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Helping premature babies thrive

Providing TLC at the ICU

New mom Marjory Co, left, helps Missy Scholze, a Madigan NICU nurse, take the temperature of Co’s son, Angelo. Angelo was born Aug. 18 and now weighs 5 pounds. (Photo Madigan PAO)

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Some babies are born too early, before their bodies are ready to keep their breathing or their temperatures steady. Others may have a birth defect like a cleft palate, which requires specialized feeding before surgery. Still, others may be born with a narcotics addiction, or with an infection, or with heart disease.

Whenever the hospital’s tiniest babies need specialized treatment, they’re placed in the care of the highly-trained nurses of Madigan Army Medical Center’s Neonatal Intensive Care Unit.

The staff knows just how harrowing having an ill or premature baby can be, so they strive to make the NICU a welcoming place for parents to be with and even help care for their babies.

“Whenever they want to come in even if it’s 3 o’clock in the morning to visit their baby, the nurse is at the bedside,” said Kristy Rowland, the clinical nurse officer-in-charge of the NICU.

While the NICU cares for anywhere from six to 16 babies a day, the NICU nurses realize that the parents need some extra care as well.

“You give the babies the TLC, but the parents need the emotional support,” said Carmelita Rivero, the unit’s assistant clinical nurse officer-in-charge.

Much like an adult ICU, needing the care of a neonatal ICU is not something most families anticipate.

“I don’t think any parent or family who goes into being excited about a pregnancy ever thinks about being in the NICU, so it’s a very hard deviation from the idea of the birth plan,” Rowland said.

While the NICU staff offers emotional support to families — bringing in social workers and chaplains as well — they also provide individualized training for parents on everything from gavage (or tube) feeding to changing diapers to explaining complicated medical care.

Care for infants gets even more complicated because the physiology of infants can be markedly different than adults; breathing rates are faster, blood pressure is lower, and the healthy range of lab results such as pH blood gasses can vary more safely in infants than adults.

“Things that we might see in adult labs or procedures might be opposite in neonates, so it’s very different for how you care for the entire patient,” Rowland said.

Likewise, whenever babies are given medication, the NICU staff is meticulous with how they dole it out, according to Rivero. Despite the years of experience each NICU nurse brings, two nurses pair up to give every single medication to ensure they give the appropriate dosage based on the babies’ weight at the right time and in the best way.

There are four levels of care available at NICUs; the highest is level IV and Madigan is a level III hospital. The NICU’s ability to provide Level III care means they can provide nearly all of the highly specialized care that infants might need; in fact, Madigan sees regional Navy patients as well as transfers from Korea and Hawaii whose parents often come here on compassionate reassignments. Babies stay as short as 24 hours when they’re being observed for reaction to a medication, for instance, and as long as several months; premature infants can be cared for at the NICU as early gestation as 23 weeks.

“Madigan’s NICU in particular has some of the highest outcomes across the nation” in areas such as infection, chronic lung disease and more, Rowland said.

Rivero credits those high rates to the experience of the NICU staff; most NICU nurses at Madigan average about 10 years of experience in the NICU while serving prior as maternal child nurses before that.

Rowland also points to the culture of using evidence-based practice to provide the best patient care.

“There is a passion in here to do what’s best for the baby,” Rowland said. “It’s really a community; people stay here because we love this job. Taking care of (service members) and their babies means a lot to us.”

While Rivero got her start in the field as a military pediatrics nurse who transitioned to NICU nursing in the 1990s, Rowland grew up watching her mom, also a NICU nurse, make a difference in the lives of some of the most vulnerable patients. She went into NICU nursing to give families that same hope herself.

The best outcome is when parents come back to visit with the staff and show off their healthy babies.

“It’s amazing to know that you can make a difference,” Rowland said.

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