. They take the baby’s temperature and change diapers. They bring tape recorded songs or nursery rhymes with a battery operated recorder that can be turned down low and played in the bed with the baby. Parents may sit by the bedside and read so that their baby can hear their familiar voices. They also provide Kangaroo care, where mom or dad relax in a recliner or rocker with the baby on their chest, skin to skin with a blanket wrapped around them. Research shows that this helps babies gain weight faster and move more quickly through their NICU course.
It can be very frightening the first time parents see their baby so tiny with tubes and equipment attached. “Every parent has that reaction, but they quickly become acclimated and begin to speak the language,” Woodruff comments. “We encourage them to be present when the doctors make rounds every day between 10:30 am and 1:00 pm. It is important for them to know what is going on as they will be the baby’s advocate not just during this hospital stay, but as the baby grows up.”
Kim and Matthew Rehring became parents of quadruplets at Erlanger on June 9. With weights between two and three pounds each, they needed NICU care. “The people in the NICU were awesome. They let me know what all the beeps and whistles meant so that I would not be scared when I went in to see my little ones,” Kim says. “The nurses were very loving to my babies and fed and rocked them when I could not be there. That made it much easier when I could bring one or two of my babies home. I was dividing my time between them and the ones in the hospital and felt that I was not giving any of them enough time. I could call at anytime day or night to find out how they were and can continue to call them, even after all my babies come home. The nurses and doctors were so wonderful. I believe they are the reason the babies were able to come home so quickly.”
The NICU has a 97 percent survival rate, but unfortunately not all the babies survive. The staff takes care of those families too through a bereavement program where they have a celebration of that baby’s life. “Every year, we partner with Ronald McDonald house to have a candlelight ceremony, ‘Moments of Sharing,’ where we honor the babies who did not make it,” Woodruff explains. “The baby is not still here but to that family, it was a very important part of their life. Unfortunately, people sometimes try to brush it away and say it is okay, you can have another baby, but other children will never replace the baby they lost. We have people in the community who create beautiful painted memory boxes. We do a set of hand and footprints for them. We put the blankets and clothing, everything that touched their baby in the box. We call it our ‘Never Forgotten’ program to remind them that their baby will never be forgotten.”
“It takes an entire team to take care of babies in the NICU,” notes Woodruff. “We say that the one who wears the diaper is boss and the smaller the diaper, the more people they boss around. The tiniest baby may have 15 people running around it. You start to go home at night and look at that little baby and think, I was run over by a one-pounder today!”