**Warning! I want to show you some pictures of premature infants…if you are not comfortable with this, this is your warning! I will stick with the PG version, but this is what I work with every day, so what I’M comfortable with may not be your comfort level!*
While I’m on the topic of work, I want to take a few moments to share about my job. Working in a neonatal unit is kind of top secret. Like most NICUs, I work on a locked-down unit, meaning only certain people have access to it. Parents of our little patients, the guests they bring with them, and Women and Infant’s staff are pretty much the only people allowed on our unit. They do this for security reasons. In the old days, hospitals had large nurseries and you could peek into the windows and see the babies. Unfortunately, horrible people in this world attempted and sometimes successfully stole babies from hospitals. So now our precious babies (both full term and premies) are in locked units.
That being said, not a lot of people besides those who have been involved or had experience in the world of the NICU know what I do or get to see the little patients I work with each day. Obviously, I cannot show you actual UAB patients, or discuss actual cases for the sake of confidentiality. However, thanks to the internet world, I can show you other premies and tell you about some general neonatal knowledge and share with you all the wonderful work that I love to do! And I love to talk about it, so if you’re willing to listen (or read!) then let’s go! 🙂
A baby is considered “term” if they deliver anytime after 37 weeks gestation. Full term (meaning a mother’s due date) is at 40 weeks. Pre-term is obviously anything prior to 37 weeks. Thanks to the medical science of neonatal medicine, it is possible to deliver a baby as early as 23 weeks and they still have a chance for survival. 23 weeks means delivering at only a 5 1/2 months pregnancy! Obviously these babies have many milestones they have to overcome in order to survive. They typically need ventilator support to breathe, they often have difficulties digesting the nutrition they are given, they are at very high risk of infection, and everything about their tiny little bodies is simply that…TINY! A 23-weeker typically weighs about 1 pound, around 500-600 grams. They fit in the palm of your hand.
Everyone remembers baby Josie (19th child of the Duggar family). She was born at 25 weeks weighing 1 lb. 6 oz…
Here’s another 25-weeker (who was only 15 oz. at birth). He is 1 week old in this pic…
There is a vast degree of developmental changes that occur between 25 and 32 weeks gestation. The most significant challenge for these infants is breathing. Their lungs lack the intricate branches that are used for ventilation. Another challenge is eating. Until infants reach at least 32 weeks, they don’t have the neuro-development to coordinate breathing and swallowing at the same time. This means until our babies reach 32 weeks adjusted gestational age, we provide all their feedings through a feeding tube either through their nose or mouth.
Once they reach 32 weeks, we can begin introducing the bottle. This can be a smooth and quick process, only taking a few weeks for the infant to fully transition from tube feedings to bottle feeding. Or it can take many many weeks. Typically, the more neurological challenges the infant has faced the more challenges they face with learning to eat. Brain bleeds are common in premature infants (Intraventricular Hemorrhaging, or IVH). Infants with larger, more severe IVHs have more significant neurodevelopmental issues. A large portion of my job consists of working with teaching infants how to bottle feed.
Also, premature infants have difficulty maintaining their heart-rates at times. They frequently have bradycardias, where their heart rates drop below 100 beats per minute. They often receive medication that helps them maintain their heart-rates, but in order to go home they must be weaned from this medication. It’s all a matter of time with most these infants. They also have to grow and be able to maintain their own body temperature. Typically when infants reach around 1600 grams (about 3 1/2 lbs), they are able to maintain an acceptable temperature, at least 97.6 degrees F. At this time we begin to wean them from their isolette to an open crib. But until that time, the isolette heats and cools to maintain their temperature.
There are SO many other things I could tell you about my day to day duties at work, but I don’t want to completely overwhelm everyone. So in a nutshell, here’s a typical day…
- get report at 0730 on the 3 or 4 infants in my daily assignment
- first “round” begins at 0800 with whoever eats first. Our babies eat around the clock, every 3 hours. So, there is always an 0800, 0830, 0900, and 0930 infant I round on, and then the cycle continues every 3 hours from that at 1100,1130, 1200, 1230….and so on.
- Infants on oxygen get vital signs written every 2 hours.
- Oral medications are typically given at feeding times closest to the meds’ dose time, with the exception of IV medications which are given within 30 mins of whatever the dose time.
- Full assessments are done during the 1st round. Continued assessments are done throughout the day and changes are charted accordingly.
- Labs are run typically on PM shift, but on day shift as needed.
- Some infants eat entirely by feeding tube. Some eat by bottle once a day, twice a day, or as often as tolerated depending on how far they are in their development.
- Babies are weighed every night, either the last round of day shift or the first round of night shift.
- Speech and physical therapy work with RNs to help infants grow developmentally.
- The day runs fairly smoothly unless an infant show signs of illness or worsening conditions. A “work-up” is then done which can be as simple as a few labs, or as complex as chest and abdominal x-rays (typically with breathing or digestion problems), lumbar punctures, and changes in medications, sometimes starting IVs for initiating antibiotics.
- And most importantly, working with parents and teaching them all the things they need to know about taking care of their baby.
Whew. How about that!? So I’ll leave you with some of my favorite pictures I came across today, all of which are very typical of what I see and work with every day!