Neonatal Intensive Care Unit (NICU)

I have always had a passion for working with little children and babies. There are no words to describe just how incredible they are. They are the main reason behind my decision to pursue nursing. Quoting the Stanford Children’s Health, “the birth of a baby is a wonderful yet complex process bringing about many physical and emotional changes for both the mother and the baby,” (Stanford Children’s Health, 2018.)

The joy of seeing little children getting better after an illness and eventually returning home has to be the best feeling ever. Honestly speaking, serving people in a field where you are truly passionate about is awesome. You always look forward to your next shift with zeal and zest, and even while on your shift one hardly realizes how fast time moves. It is even more gratifying to receive good feedback for the work one is doing.

The neonatal intensive care unit (vastasyntyneiden osasto) at the Central Hospital Central Finland has been an ideal place for me. The environment, the people in it and everything that goes on around the place can’t be compared to anything anywhere else. Everything seems to fit in place perfectly well. It is a great honour to be among the very few tasked with saving the lives of little children and infants.

However, this may not be the case for parents whose children have been admitted to the NICU. Stanford Children’s Health, 2018, points out that giving birth to a sick or premature baby can be quite unexpected for any parent. Furthermore, unfamiliar sights, sounds, and equipment at the ICU can be overwhelming.

According to Ionio and colleagues, 2016, parents of premature babies, in particular mothers, since the birth of their babies, are at risk of developing higher levels of anxiety, depression, anger and stress. Furthermore, the preterm infants’ external characteristics and signals associated with immaturity and severity of medical status could be a further stressor especially for mothers (Ionio, Colombo, Brazzoduro, Mascheroni, Confalonieri, Castoldi and Lista, 2016, 618).

It is important to understand what factors result in a newborn being admitted in the NICU. According to the Stanford Children’s Health, 2018, maternal factors, delivery factors, and baby factors can cause a baby to be admitted to the NICU. Maternal factors include; age of mother younger than 16 or older than 40, drug or alcohol exposure, diabetes, hypertension, bleeding, sexually transmitted diseases, multiple pregnancy, and the premature rapture of amniotic sac.

Delivery factors may include; fetal distress, breech delivery, meconium in amniotic fluid, nuchal cord around baby’s neck, and forceps or cesarean delivery. Baby factors include; birth at gestational age less than 37 weeks or more than 42 weeks, birth weight less than 2500 g, medication or resuscitation in delivery room, birth defects, respiratory distress, infection such as herpes, group B streptococcus, and chlamydia, seizures, hypoglycemia, need for extra O2, monitoring, IV, or medications, and need for special treatment or procedures such as blood transfusion. (Stanford Children’s Health, 2018.)

Ionio and colleagues, 2016, remind the healthcare personnel in charge of the neonates that it is important to support parents of preterm children from the very first moment after birth in order to reduce possible further negative consequences on preterm babies. Family-centered intervention is necessary in order to improve parents’ involvement in the care of their infant from the very first moment, to make them more conscious that they may have an active role in their infant’s development. (Ionio, Colombo, Brazzoduro, Mascheroni, Confalonieri, Castoldi and Lista, 2016, 620).

According to Dighe and colleagues, 2011,when a newborn is admitted to an NICU, the anticipated natural course after a much awaited birth takes a turn for the worse. Having a child admitted to an NICU creates a stressful situation for the parents. They are faced with a high technology environment that inhibits normal parenting activities. (Dighe, Muckaden, Manerkar, and Duraisamy, 2011, 106).

According to Ramezani and colleagues, 2014, decision making and the responsibility for taking care of neonates and supplying treatment at home can be gained by using the family members’ capabilities. Parents can recognize their own babies’ behaviors well and take care of them with their endless affection and attention. Their needs provide the basis to design care plans, so that qualified cares can be provided in accordance with all preferences and priorities. (Ramezani, Shirazi, Sarvestani, and Moattari, 2014, 273).

Involving parents in the care for their newborn is crucial in that it ensures a smooth transition of the baby after discharge from the hospital. Parents shouild have the knowledge and confidence of caring for their newborn.

According to Dighe and colleagues, 2011, appropriate pain control is an essential component of good neonatal practice. Babies who are very ill or are in severe pain may have limited expression of pain. This is a barrier to adequate pain relief of neonates who may continue to suffer. (Dighe, Muckaden, Manerkar, and Duraisamy, 2011, 106). The blood pressure has often been used to point out if and when an infant is in pain. Normally the blood pressure would be high. Also crying too often and for prolonged periods could be an indicator of pain in the infant.

Besides pain, some of the infections treated at the NICU may include: Group B Streptococcal Disease (GBS), Listeriosis, E. Coli infection, Meningitis, Sepsis, Conjunctivitis, Candidiasis, and Congenital Infections. Some of the signs of an infection on a newborn include; poor feeding, breathing difficulty, listlessness, very low or high temperature, unusual skin rush or change in skin color, and lasting crying and irritability.

The Neonatal Intensive Care Unit (NICU), at the Central Hospital Central Finland has 10 patients places. This is a closed ward. Extra caution is exercised at all times due to the vulnerability of the patients some of whom are premature. At the NICU, we have an ICU with 5 patient places and one extra place reserved for emergency cases. Patients in this room are under full-time monitoring by nurses and doctors.

We also have three recovery rooms and each can host up-to two patients at a time and a bed for mother to rest. There is also one extra room for isolation or emergency situations. The ward also has one parent room that is self-contained  where parents can stay with their new born.

Along the corridor in the ward is a standby incubator ready for use in transporting very sick or very premature infants (born before 32 weeks) by ambulance for further treatment in a different hospital. The staff consist of one head doctor and a resident doctor, a head nurse and an assistant head nurse, nurses, and the support staff who clean the ward full-time.

We also seek the services of other professionals such as lab technicians who take samples and give results, social worker, psychologist, physiotherapist and nutritionist who is in charge of formula milk for infants at the ward.

Generally, the NICU at the Central Hospital is fully equipped and properly staffed ready to handle even the most extreme of situations for infants. We believe that every life of every little child or infant is worth saving and fully prepared to act at all times.

References;

Dighe, M.P., Muckaden, M.A., Manerkar, S.A., and Duraisamy, B.P. 2011. Is there a role of palliative care in the neonatal intensive care unit in India? Indian Journal of Palliative Care; 17(2): 104-107.

Ionio, C., Colombo, C., Brazzoduro, V., Mascheroni, E., Confalonieri, E., Castoldi, F., and Lista, G. 2016. Mothers and Fathers in NICU: The Impact of Preterm Birth on Parental Distress. Europe’s Journal of Psychology; 12(4): 604–621.

Ramezani, T., Shirazi, Z.H., Sarvestani, R.S., and Moattari, M. 2014. Family-Centred Care in Neonatal Intensive Care Unit: A Concept Analysis. International Journal Community-based Nursing Midwifery; 2(4): 268-278-

Stanford Children’s Health. 2018. The Neonatal Intensive Care Unit. Accessed on May 28th 2018. Retrieved from http://www.stanfordchildrens.org/en/topic/default?id=the-neonatal-intensive-care-unit-nicu-90-P02389

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