PREMIUM PREEMIE CARE
Neonatal ICU promotes parent, child bonding
High-tech equipment has made a huge difference in the survival of the frailest and tiniest of premature babies. But the latest evidence shows that having the proper environment in neonatal intensive care units and lots of old-fashioned skin-to-skin contact between parents and babies provide myriad health benefits for both.
So in the state-of-the-art neonatal intensive care unit, or NICU, that opens next month in the new Teck Acute Care Centre on the campus of B.C. Children’s and Women’s hospitals, parents will be given every opportunity to bond intimately with their babies. That’s because parents with a baby in intensive care will now be able to sleep in spacious, quiet, spa-like rooms next to their baby’s incubator, even when babies are born at the threshold of viability, as early as 22 weeks into the usual 40-week pregnancy.
Premature and sick babies have traditionally been deprived of constant contact with their parents because the conventional design of such intensive care units is a central nursery in which incubators are lined up in rows, offering no privacy or space for visiting parents, not to mention being less than conducive to breastfeeding and cuddling.
While fragile infants in the new single-occupancy NICU suites will still spend much of their time cocooned in $70,000 incubators, the new style of care creates favourable conditions for ideal baby development and parental bonding. It is expected to reduce infections, improve sleep, decrease the length of hospital stays and reduce hospital readmissions, among other benefits.
And in a precedent-setting model of care, some mothers who have just given birth at B.C. Women’s Hospital — even those who have had a caesarean section — will not only share a room with their babies, they will also receive their postpartum care from the same nurse assigned to their fragile infants. The NICU mom and baby co-sharing of a room and a nurse is being called a “flagship initiative” — a North American first of its kind care model that will be rolled out gradually in up to 12 of the 70 NICU suites (The other 58 are designed for mothers who don’t need medical care to live with their babies).
Before committing to mothers and babies sharing rooms, the hospital renovated space in the old NICU to conduct an experiment in what a mom and baby sharing a room might be like. Seven months ago, when her baby Elijah was born six weeks prematurely, Amanda Lockitch was one of the first new moms to participate in the roomsharing trial.
“I would have been discharged a day or two after delivering him, but I heard about this trial and I wrangled one of the rooms so I could be with my baby the whole time he was in the NICU,” Lockitch said. They were there for 10 days.
“I felt like I got a good crash course in neonatal care from the nurses. My baby had a feeding tube and was under the lights because he was jaundiced, but other than that he was healthy.”
Lockitch, an actress/filmmaker, said she grew curious about how nurses will be expected to not only train parents to take a more hands-on role but will have to care for postpartum moms as well.
“I started to ask nurses how they feel about this and I learned that some are more excited about this than others,” she said, adding that she’s applied for a grant to make a short documentary about the new model of care in the NICU.
“But as a parent of a baby who was in the NICU, I can tell you that I felt like I won the lottery by getting to stay in the room with my baby. I’m not a religious person, but it was a real blessing.”
The new NICU fully embraces so-called “kangaroo care,” named for its resemblance to the way kangaroos carry their young, except in humans it is all about skin-to-skin contact between newborn (often premature) babies and their parents. Most often that means holding a tiny baby upright against a bare chest. The approach provides both physiological and psychological benefits and is associated with improved baby weight, baby length, baby head circumference, successful breastfeeding, maternal satisfaction and better parental attachment to their babies.
A recent Cochrane meta-analysis review of the technique validated many benefits of kangaroo care, including a reduction in stress for moms and babies, lower mortality rates in babies, and a reduction in severe infections, hypothermia and other severe illnesses in the neonates.
The NICU at B.C. Women’s takes in 1,700 neonates each year. About 60 per cent of them are from Metro Vancouver, the other 40 per cent from across B.C. and Yukon.
There are 70 rooms — all private — in the neonatal intensive care unit in the new Teck Acute Care Centre, 10 more than in the hospital’s existing central nursery-type NICU.
The additional beds mean it is far less likely that pregnant women expected to need neonatal intensive care for their newborns will have to be sent out of province during busy times. That was a common practice in past years when a lack of beds or doctors or nurses meant women had to go to Alberta or Washington state. In 2008, for example, B.C. transferred a record 111 women outside the province. Now, only women living in the most eastern regions of the province may go to Alberta in emergencies, according to hospital leaders.
The new rooms in the NICU are so well-equipped that some minimally invasive procedures and surgeries, such as intestinal resections, retinal laser treatment, and vascular catheter placements, can be done in them so that babies in their incubators don’t have to be wheeled into operating rooms. The two-floor NICU also allows parents to dim their room lighting, do their own laundry, take showers, store food in fridges, clothes in lockers and enjoy natural lighting in all rooms.
Cheryl Davies, a vice-president at B.C. Women’s Hospital, said care in the new NICU will fully embrace the concept that parents are “partners” in health care, not just visitors. “They will be fully involved and nurses will be sharing the care of infants, but they are more like coaches, teaching parents.”
Davies concedes that the sharedcare approach may not work for all parents and their newborns, especially in rare cases of mothers with mental health problems who may pose a risk to their babies.
“All moms will be assessed and if risk factors such as acute psychosis, for example, are identified, then this model of care may not be suitable,” she said.
Davies acknowledges that having NICU nurses care for both postpartum moms and their babies is a major shift in the way health care is provided.
“It is a change, a paradigm shift in the way nurses have traditionally provided care. Some nurses have felt challenged by this and some are very excited. But there’s been lots of preparation leading up to the move. We’ve been training nurses to get them on board.”
Julie de Salaberry, director of maternal newborn programs at B.C. Women’s Hospital, said some babies stay in their NICU incubators (“baby’s first bedrooms”) as long as a year; private donors to the B.C. Women’s Hospital and Health
Care Foundation helped pay for incubators and other equipment in the NICU.
Although the official opening of the Teck centre is not until the end of October, de Salaberry invited Hilary Blackadar, a former patient who was involved in the design of the NICU, to tour the new unit.
In the planning stages, Blackadar and the rest of the parent advisory team used Lego pieces, cardboard and string to re-imagine rooms and care. Blackadar, whose son was born 12 years ago, said she kept moving the Lego pieces, continually asking, “Why can’t moms receive their own postnatal care in the same room as their baby?”
Eventually, hospital leaders relented and said, “why not?”
“We listened to the voices of moms and families about what’s important to them,” said de Salaberry.
“They told us that even after having a C-section, they wanted to be with their babies right away.”
De Salaberry said Blackadar “kept challenging us with why and why not discussions.”
Though Blackadar concedes she was persistent, she was still awestruck by the room designs in the soon-to-open NICU. During her tour of the unit, she sat on a brand new reclining chair while surveying the large patient suites, taking deep sighs and wiping away tears as they trickled down her cheeks.
The culmination of everyone’s efforts was “surreal and just perfect.”
Eleanor Lee is executive director of the B.C. Children’s and B.C. Women’s hospitals redevelopment project, which includes the new Teck Acute Care Centre. There are 70 rooms — all private — in the neonatal intensive care unit in the new centre, 10 more...
The existing neonatal intensive care unit at B.C. Children’s Hospital is often crowded. The new, larger NICU embraces so-called “kangaroo care,” where moms hold their babies upright against a bare chest.
Amanda Lockitch spent 10 days with her baby Elijah, who was born prematurely, in the NICU room-sharing pilot project.