Posts Tagged ‘NICU’

Pneumonia and preemies

Wednesday, March 16th, 2016

BabyOnChest-Pneumonia is an infection in the lung(s) which can make it hard to breathe. Premature infants are more prone to developing infections due to their immature immune systems. They were born before they could acquire their mother’s antibodies to fight off infection, which are usually transferred in the third trimester. In addition, due to prematurity, their lungs are not fully formed, making it easier to develop infections such as pneumonia.

Causes and treatments

Pneumonia can have different causes: viral, bacterial or even fungal. It can be hard for doctors to diagnose pneumonia, as it can look like other common preemie disorders, (eg. Respiratory Distress Syndrome). In addition, it may take some time for blood, urine or other lab tests to confirm the diagnosis. Therefore, as soon as pneumonia is suspected, most babies will receive an antibiotic that can fight a broad spectrum of bacteria to help combat the infection. Once the tests confirm the type of infection, the medication may be altered.

Your baby may also receive oxygen to help him breathe easier, or he may be placed on a ventilator. Keeping your baby well hydrated and nourished are also top priorities – his body needs nutrients to fight the infection. With all of this treatment, your baby’s lungs can begin to repair themselves.

Can pneumonia be prevented?

A premature baby may develop different infections for the reasons noted above. But the spread of infections can be avoided through the use of proper hygiene. Visitors who come to the NICU should be free from illness (colds, sore throats, coughs). All visitors should wash hands thoroughly or use foam disinfectant before seeing or touching your baby.

Some infections can spread through the air. Having visitors wear a face mask that covers the nose and mouth can provide an added layer of protection for your baby. NICU staff follows strict protocols regarding hand washing and keeping equipment squeaky clean. They are aware of how to prevent the spread of germs.

The good news

Most babies respond well to medications and recover without lasting issues.

Have questions? Send them to AskUs@marchofdimes.org

The A’s and B’s of the NICU

Wednesday, March 9th, 2016

help-breathingApnea (A) and bradycardia (B) are two conditions that are monitored in the NICU. Apnea refers to an interruption in your baby’s breathing, while bradycardia is the slowing of your baby’s heart rate.

Babies in the NICU are constantly monitored for these “A’s and B’s.”

Premature babies often have breathing problems because they were born before their lungs were fully developed. As many as 80 percent of babies born before 30 weeks of pregnancy have apnea. Full-term babies may have breathing problems due to birth defects, infections or complications from labor and delivery.

When is irregular breathing considered apnea?

Often, preemies do not breathe regularly. Your baby may take a long breath, a short one, and then pause for 5-10 seconds before breathing regularly. This is not considered harmful and your baby should outgrow it. But, if a preemie or sick baby stops breathing for 15 – 20 seconds or longer, or if the pause in breathing happens along with a slower heart rate (bradycardia) or a change in your baby’s color, then it is called apnea.

A premature baby’s heart beats much than faster yours. Bradycardia is defined as “the slowing of a baby’s heart rate from its usual range of 120 to 160 beats per minute to a rate of fewer than 100 beats per minute” according to the authors of the Preemies book.

The sensors on your baby’s chest are connected to a machine which will start beeping if your baby stops breathing. The nurse will check your baby and determine if she needs to be stimulated to help her start breathing again. To resume breathing, the nurse may gently touch your baby.

If necessary, your baby’s neonatologist may give your baby medication or place her on a C-PAP machine to help deliver air to your baby’s lungs. In C-PAP (continuous positive airway pressure), air is delivered to your baby’s lungs either through small tubes in her nose or through a tube that has been inserted into her windpipe. The tubes are attached to a machine, which helps your baby breathe. With C-PAP, your baby breathes on her own, but the steady flow of air coming in through the tubes keeps enough pressure in her lungs to prevent the air sacs from collapsing after each breath. It’s a little extra support to help her lungs work better.

Machines can be scary

Seeing your baby hooked up to machines can be scary, and when those machines start to beep, it can be nerve wracking. But, the way your baby looks is a very important indicator of how she is doing. For example, some experts recommend that when machines start beeping, take a look at your baby, not at the machine. Is your baby pink? Is her chest moving in and out? Are her nostrils slightly widening with each breath? If so, she is breathing and getting oxygen.

