NICUs: Working Together to Help Their Patients

Wendy Levinson Beth Israel Deaconess Medical Center correspondent

SEPTEMBER 01, 2012


According to the Centers for Disease Control and Prevention (CDC), more than a half million babies in the United States - that's one in every eight - are born premature each year. And, the rate of premature births in the United States has risen 36 percent in the last 25 years.

A premature birth is a birth that occurs at least three weeks before a baby's due date or less than 37 weeks into a woman's pregnancy. Preterm babies are at greater risk of infections and complications because their organs haven't fully developed. The earlier a baby arrives before the actual due date, the greater the risk of severe health implications.

In Massachusetts, there are 10 medical institutions with Level III Neonatal Intensive Care Units (NICU). A Level III NICU is capable of caring for the sickest of newborn and preterm babies.

Massachusetts is one of just a few states where these NICUs share information in an effort to help ensure the best outcome for their patients - the tiniest and most vulnerable. DeWayne Pursley, MD, Chief of Neonatology at Beth Israel Deaconess Medical Center (BIDMC), is proud of the cooperative efforts amongst the facilities and faculty, and what they are learning from each other. He leads the team at BIDMC's Level III NICU.

There are 4,800 babies born each year at BIDMC, and more than 900 are high-risk newborns. In addition, BIDMC'S community partners, including Mount Auburn, Beverly, Anna Jaques and Winchester Hospitals, transfer 12 to 15 high-risk obstetric patients each month to the NICU. On an average day, the unit provides care for 40 babies.

BIDMC has newborn specialists on-site 24/7, together with a staff and unit capable of caring for the sickest or most premature babies. The babies who have gone through BIDMC's NICU range in gestational age at birth from 23 to 42 weeks, and are as small as 13 ounces to as large as 13 pounds at birth.

When Dr. Pursley meets expectant high-risk mothers for the first time - those who are likely to deliver a preterm newborn who will require intensive care - he helps prepare them, wishes them well and often says, "I hope to not meet you again."

Working closely with the specialists in BIDMC's maternal-fetal medicine division, the NICU team tracks high-risk expectant mothers on the Labor and Delivery floor. They coordinate the many different services that may be needed if any newborn is to be placed in their capable car.

All specialty care is provided within the NICU, a warm and caring state-of-the-art facility designed with the comforts of families and their newborns in mind. The NICU team includes 12 full-time neonatologists and nine nurse practitioners as well as neonatal clinical nurses, dieticians, social workers, occupational, physical and respiratory therapists, feeding specialists, pharmacists, and perinatal social workers.

"Most mothers don't expect that they will have babies who will require intensive care and will have done everything to ensure a healthy baby," says Dr. Pursley. "I remind and reassure the majority of mothers with newborns who do end up in the NICU that they did everything they could to ensure they'd deliver healthy babies, and - in most cases - these conditions could simply not be prevented."

This was the case when Marley Belle, a baby delivered full-term (39 weeks) at BIDMC, was whisked away to the NICU the day after her birth, with her mother Beth by her side. Born on September 2, 2012, doctors thought they heard a heart murmur in baby Marley at birth and, again, 24 hours later.

The team of NICU specialists went to work evaluating Marley. They monitored her blood pressure, performed an EKG and an X-ray, and examined her closely for several hours. All test results came back normal. The BIDMC neonatologists and a specialist from Children's Hospital eventually determined she was okay to go home as planned, with strict instructions for a follow-up exam by her pediatrician in two days.

Fortunately, Marley's pediatrician ruled out a heart murmur or anything serious. She received a clean bill of health. While Marley's stay at the NICU was relatively brief, it was certainly an emotionally charged time for her family.

Beth, an experienced mother of four and considered high-risk due to her age, 42, had never even been inside a NICU. She recalls how scared she felt, but that the staff was "so nice and calming."

NICU social workers are assigned to meet the needs of the families, for both long and short term stays. In addition to social workers, there are numerous other NICU support programs available to families of newborns.

Susan Young, RNC, MS, a Clinical Nurse Specialist at the NICU, immediately highlights the breastfeeding program with an emphasis on helping mothers provide their own milk, aided by the latest and most technologically advanced pumps and NICU-dedicated lactation consultants.

"Because many of the babies are so young and immature, they are not able to breastfeed for many weeks," she explains. "Our lactation consultants are trained specifically for the NICU and to handle the unique challenges these new moms have."

Additional programs BIDMC's NICU provides to families include a "cuddler" program, developed for medically stable infants to be held and rocked; Lullabies for Little Ones, a stimulating infant music program; car seat training; CPR training; infant massage; a support group to meet other "NICU graduate" families after discharge, as well as a playgroup for the children.

"Some newborns stay for just a few minutes for evaluation and triage, while others stay as long as five months. Some go right home and some need rehabilitation services next," explains Dr. Pursley. "It's important to remember that a great majority of these babies do go home healthy."

And, with top Massachusetts NICUs collaborating, that can only mean even better results on the horizon.


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