Today’s post offers parents some information on who may be part of their baby’s care team in the NICU – and what, in general, their roles may be. There may be many different members on your baby’s care team – especially in a Level III NICU. These care providers may rotate in and out based on your baby’s needs and daily goals of care, their own schedules and the needs of other babies in the NICU. As important as knowing what they do is knowing who they are – in other words – their names! The human connection is essential in fostering what will be the all important parent-provider partnership that may last many weeks or months.

1. Your baby’s physicians are called neonatologists. They are pediatricians who have been specifically trained in the care of newborn babies or neonates.
2. Nurses in the NICU are specifically trained to care for neonates. They provide the day-to-day care and know best the goals of the daily care plan for your baby. Get to know your baby’s nurses. They are the human face of high-tech care. Nurses in the NICU generally work 12-hour shifts. Because the work is very demanding their schedule may be something like 2 days on and one day off. You may not have the same nurses every day as they rotate around the nursery based on the daily assessment of the needs of all the infants. As a result, you will most likely work with many nurses over the course of your baby’s stay in the NICU. As in any life situation, you will find that you develop different relationships with different nurses based in part on personalities and how closely you work with them.
3. Respiratory Therapists can be an integral part of a preemie’s medical care team because the lungs are the last major organs to develop in utero. Infants may need extra help in maturation and monitoring to avoid respiratory distress, which is carefully supervised by respiratory therapists.
4. Physical and Occupational Therapists: Neonates, because they arrive too early, often need help with sucking and feeding – which falls under the realm of physical therapists. Occupational therapists will work with babies to position them in the isolettes to maximize healthy growth of their limbs.
5. Social Workers work with families on logistical and financial issues and organize ongoing care if your baby needs it once he or she leaves the NICU.

While your medical team provides the highly technical and specialized care your baby needs to mature given interrupted gestation, ask your nurses how you can participate in day-to-day care – when can you hold, bathe, feed and change your infant? Your baby needs your loving care just as much!

I would love to hear from readers how they learned to partner with their baby’s care team.

Every expectant mother eagerly awaits the day when she will finally hold her baby in her arms. But for mothers of premature or very sick newborns – that moment is postponed as their baby is whisked away by a team of highly trained physicians and nurses to be cared for in the most high-tech of hospital units – the Neonatal Intensive Care Unit called the NICU (rhymes with “pick you”).

Parents of premature or sick infants must contend with many stressful elements that can accompany a stay in the NICU – first and foremost the reality that you will leave while your baby will stay behind – often for weeks or months. The sights and sounds of incubators, monitors, tubes and other medical equipment combined with teams of specialist physicians and nurses speaking a foreign, medical language as they provide complex treatment to the most tiny and fragile of patients can, understandably, be overwhelming to parents. Worry and questions about one’s baby are coupled with worry and questions about understanding the NICU itself.

In my book, The Patient’s Checklist, I offer patients and their families 10 simple and common-sensed based checklists to help navigate a hospital stay. This week I will be provide basic information, strategies and checklists tailored to help parents cope with having an infant in the NICU. Clear communication, as in all healthcare interactions, is key to partnering with your baby’s medical team. An ongoing dialogue with your baby’s physicians and nurses is the foundation to understanding and participating in your infant’s care. But where to begin?  Ask as many questions as you need to so you can make informed choices about your baby’s care. Your first question may be “When can I hold my baby?” and that seems a fitting place to begin.

It can be very hard for parents to feel that they play a vital role in their preemie’s day-to-day care when that care is so technology driven. But your role is the most important of all. Your infant may now be the tiniest of patients but he or she is first and foremost your child.  Even in these first days and weeks of life, you instinctively know your baby in a way that the doctors and nurses never will. You will find the best ways to bond with your baby within this complex and unfamiliar environment even if at first you cannot hold your baby. Your voice, which your infant recognizes at birth, can provide that first connection and comfort. As you gain your bearings, your insights lend a powerful perspective to your child’s care. Your infant needs you as both loving parent and engaged advocate in the NICU.

If your baby was in the NICU, what did you do the first few days to help you get adjusted?

Babies Are Built from Food

When a brand-new baby opens her eyes and, for the first time, settles her gaze on her parents with a spark of recognition, something very complex has taken place. The light in the room has focused through a tiny living lens to project an image on the canvas of tightly packed nerve cells in the back of her eyes. The postage-stamp- of tissue that we call the retina contains miraculous little rods or “black-and-white” receptors that photograph the ever-changing patterns of light and darkness before her eyes. They transform images from across the room into coherent neural signals that race along the optic nerve, through the optic chiasm, separating and rejoining until they reach the occipital lobe of her brain, a processing system of daunting speed, power, and complexity.

And all of this intricate, invisible complexity in her first glance has been built out of food.