In addition, the machines are set up to start beeping with plenty of time for the nurse to attend to your baby, before your baby is in distress.

If your baby’s apnea is not resolving, the medical team will consider whether there is something else going on, such as an infection or other problem. As difficult as it is to see your baby struggle with breathing, it may be very comforting to know that apnea usually resolves without any problems.

Have questions? Send them to AskUs@marchofdimes.org. We are here to help.

Did your baby experience apnea? Did it resolve on its own?

 

Holidays & your child with special needs- tips for the NICU, visiting Santa, dinners & traveling

Wednesday, December 9th, 2015

Parents in NICUFrom spending holidays in the NICU, finding developmentally appropriate toys, eating at Grandma’s house (without a meltdown!), to visiting Santa in a loud, bright mall, the holidays can be oh so hard for a child with special needs. Here is a walk down blog post memory lane to help you get through the next few weeks and even have some fun.

We wish you a stress-free, calm, smooth holiday season. If you have any tips that have worked for you, please share them! You can find more posts on parenting a child with special needs, here.

Questions? Send them to AskUs@marchofdimes.org.

 

Is donor milk right for your preemie?

Monday, November 23rd, 2015

feeding in the NICUFor premature babies, breast milk can be lifesaving. It is more easily digested and provides protection against many diseases. Providing breast milk, however, can be a challenge for some moms. Many moms are not able to provide their baby with their own breast milk for various reasons, they:

  • are recovering from surgery or have certain medical conditions that make it difficult to initiate and maintain a milk supply;
  • find it difficult to pump enough milk to meet their baby’s needs;
  • have chronic conditions and need to take medications that may make their breast milk unsafe.

In these cases, donor milk may be the best option for your preemie, and a better alternative to formula.

What is donor milk and where does it come from?

A milk bank is a service that collects, screens, processes and distributes safe human milk to babies in need. All donated milk goes through a pasteurization process to eliminate bacteria while keeping the milk’s essential nutrients. The milk is then packaged, stored and ready to ship to hospitals or individual recipients at home. Lactating women who wish to donate their breast milk may do so through a milk bank.

Does your preemie need donor milk?

The nutritional needs of each baby depends on many different factors. It’s important to talk to your baby’s doctor to see if donor milk is right for your baby. Some hospitals have their own donor milk bank or have a partnership with a milk bank near them. If your baby’s doctor indicates that your baby will benefit from donor milk, he can write a prescription. For more information about the milk bank closest to you, visit the Human Milk Banking Association of North America.

Can you buy breast milk from another mom who has milk to spare?

There are risks with getting breast milk from a stranger or a friend; this milk is not tested or screened for infectious diseases or contamination. A study published in the American Academy of Pediatrics showed that out of 101 samples of milk purchased online from different mothers, 74% of samples were contaminated with bacteria and 21% of samples contained cytomegalovirus (CMV) bacteria.

It’s important to be informed when making feeding decisions for your preemie. If you have any questions about donor milk or your baby’s nutritional needs, speak with your baby’s healthcare provider.

Necrotizing enterocolitis (NEC)

Friday, November 20th, 2015

Passing the time while your baby is in the NICUNecrotizing enterocoloitis, also known as NEC, is a condition of the intestinal tract that almost only affects premature babies. It often begins 2 or 3 weeks after birth and appears in preemies who seem to be getting better. NEC occurs when the lining of the intestine becomes inflamed. Most of the time, the damaged section of the intestine will heal on its own. But in some cases, the tissue dies. When this happens, that part of the intestine no longer works the way that it should. This damage may cause the intestine to tear. The bacteria in the intestine can then enter the blood and this can then lead to infection throughout the body.

What causes NEC?

Researchers are still not exactly sure what causes NEC. But in premature infants, it is probably related to the immaturity of the baby’s intestine. Some other factors that may contribute to NEC include:

  • An injury to the immature intestine
  • Reduced blood flow to the intestine
  • Growth of bacteria in the intestine that damages the intestinal wall

What are the signs of NEC?

