PRE­MIUM PREEMIE CARE

Neona­tal ICU pro­motes par­ent, child bond­ing

Vancouver Sun - - FRONT PAGE - pfay­er­man@post­media.com

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.”

JASON PAYNE

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 than in the ex­ist­ing fa­cil­ity.

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.

FRAN­CIS GE­OR­GIAN

Amanda Lock­itch spent 10 days with her baby Eli­jah, who was born pre­ma­turely, in the NICU room-shar­ing pi­lot project.

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