The realization that babies are built from food is both liberating and inspiring. With a new baby, you have the ability to “get in on the ground floor” when you invest in your child by making healthy food choices.

During pregnancy, and in the months before, each healthy food choice has a bigger payoff than at any other time of life. Even a little change in the right direction can have big rewards. It can help you become even better soil in which your child grows.

As we’ll see, a mother’s body is designed-with its special cravings and aversions, with its changing sense of taste and smell-to help choose the best foods for her baby. And her baby is designed to make the best use of those foods, to learn from her mother about what foods to eat, how much to eat, and how to use those calories. It starts even before she is born.

If you’ve ever had a massage, you know how soothing and wonderful touch can be. Infant massage has been the subject of recent studies and shown remarkable benefits. Dr. Marshall Klaus reported that in one study of premature babies, those who received three 15-minute massages a day had nearly 50 percent better weight gain, scored better on developmental tests, and went home from the neonatal intensive care unit an average of six days earlier! For full-term babies, a daily massage during the screaming stage can reduce crying and improve sleep for all concerned.

Massage can be particularly powerful if Mom is depressed. Not only does the baby’s crying decrease, but the brain wave patterns of distress and depression measurably decrease as well. In my experience, Mom also benefits directly from giving the massage (the reduced crying) and also benefits from getting a massage of her own.

Your instincts on how to give a soothing massage to your baby are probably all that you need. But here are some ideas. You might put on some of your favorite relaxing music. With your baby on his back, the feet are a great place to start a soothing massage. You can gently rub the top of the foot with your thumbs and the bottom with your fingers. Then separate his toes, and roll each one lightly between your thumb and forefinger, perhaps tugging slightly. Next, make a circle around the foot with one hand, and pull his foot through, hand-over-hand, and again with the other hand. You may want to lay his leg on one palm and knead the calves and hamstrings. End with gently pulling his whole leg through the partial circle of your hand, from foot to thigh, over and over, working toward the heart. Now it’s the other leg’s turn.

You can do the same for each hand and arm. Open his hands and gently knead and rub the palm and the back of the hand with your thumbs and fingers. Separate the fingers, and one by one pull each through your thumb and forefinger. And then his whole arm through the circle of your hand, working toward the heart.

You can turn him on his tummy, and let your hands glide down his back in gentle, firm strokes, with thumbs just to either side of his spine.

There is no one magic method. Be an artist with your hands to gently massage your baby, paying attention to his cues and your own. I’m a fan of relaxing music, warm towels, and perhaps a little baby oil or infant massage gel. Candles, a safe distance from your baby, can be a mesmerizing treat. There is something primal about a flickering flame.

This is an excerpt from: From First Kicks to First Steps: Nurturing Your Babys Development from Pregnancy Through the First Year of Life, McGraw-Hill, 2004, Pp 230-231

When a baby is admitted to a neonatal intensive care unit (NICU), life can be quite stressful for the baby – and for the parents. Mothers often report that being separated from their babies, especially not being able to hold their babies, is particularly stressful. Researchers at University Hospital, Linkg, Sweden wondered whether encouraging skin-to-skin contact might reduce stress. The exciting results of their study appear in the November 2005 Pediatrics.

Previous studies have shown that kangaroo, or skin-to-skin care is safe, and can improve breastfeeding rates and improves bonding between mother and infant. It can act to effectively reduce pain during uncomfortable procedures. And it can reduce medical complications when compared to incubators. What does skin-to-skin care do for stress?

The researchers studied 17 preterm babies from 25 to 33 weeks gestation to find out. First, they measured cortisol levels in the saliva of the babies, recorded their heart rates, and because pain is one facet of stress, used 2 different pain scales to assess their comfort. In their mothers, they also measured cortisol, heart rate, and visible stress levels, as well as having them perform a mood survey.

Everyone was stressed before the first skin-to-skin contact. Mothers also reported low mood, especially low levels of control, calmness, and pleasantness. Then, the mother changed into a hospital gown that opened down the front. The baby was removed gently from the incubator and placed on the mother’s chest in an upright position. The baby was wearing a cap and a diaper. She or he was placed inside the mother’s hospital gown with extra blankets on top. The mother was given a mirror so she could watch her baby’s face while they cuddled. The father was sitting on a chair close to the mother and baby.

The babies were immediately less stressed. But the effect on the mothers was even more dramatic. And by the fourth 30-minute session, when moms were comfortable holding their tiny preterm babies, their stress hormones had fallen by 32 percent, their stress indicators had dropped by 89 percent, their heart rates had relaxed, and their moods had increased significantly. I only wish that the fathers in the study had also enjoyed sessions of skin-to-skin care. What a simple, wonderful way to make life better in the intensive care unit – for babies and also for parents!