Providing TLC for ICU babies
New mom Kimberly Neifert watches NICU Nurse Brandy Lor check the breathing rate of her daughter Ruelyn at Madigan Army Medical Center. Premature babies experience faster heart rates than adults and may also pause longer between breaths due to immature breathing patterns. (U.S. Army photo by Suzanne Ovel)
MADIGAN ARMY MEDICAL CENTER, Wash. — Some babies are born too early, before their bodies are ready to keep their breathing or their temperatures steady. Others may have a birth defect like a cleft palate which requires specialized feeding before surgery. Still others may be born with a narcotics addiction, or with an infection, or with heart disease.
Whenever the hospital's tiniest babies need specialized treatment, they're placed in the care of the highly-trained nurses of Madigan’s Neonatal Intensive Care Unit.
The staff knows just how harrowing having an ill or premature baby can be, so they strive to make the NICU a welcoming place for parents to be with and even help care for their babies.
"Whenever they want to come in, even if it's 3 o'clock in the morning to visit their baby, the nurse is at the bedside," said Kristy Rowland, the clinical nurse officer-in-charge of the NICU.
While the NICU cares for anywhere from 6 to 16 babies a day, the NICU nurses realize that the parents need some extra care as well.
"You give the babies the TLC, but the parents need the emotional support," said Carmelita Rivero, the unit's assistant CNOIC.
Much like an adult ICU, needing the care of a neonatal ICU is not something most families anticipate.
"I don't think any parent or family who goes into being excited about a pregnancy ever thinks about being in the NICU, so it's a very hard deviation from the idea of the birth plan," said Rowland.
While the NICU staff offers emotional support to families – bringing in social workers and chaplains as well – they also provide individualized training for parents on everything from gavage (or tube) feeding to changing diapers to explaining complicated medical care.
Care for infants gets even more complicated because the physiology of infants can be markedly different than adults; breathing rates are faster, blood pressure is lower, and the healthy range of lab results such as pH blood gasses can vary more safely in infants than adults.
"Things that we might see in adult labs or procedures might be opposite in neonates, so it's very different for how you care for the entire patient," said Rowland.
Likewise, whenever babies are given medications the NICU staff is meticulous on how they dole it out, said Rivero. Despite the years of experience each NICU nurse brings, two nurses pair up to give every single medication to ensure they give the appropriate dosage based on the baby's weight at the right time and in the best way.
The NICU's ability to provide Level III care means they can provide nearly all of the highly specialized care that infants might need; in fact, Madigan sees regional naval patients as well as transfers from Korea and Hawaii whose parents often come here as compassionate reassignments.
Likewise, whenever babies are given medications the NICU staff is meticulous on how they dole it out, said Rivero. Despite the years of experience each NICU nurse brings, two nurses pair up to give every single medication to ensure they give the appropriate dosage based on the baby's weight at the right time and in the best way.
The NICU's ability to provide Level III care means they can provide nearly all of the highly specialized care that infants might need; in fact, Madigan sees regional naval patients as well as transfers from Korea and Hawaii whose parents often come here as compassionate reassignments.
Babies stay as short as 24 hours when they're being observed for reaction to a medication, for instance, and as long as several months; premature infants can be cared for at the NICU as early gestation as 23 or 24 weeks.
"Madigan's NICU in particular has some of the highest outcomes across the nation" in areas such as infection, chronic lung disease and more, said Rowland.
Rivero credits those high rates to the experience of the NICU staff; most NICU nurses here average about 10 years' experience in the NICU and served prior as maternal child nurses before that.
Rowland also points to the culture of using evidence-based practice to provide the best patient care.
"There is a passion in here to do what's best for the baby," said Rowland. "It's really a community; people stay here because we love this job. Taking care of Soldiers and their babies means a lot to us."
While Rivero got her start in the field as a military pediatrics nurse who transitioned to NICU nursing in the 1990s, Rowland grew up watching her mom, also a NICU nurse, make a difference in the lives of some of the most vulnerable patients. She went into NICU nursing to give families that same hope herself.
The best outcome, she said, is when parents come back to visit with the staff and show off their healthy babies.
"It's amazing to know that you can make a difference," said Rowland.
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