NEC can be difficult to diagnose. The early signs can be similar to other infections or to problems caused by feeding difficulties often seen in preemies. However, NEC can get worse very quickly. Some common symptoms include:

  • Loss of appetite, not tolerating feedings
  • Red, painful, and swollen belly
  • Diarrhea or bloody stool
  • Decreased activity
  • Body temperature instability (may be lower than normal or fluctuate)
  • Episodes of low heart rate or apnea
  • Sometimes greenish vomit

Doctors can diagnose NEC with an X-ray of the belly.  When they examine the X-ray, they are looking for tiny gas bubbles inside the walls of the intestine. They can also see if air has leaked out of the intestine through a tear or hole.

How is NEC treated?

Early diagnosis and intervention is very important. Typical treatment includes:

  • Stopping oral (mouth) feedings and replacing with IV nutrition to give the bowel time to rest,
  • Inserting a tube through the nose and into the stomach to remove air and other secretions from the intestine,
  • Giving broad-spectrum antibiotics to treat and prevent infection,
  • Continuous monitoring using X-rays, blood and urine cultures,

If these interventions work, NEC typically lasts 2-3 weeks, although the critical stage is often over after a few days. Usually doctors will continue IV feedings until the intestines heal and the pockets of gas have been gone for 5 or more days. They will then start to gradually re-introduce oral feedings.

Surgery may be necessary for those babies who do not respond to the treatments above. In that case, the surgeon will remove the damaged section of intestines.

How can NEC be prevented?

Researchers are trying to better understand NEC so that they can prevent it. However, here are some things that seem to be beneficial:

  • It is important to start oral feedings early. The introduction of tiny amounts of milk to the digestive system may help the intestine to mature faster and possibly reduce the chance of your baby developing NEC.
  • Early feeding with colostrum and breast milk may be beneficial. It is easy to digest, supports the growth of good bacteria in the intestine, and helps to build your baby’s immune system.

If your baby has NEC or had it in the past, please go to Share Your Story where you can connect with other families and find comfort, support, and advice.

Have questions? Text or email us at AskUs@marchofdimes.org.

Skin to skin contact helps your baby AND you

Wednesday, November 11th, 2015

Skin to SkinResearch has shown that skin to skin holding, also known as “kangaroo care,” is one way to help stabilize your baby’s body temperature and help his heart rate become regular. It is comforting to your baby, and may help him gain weight. Even very sick or fragile babies can usually benefit from kangaroo care.

It’s good for parents, too. It helps you bond with your baby, which boosts your spirits. For moms, it encourages your breast milk supply, too.

What is skin to skin holding or kangaroo care?

It is when you hold your baby, skin to skin, bare chest to bare chest, in an upright position. Your baby is wearing only a diaper.

Does it have other benefits?

Yes. For your baby…

Skin to skin holding may help lower the risk of infection, improve survival rates, and encourage your baby to spend more time in deep sleep (which is important for growth and good health). It may also lessen your baby’s pain and help with brain development. Kangaroo care may help your baby spend more time being quiet when awake, and less time crying.

For you and dad…

Skin to skin increases the feeling of intimacy between the baby and parent, helping the mom or dad feel connected. Often dads are fearful of holding their baby – skin to skin may promote a sense of empowerment and confidence. It may decrease anxiety, fear and depression and encourages attachment. Parents say it is the most comforting activity they experience in the NICU.

One mom told us she wrote in her journal “Today I feel like a mother for the first time” – that was the first time she held her twin boys skin to skin, 5 weeks after they were born!

Should you ask to hold your baby?

Yes! If you have not yet held your baby skin to skin, ask if you can. Often, the NICU staff is just so busy with other important duties that they don’t think to offer it. Typically, your baby must be medically stable before he is ready for kangaroo care. But, you can do it even if your baby is hooked up to machines.

How much kangaroo care should you do?

The more you can do, the better. It has been shown that skin to skin contact should take place for a minimum of one hour, but several hours at a time are better. It takes a while for a baby to transition from the isolette to chest and back, so you must take that into account. In some countries, parents are encouraged to do kangaroo care round the clock – that’s how good it is for babies!

Still wondering if skin to skin holding is for you?

Watch this video.

Did you experience kangaroo care in the NICU? Please tell us about it.

 

Have questions? Email or text AskUs@marchofdimes.org. We are here to help.

