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Neonatal Intensive Care Unit: What is it like to work with the tiniest and most fragile patients?


Korey Huyler for GBMC

May 7, 2018
The most vulnerable patients at GBMC aren’t always in the cancer unit or Emergency Department. Think again. The most fragile (and tiniest) patients are cared for in the Neonatal Intensive Care Unit, best known as the NICU.

Here you will find babies born prematurely (as early as 23 weeks), along with babies with respiratory problems, organs that aren’t fully formed, neurological issues and many other potentially devastating realities.

With pre-term babies, everyone is involved with every decision. We meet with the families. We're a team.
“It’s an awesome responsibility that we’re entrusted with to care for these sick and pre-term babies,” explains Dr. Howard Birenbaum, a neonatologist and director of the Division of Neonatology at GMBC. “I’m not just talking about the baby; we are working with the whole family. With pre-term babies everyone is involved with every decision. We meet with the families. We’re a team.”

For a bit of background, a neonatologist is a pediatrician with three additional years of training focused on newborn medical care. He or she cares for newborn babies, sick babies and premature babies in a regular hospital setting or in a specialized area like the NICU, which is designed for critical-care scenarios.

GBMC is home to a Level 3 NICU, which is capable of caring for very small or very sick infants, says Kristin Trawinski, MSN, RN, and clinical manager of the GBMC NICU.

“Level 3 NICUs have a wide variety of staff available including neonatologists, neonatal nurses and respiratory therapists available 24 hours a day,” she says. The NICU staff members also include neonatal nurse practitioners and neonatal physician assistants who also provide care and perform needed procedures. “A common challenge in the NICU is making sure our communication with the families and multidisciplinary team is consistent and accurate. In order to have the best plan of care, we need to be on the same page with our families and each other.”

In addition to their low birth weight (some as little as a pound or less), pre-term babies typically have many obstacles to overcome.

“The smallest babies often have lungs that don’t work yet,” explains Birenbaum. “Some require oxygen, others require more support with Bubble CPAP [a noninvasive ventilation strategy for newborns with infant respiratory distress syndrome], and some require endotracheal intubation [placing a breathing tube in the baby’s windpipe] and mechanical ventilation and surfactant replacement therapy.”

Another struggle is nutrition. “There is no way to match what the babies would be getting if they were still inside their mother. That is a major challenge,” explains Birenbaum. “By using mom’s own milk, we can help prevent infection and certain gastrointestinal illness. We also have a milk bank on site that we depend on.”

Other challenges include risk of infection, brain hemorrhage, visual problems, and long-term neurodevelopmental outcomes. Every decision along the way is made with the family. “We always make sure we have the involvement of the families,” says Birenbaum. “It’s something we try to do from the very beginning. We want the parents to be part of the team. Examples are skin-to-skin care and routine daily care such as taking temperatures and giving baths.”

Trawinski is also extremely proud of the family involvement.

"We share so much with these families and rejoice in their infants as they grow and thrive"
“We also sympathize and share in the grief of the families that go through some tough times,” she says.

Successes in the NICU come on a daily basis — everything from sending babies home with their parents to avoiding complications of prematurity to working with parents on a successful plan of care. For the NICU staff, it ends with sending the family home and eventually seeing the babies and their families at the annual NICU reunion and other events, like the Father’s Day 5K and 1-Mile Fun Walk, which benefits GBMC’s NICU.

“It always amazes me how these tiny, fragile infants are incredibly resilient,” says Trawinski. “I enjoy working with the families in order to help them cope with the highs and lows of having a premature infant. I really respect the multidisciplinary team that care for these infants.”

Birenbaum says the job is rewarding for a number of reasons.

“We are able to help babies in need and watch them grow and thrive,” he says. “But neonatology is still a young field, and there are a lot of questions still to be answered about the best way to manage babies’ care in order to provide the best possible outcomes. We’re just beginning now. There have been some major advances, which has significantly increased their survival. It’s a field that is ripe for ongoing clinical research.”
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