Neonatology: Caring for premature babies in the NICU

Part of a special report from the Tampa Bay Times on extremely premature births and the advances in neonatal care that can make survival possible. The delicate science of keeping preemies alive Caring for an extreme preemie in the first days of life means creating a 21-100% In oxygen is provided as needed. Room Out air is 21%. Check technological womb. Caretakers must perform a balancing act of measurements, odds and difficult choices. The Endotracheal tube connects the baby to the ventilator until she can breathe on her own. preemie's body, sometimes as small as a Barbie doll's, does not provide much access for the myriad tubes and sensors for Replogle tube temperature, oxygen intake continuous suction to vent stomach and nutrition, and more. acid or air. 40-60 breaths per minute is the optimal respiration rate Chest leads measure heart rate and 100-160 respiration. beats per minute is the optimal heart rate UVC The umbilical venous catheter runs up near the heart, dispensing medicine and nutrition: •Dopamine - for blood pressure • TPN - Total Parenteral Nutrition • Liquid fats • Antibiotics Caffeine UAC The umbilical artery catheter is used to draw blood. It provides a constant measure of blood pressure. Peripheral IV Is used to give blood products and sodium bicarbonate, which balances acidity in the blood. Blood pressure cuff Measures blood pressure every hour. 85-92% is the ideal oxygen saturation in the blood, measured by the pulse oximeter The footprints of Juniper French, born at 23 weeks, measured 1.5m. in. Aglossary of severe complications Babies born weighing less than about three pounds are at risk for the following: 7* Severe 6" bleeding in the brain %, Retinopathy of prematurity the fully developed lungs of a newborn compared to those of a preemie Intraventricular hemorrhage iş most common in babies born before 30 weeks of pregnancy. It can cause pressure in the brain and brain damage. Is an abnormal growth of blood vessels in the eye. In severe cases, laser surgery is required to prevent vision loss. 26 Chronic lung disease CLD is a breathing problem that affects mainly babies born before 32 weeks or who are put on a breathing machine after birth. It is often related to bronchopulmonary dysplasia and is treated with respiratory therapy. 30% Patent ductus arteriosus % Necrotizing An unborn baby has an open cardiovascular blood vessel that normally closes on its own. When a baby comes too soon, sometimes doctors have to close the vessel. Left untreated, PDA can lead to heart failure. enterocolitis NEC is the death of intestinal tissue Sepsis thought to be related to Serious infection is usually caused when bacteria bacteria or to make toxins that cause the immune system to attack the body's own organs and tissues. Preemies are susceptible due to their immature immune systems. It is treated with medication. decreased blood flow to the bowels. It causes feeding problems and can be fatal. An incubator for a womb Some of the first incubators were modeled after those used for poultry. An early one was designed by the director of the Paris Zoo. In the early 1900s, hospitals had no facilities for preemies. A doctor named Martin Couney saved many babies by exhibiting them in incubators at expos and World's Fairs as a 10-cent sideshow. Today, the GE Giraffe Omnibed is a hospital standard. One doctor calls it the "BMW Bed" because it costs as much as a car. :43 100 23 == 10,8 853 PHILIPS 36.8 t037°c O hours is the optimal temperature for early preemies. A heat lamp and a radiant warmer built into the mattress keep the baby warm from all sides. The incubator's air flow system can maintain the proper temperature even when the hood is every a hands-on assessment is performed. Caretakers try not to disturb the baby more often than that. A monitoring system alerts them when they're needed. 4, Girane A portholes open. provide access for diaper changes and repositioning. Parents are encouraged to touch their babies but are taught not to overstimulate them. 95% ) is the ideal humidity level. Humidity protects the delicate skin not yet ready for everyday handling. Preemies' skin easily tears, which can lead to infection. $35% 360 Cost of the Omnibed. 45 minutes of battery power can be provided for transfers to treatment in an emergency. Rotation of the "baby Susan" allows for improved access during critical procedures. Sensors in the bed provide temperature and weight readings useful in dosing and treatment decisions. or Never let go: a micropreemie's story Visit tampabay.com/neverletgo to read the story of Juniper French, born in 2011 at Bayfront Medical Center and cared for in the NICU at All Children's Hospital in St. Petersburg, Fla. When the baby came four months early, Kelley Benham and her husband faced impossible questions. Was the dream of a healthy baby too much to hope for, the cost of saving her too high? And if so, did they have the strength to let her go? Sources: March of Dimes, Eunice Kennedy Shriver National Institute for Child Health and Human Development, G.E., spokesman Roy Adams and Tampa Bay Times ses Tracy Hullett and Scott Levengood from All Children's Hospital. Research assistance from Natalie Watson. tampabay.com Photos: Cherie Diez | Times Graphic: Kelley Benham, Lee Glynn | Times 11.4 was how long baby Juniper measured at birth. Roughly in. the size of a Barbie doll, she weighed only 1 lb. 4 oz.