NICU parents can develop PTSD due to stress and trauma

Wednesday, October 7th, 2015

parents in the NICUParents of NICU babies have been found to be at risk for developing stress disorders, according to research. It is very scary for parents to see their infant hooked up to monitors or undergoing serious medical procedures. Every parent’s reaction to the NICU journey is different and what is overwhelming or traumatic for one person might not be for another. But for some parents, it is possible for feelings of fear, grief, helplessness and continued anxiety to result in a stress disorder.

What is a stress disorder?

Stress disorders include ASD (acute stress disorder) or PTSD (post traumatic stress disorder). These can develop in anyone who has seen or lived through a crisis or terrible event. You may have heard about PTSD in the news – many military veterans returning from active duty have developed it. The prolonged stress of deployment or the witnessing of traumatic events can trigger debilitating symptoms. But, PTSD can occur in anyone who has gone through a traumatizing event, including a NICU experience.

Every parent comes to the NICU with varying coping mechanisms, and react or handle the situation in their own, unique way. According to Stanford University researcher Dr. Richard Shaw, the NICU experience can be so traumatic that almost 60% of NICU parents were found to be at risk for PTSD. In some cases, the stress disorder continues for years after the baby’s birth.

It might seem logical that the longer a baby stays in the NICU, the more traumatic the experience may be for the parents. However, research shows that the impact of a shorter NICU stay, even less than two weeks, can lead to a parent developing ASD or PTSD. A stress disorder can occur along with postpartum depression (PPD), too.

How do ASD and PTSD differ?

ASD and PTSD share many of the same symptoms. The biggest difference between the two is when a parent’s symptoms begin.

  • ASD refers to symptoms that begin during the period from 2 days following an event up to 4 weeks post trauma. (The “trauma” in this case is the baby’s experiences in the NICU.) Symptoms usually start to occur while the baby is still in the NICU. ASD is a good indicator that the parent may later develop symptoms of PTSD.
  • PTSD symptoms occur later than ASD, starting from at least 4 weeks post trauma, and can last for years.

Both ASD and PTSD include symptoms such as trouble sleeping or staying awake, avoiding reminders of the event, and experiencing flashbacks, dreams/nightmares.

Additional symptoms of ASD include a lack of emotional responsiveness – you feel numb and like you’re in a fog.

Other symptoms of PTSD symptoms include physical responses (like a racing heartbeat or sweating) when reminded of the event, a depressed mood, persistent and exaggerated negative beliefs about yourself, little interest in activities, irritability, difficulty concentrating, hyper vigilance and startling easily.

What can lessen the likelihood of developing a stress disorder?

Researchers have found that NICU parents cope better when they:

  • feel involved with their baby’s care, such as reading to their baby, practicing kangaroo care (skin to skin bonding), decorating the isolette, taking the baby’s temperature, etc.
  • feel heard – they feel free to ask questions and fully understand what is happening to their baby in the NICU.
  • take care of themselves.
  • reach out and receive support from other NICU parent graduates who have been in their situation. March of Dimes offers an online community, Share Your Story, which is specifically designed to provide support and comfort to parents of babies in the NICU.
  • understand that the feelings of fear, anxiety, sleep interruption or loss of appetite might pop up unexpectedly once they go home.

Bottom line

The NICU experience can be difficult and even traumatizing. If you or someone you know has a baby in the NICU, please share this post with them so that they get the help they need. Parents suffering from ASD or PTSD can receive treatment from a healthcare provider who is trained in stress disorders (such as a social worker, psychologist or psychiatrist).

Have questions? Text or email them to AskUs@marchofdimes.org.

See other posts on how to help your child including how to transition from the NICU to Early Intervention services.

Your NICU healthcare team

Tuesday, September 29th, 2015

NICU doctor and baby resizedAt times, it may seem that there is a constant flow of different people caring for your baby in the neonatal intensive care unit (NICU).  A team of professionals work together to give your baby every possible chance of achieving good health.

