Six-day-old Josephine (Josie) Morrison has attitude. Delivered at Vanderbilt University Medical Center at a mere four pounds, five ounces, attitude’s a fighting quality that can serve an infant well in the neonatal intensive care unit (NICU). Josie arrived at 33 weeks — seven weeks shy of full term — after her mom, Megan, developed high blood pressure which lead to preeclampsia. Josie’s early birth surprised Megan and her husband who had envisioned things much differently — as most new parents do. After spending a day in the open ward of Vanderbilt’s Stahlman NICU, she moved to the NICU in Children’s Hospital, a state-of-the-art, 100-bed unit that accommodates preemies as young as 24 weeks and other sick babies with various issues. Josie spends most of her time in the temperature-controlled isolette and is doted on by nurses and her ever-present mom.
“She can come out for feedings,” wistful Megan says. “But she’s a lot like me: she doesn’t really like to be fussed with ... but she loves being sung to.”
Nurses in the NICU say preemies exhibit unique traits from the start. It’s this human aspect that helps new parents bond with their babies, especially since being in the NICU means a full medical team will care for your infant, leaving parents uncertain at first of where they fit in. Marlee Crankshaw, R.N., administrative director of neonatal service at Vanderbilt says neonatal nurses aim to draw parents to their babies right away.
“One of the first things I learned a long time ago was when parents come into the NICU, we have to help them concentrate on the things that are OK about the baby,” Crankshaw says. “Look at the baby’s hair. Try to focus away from the equipment and focus on the baby. Make the baby a person,” she says.
Thirty-eight-week-old Axel Saso is a feisty person, his mom Desiree says. She has been with him since he arrived; her husband travels back and forth from Kentucky since they have a 4-year-old at home.
“Axel really wants to move, and he’s strong,” Desiree says.
“Desiree’s a champ,” Leandra Hampton, Desiree’s primary nurse says. “She gets right in there and wants to do everything she can for Axel.”
It’s a result of the family care practiced in the NICU.
“We try really hard to let parents have the parent role from the start,” Hampton says. “We teach them and explain what’s going on with their babies from the beginning with a lot of encouragement.”
Helping parents “learn” their babies is top priority in the NICU, since the ultimate goal is for each baby to reach his milestones and go home to continue thriving. Depending upon the stability of the premature infant, parents can begin diapering and taking their babies’ temperatures as soon as possible.
The largest population of preterm babies (accounting for 75 percent of them) is in the 34 - 37 week range, according to Victoria DeVito, M.D., a neonatologist at Vanderbilt Children’s. It’s an automatic admission to the NICU, which means the infant is separated from the mother from the start. From there — and depending upon the severity of the baby’s situation — medical staff work hard to bring the family together again. Obviously, the younger a preemie’s gestational age, the more health issues he will have. Some preemies are in the NICU for only days; others stay upward of three months with an experience marked by medical setbacks and triumphs, emotions and fatigue. It can be like a roller coaster for parents.
LEARNING YOUR BABY
One word describes what new parents entering the NICU for the first time feel: terror. Wires, machines, medical personnel buzzing around. New parents are exhausted and experiencing a sort of grieving for a situation they didn’t realize they’d be in. They also don’t know where they fit in and can feel sort of helpless.
“It’s not what they thought,” DeVito says. “It’s not easy for anybody. They want to touch their baby, hold their baby. But often they’re afraid, so we have to make the effort to get the family engaged, and the whole thing is really difficult for families,” she adds.
Respiratory specialists, nutritionists, lactation consultants, nurses and others aim to make parents their partners in the baby’s care. But it’s not until a preemie is medically stable that NICU nurses can fold moms and dads into their baby’s care — like changing his diaper and taking his temperature. If the baby’s well enough for all-important kangaroo care, it can begin.
“We try to have the mom hold the baby skin to skin, although some babies born at 24 weeks, for example, don’t want to be held yet. The skin hasn’t developed adequately, so it’s very thin. During that time we let moms and dads hold their baby around their head and bottom through an isolette,” DeVito says.
Sensory experiences are very important to preemies, and getting skin to skin helps parents bond while transferring good bacteria to the baby which helps to strengthen him.
Everything’s very tentative at the beginning for new parents worried about their child’s fragility.
“We have to help them overcome their fears and understand that they’re partners with us in caring for their babies,” DeVito says softly. “The more they’re involved, the earlier they’re involved, the more they understand and know their baby, the better it’s going to be for them,” she adds.
Carlye Scott, a neonatal nurse practitioner at Vanderbilt, suddenly found herself in the mommy role in the NICU after her daughter, Eleanor, arrived at 33 weeks. Scott thought that because of her expertise she might somehow be left to her own devices with Eleanor. She was wrong.
“I felt immensely cared for,” Scott says. “The staff never asked more of me than to be the mother and there was just so much freedom in just allowing me to be the parent.”
Slowly, and with the utmost patience and support, moms and dads learn to care for their preemies, transitioning from jittery caregivers to pros with full knowledge of the NICU language. As this happens, medical staff back off as much as possible, letting parents take charge. Discussions of going home begin.
But when the equipment pieces are disconnected, and parents realize they will take Baby home soon — terror. No more medical team support. No more machines explaining Baby’s vitals.
DeVito says babies can go home when they’ve achieved the milestones of maintaining their temperature on their own in an open crib; taking complete feedings by bottle or breast and gaining weight; and having a stable breathing pattern with no apnea.
“When a baby is ready to go home, we really look at whether the family is ready to receive the baby and provide the care for the baby to be safely discharged,” Devito says.
A mixture of joy and fear fill parents’ hearts when at last they can buckle their preemie into their modified car seat for the momentous drive home.
HOME AT LAST
Most preemies don’t need specialized medical support after leaving the hospital, but that doesn’t stop parents from worrying — it simply comes with the territory of caring for an infant at home whether it’s a preemie or a full-term baby.
For parents of preemies who have fully engaged in learning to care for their baby in the NICU, the transition is easier. And if a problem develops at home, the baby will show you.
“When you go home, you’re not going to have the NICU equipment,” Crankshaw says. “So we teach parents to look at their baby; look at the color of the baby’s lips,” she adds.
And when in doubt, if there is an issue with your preemie, your pediatrician is just a call away. If it’s an emergency, Crankshaw says to phone 9-1-1.
When Scott brought baby Eleanor home, she admits she was terrified at first, but she did feel prepared by her experience in the NICU.
“We had peace and strength enough for each day and not more than a day at a time. Because looking back, the whole thing was so traumatic, I don’t know how we made it,” she says.