Some or all of these people may be part of the NICU team at your hospital:

chaplain – A person who provides spiritual support to NICU families.

charge nurse – A health care provider who has nursing training. The charge nurse makes sure that the NICU runs well. This nurse also oversees admitting babies to and discharging them from the NICU.

clinical nurse specialist – Also called CNS. A health care provider who has special nursing training in the care of children and their families. The CNS helps parents deal with their baby’s stay in the NICU. The CNS provides support and teaches parents about their baby’s health condition. The CNS is also involved in nursing staff education.

family support specialist – A person who provides information, help and comfort to families when their baby is in the NICU.

lactation consultant – A person who has special training to help women breastfeed.

medical geneticist – A doctor who has special training in diseases that are inherited and other birth defects.

neonatal nurse practitioner – Also called NNP. A health care provider who has special nursing and medical training in caring for sick babies. The NNP works with the baby’s neonatologist and other medical team members. The NNP can perform medical procedures and care for babies.

neonatal physician assistant – Also called PA. A health care provider who has special medical training in working with sick newborns. The PA works with the neonatologist, performs medical procedures and may direct your baby’s care.

neonatologist – A pediatrician (children’s doctor) who has years of additional medical training in the care of sick newborns.

neonatology fellow – A fully trained pediatrician who is getting additional medical training in the care of sick newborns.

occupational therapist - Also called OT. A health care provider who helps figure out how well babies feed and swallow and how well they move their arms and legs.

ophthalmologist – A doctor who has special medical training in the care of eyes and vision.

patient care assistant – Also called PCA. A NICU staff member who helps nurses change bed sheets, feed babies and prepare bottles.

pediatric cardiologist – A doctor who has special medical training in the care of a baby’s or child’s heart.

pediatric gastroenterologist – A doctor who has special medical training in the care of a baby’s or child’s digestive system. The digestive system is made up of organs and tubes that digest (break down) the food a baby eats.

pediatric neurologist – A doctor who has special medical training in the care of a baby’s or child’s brain and spinal cord. A spinal cord is a bundle of nerves that carries signals between the brain and the body.

pediatric pulmonologist - A doctor who has special medical training in the care of a baby’s or child’s lungs.

pediatric resident – A doctor who is getting medical training in taking care of babies and children.

pediatrician – A doctor who has special training in taking care of babies and children.

pharmacist – A person who has special training in how medicines work and the side effects they may cause. People get prescription medicine from a pharmacist. Pharmacists also provide medicines in the hospital and may visit patients with the NICU team.

physical therapist – Also called PT. A health care provider who looks at any movement problems babies have and how they may affect developmental milestones such as sitting, rolling over or walking. The PT helps a baby improve muscle strength and coordination.

registered dietitian – Also called RD. A health care provider who is trained as an expert in nutrition. The RD works with the NICU doctors and nurses to help make sure babies get all the nutrients they need. Nutrients, like vitamins and minerals, help the body stay healthy.

registered nurse – Also called RN. A health care provider who has nursing training. An RN in the NICU has special training in caring for sick newborns.

respiratory therapist — Also called RT. A health care provider who cares for babies with breathing problems. An RT is trained to use medical equipment needed to care for babies.

social worker – A person who is trained to help families cope with their baby’s NICU stay. The social worker can help families get information from health care providers about their baby’s medical conditions, give emotional support, help families work with medical insurance companies, and help plan for when their baby comes home.

speech and language therapist – A health care provider who has training to help people with speech and language problems. In the NICU, this therapist often helps newborns with feeding problems.

surgeon – A doctor who has additional specialized medical training in performing surgery and other procedures.

technician – A member of the hospital staff who may draw blood or take X-rays (a test that uses small amounts of radiation to take pictures of inside the body).

At one point or another, you may encounter many of the above people while your baby is in the NICU. They all work together to provide continuous care for your baby. Learn more about pediatric specialties and how they may help your baby.

Remember – you are also an important member of the NICU team, too. Don’t ever hesitate to ask questions or speak up for your baby.

Have questions? Text or email AskUs@marchofdimes.org.

Priceless advice from a NICU nurse and mom

Tuesday, September 15th, 2015

Jessica sees her preemie Lily In honor of Neonatal Nurses Day, we talked to Jessica Zackula RNC, BSN, a NICU nurse and NICU mom. Jessica experienced the ups and downs of giving birth early and having her baby hospitalized in the NICU for three weeks. And, as a NICU nurse, she is aware of what parents need to know when their baby is in the NICU. Here is her advice for NICU parents:

“As a NICU nurse and NICU mom, here are 3 things I wish every parent knew walking through the doors of the NICU:

1.  Speak up for your baby.

  • You know your baby better than anyone in the NICU. You are an important part of your baby’s care team. If you have questions, be sure to ask them.

2.  Do the best you can with pumping and breastfeeding.

  • Breastmilk is one of the most important things you can give your baby while he or she is in the NICU. Even if your baby is too young to breastfeed, your baby can still receive breast milk through a feeding tube. Seek help on how to pump breastmilk.

3.  Take care of yourself; lean on other NICU parents to help get you through tough times.

  • No one knows the NICU journey better than another NICU parent.
  • It is important that you take time to care for yourself during the sometimes rocky ride through the NICU.
  • You and your baby will benefit from being well rested, drinking plenty of water, and eating healthy foods.”

Jessica realizes the value of parents working together with the NICU staff. Clear communication is key in understanding what is happening to your baby. Being an informed parent allows you to look out for your baby’s best interest and be her advocate.

More about Jessica…

Jessica Zackula RNC, BSNJessica Zackula RNC, BSN has been working as a Neonatal Intensive Care Unit (NICU) nurse at MultiCare Tacoma General Hospital in Washington, since 1999. Her daughter, Lily, was born at 32.2 weeks gestation in 2004, and was a patient in Jessica’s NICU unit for 21 days. Lily left the NICU to go home weighing just 3 pounds 5 ounces. Today, she is a healthy, bright 11 year old, who just began the 6th grade.

In 2010, Jessica was promoted to nursing leadership of the Tacoma General Hospital NICU, where she currently remains as the Clinical Nurse Manager. She is passionate about continuous quality improvement and creating an optimal experience for families in the NICU through integrated, family centered care.

In honor of Neonatal Nurses Day

We want to thank Jessica and every NICU nurse, for their dedication and tireless efforts to help fragile, sick babies. We know that their exceptional care makes a difference for each and every baby in the NICU.

NICU parents can reach out to other parents on Share Your Story, the March of Dimes online community, where you will find comfort and support. Also, we invite you to browse News Moms Need for other helpful posts on prematurity and life in the NICU.

Have questions? Text or email AskUs@marchofdimes.org

 

Brain bleeds in premature babies

Wednesday, August 12th, 2015

brainThe younger, smaller and sicker a baby is at birth, the more likely he is to have a brain bleed, also called an intraventricular hemorrhage (IVH). If you or someone you know has a baby with a brain bleed, it can be a very scary and upsetting experience.

Bleeding in the brain is most common in the smallest of babies born prematurely (weighing less than 3 1/3 pounds). A baby born before 32 weeks of pregnancy is at the highest risk of developing a brain bleed. The tiny blood vessels in a baby’s brain are very fragile and can be injured easily. The bleeds usually occur in the first few days of life.

How are brain bleeds diagnosed?

Bleeding generally occurs near the fluid-filled spaces (ventricles) in the center of the brain. An ultrasound examination can show whether a baby has a brain bleed and how severe it is. According to MedlinePlus.gov, “all babies born before 30 weeks should have an ultrasound of the head to screen for IVH. The test is done once between 7 and 14 days of age. Babies born between 30-34 weeks may also have ultrasound screening if they have symptoms of the problem.”

Are all brain bleeds the same?

Brain bleeds usually are given a number grade (1 to 4) according to their location and size. The right and left sides of the brain are graded separately. Most brain bleeds are mild (grades 1 and 2) and resolve themselves with few lasting problems. More severe bleeds (grade 3 and 4) can cause difficulties for your baby during hospitalization as well as possible problems in the future.

What happens after your baby leaves the hospital?

Every child is unique. How well your baby will do depends on several factors. Many babies will need close monitoring by a pediatric neurologist or other specialist (such as a developmental behavioral pediatrician) during infancy and early childhood. Some children may have seizures or problems with speech, movement or learning.

If your baby is delayed in meeting his developmental milestones, he may benefit from early intervention services (EI). EI services such as speech, occupational and physical therapy may help your child make strides. Read this series to learn how to access services in your state.

Where can parents find support?

Having a baby with a brain bleed can be overwhelming. The March of Dimes online community, Share Your Story, is a place where parents can find comfort and support from other parents who have (or had) a baby in the NICU with a brain bleed. Just log on and post a comment and you will be welcomed.

You can also leave a comment here on our blog, or send a question to AskUs@marchofdimes.org where a health education specialist is ready to assist you.