Ask a parent what it felt like when first seeing their premature baby in an intensive care nursery. Chances are you’ll get two answers: scared and helpless.
The tiny newborn is connected to monitors, tubes and machines doing the work that the under-developed organ systems cannot. Ventilators help with breathing, feeding tubes deliver nutrients and enclosed plastic beds (“isolettes”) keep body temperature up. These babies can weigh as little as 2 pounds. With thin, almost translucent skin, their cries are weak. They are at risk for complications that, in some cases, can change quickly from mild to life-threatening.
“It was scary,” says Julie Gonzalez, whose son Leocardio was born prematurely at 30½ weeks gestation, weighing just over 2½ pounds. Mrs. Gonzalez says she got past the shock of seeing Leo supported by tubes and machines. “I could see him growing and getting stronger.” But other stresses were harder to handle.
Because their immune systems are so immature, preemies are highly susceptible to infections. Leo developed a serious infection that was not responding to antibiotics.
“At one point, I was told that he could possibly have a stroke,” Mrs. Gonzalez said. “I’m a strong person, but I just broke down.”
Through persistent testing, Leo’s doctors determined that the infection was centered in Leo’s heart, and they were able to treat it with a specific type of antibiotic. After six weeks in Cooper’s neonatal intensive care unit (NICU), Leo went home infection-free and weighing a much healthier 5 pounds.
Family-centered care taken seriously
Cooper’s NICU embraces a philosophy of “family-centered care” that has shaped all aspects of the unit, from nursery design to visitation policies to parent-staff interactions. By deeply involving parents in the baby’s routine care, Cooper helps parents overcome any feelings of helplessness. This ultimately helps their baby thrive.
“Here, the parents are not onlookers,” says Emma Brandon, R.N., B.S.N., M.H.A., Clinical Manager, who oversaw the NICU nursing staff until a recent promotion. “Bonding starts as soon as a baby is born, so we promote that as much as possible.”
Parents are encouraged to do what any parent of a newborn would do—change diapers, feed, cuddle and take temperatures.
“Even when babies are on ventilators, as long as they’re stable, we suggest ‘kangaroo care’ by placing the baby on the parent’s chest for skin-to-skin contact,” Ms. Brandon says. “It promotes bonding, plus it helps modulate the baby’s temperature.”
In Cooper’s NICU (pronounced “nick-u”), parents enjoy a 24-hour visitation policy. Ample space surrounds each bed so that entire families, including the baby’s siblings, can spend time there comfortably. Each baby has a bulletin board that families can post photos, drawings, cards and other mementos. Nurses often put up the baby’s footprints so parents can see the baby’s growth over time.
A Ronald McDonald House “Family Room” is next to the NICU where families can relax.
Close connections with baby’s medical team
Family-centered care also means parents have frequent contact with their baby’s medical team. Parents are invited to attend the twice-daily rounds, when doctors and nurses review the baby’s progress. From the baby’s very first week, parents can attend discharge planning meetings that address special needs the baby might have after going home.
Cooper’s NICU practices “primary nursing,” in which the same two nurses (day shift and night shift) are assigned to an infant throughout his or her stay. This provides consistent care and develops strong working relationships with the parents.
Julie Gonzalez says, “I felt very included. The doctors were on top of everything. They told me what to expect with Leo—and they were always right on the money.”
Mrs. Gonzalez raves about Leo’s nurses. “They were awesome,” she says. “I was amazed at what these nurses knew—how much they needed to know to do their jobs. And you could tell they cared. They acted as if the babies were their babies.”
More than two years after Leo left the NICU, she still brings him back to visit so the nurses can see how this former preemie has become an energetic and healthy child.
Emma Brandon agrees that NICU nurses and parents form bonds that last years. “As much as parents appreciate our nurses’ medical competence, they value their compassion,” she says.
Nurses pick up on problems that parents may have trouble expressing. “The very hardest thing for a mom is to leave the unit without taking her baby home,” she said. “Our nurses may gently say something like, ‘I know it’s hard for you to be going home without the baby.’ And the mother, instead of keeping these feelings inside, is able to open up and feel a little better.”
Each family’s emotional challenges
A premature infant is any baby born before 37 weeks gestation. About 10 percent of all births in this country are premature. Depending on the infant’s condition, he or she may spend weeks or months in a NICU.
“It can be very hard for parents,” says Gary E. Stahl, M.D., Division Head of Neonatology in the Department of Pediatrics. “To some degree, all parents mourn the loss of the image of the perfect, pink-cheeked, seven-pound newborn.”
While for some parents premature delivery is completely unexpected, others have time to prepare. Julie Gonzalez, for instance, was hospitalized at Cooper with preeclampsia, a condition during pregnancy that often leads to premature births. This condition usually develops in about 5 percent of pregnancies. Preeclampsia is usually marked by an increase of blood pressure and the presence of protein in the mother’s urine. Its cause is unknown.
“I knew ahead of time there was no way I was going to go full term,” says Mrs. Gonzalez, whose other three sons had been full-term, normal births. She was hospitalized to help Leo stay in utero for as long as possible so he could develop more.
Mrs. Gonzalez and her husband, Raul, had been through three frustrating and often-disappointing years of fertility treatments, finally conceiving Leo in what they had decided would be their last attempt at in-vitro fertilization (IVF). They were helped through the Cooper Center for IVF.
Then, just days after Leo was born, Raul, an army reservist, was called into active duty at Fort Dix. Mrs. Gonzalez was already nervous about living far from Leo. Their home in Landisville, NJ, is an hour from Cooper. Raul’s absence made her feel “all alone” in Leo’s care. A Cooper nurse suggested something that would make a world of difference: staying at a room at the nearby Ronald McDonald House.
The nonprofit Ronald McDonald House of South Jersey (which also sponsors the family room near the NICU), is across the street from Cooper University Hospital. Funded entirely by private donations, the national organization provides a “home away from home” for families of children being treated at local hospitals.
Mrs. Gonzalez seized the opportunity. “Staying at the Ronald McDonald House definitely helped the baby and me bond,” she says. “I could be with him anytime I wanted to.”
Raul stayed there with Mrs. Gonzalez whenever possible.
Understanding baby’s cues
In addition to its dedication to family-centered care, Cooper’s NICU is notable in that it follows the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), a medical model that sees the premature infant as an active participant in its own progress.
“We believe that preemies are competent human beings who can communicate their needs,” Dr. Stahl said. “By learning their ‘language’—that is, by understanding their cues—we can create an environment and provide care that support their needs.”
Under the NIDCAP model, doctors and nurses focus less on following rigid treatment schedules and medical protocols. Instead they place more emphasis on observing each infant’s behaviors. For example, if the baby puts up her hands when offered a feeding, she’s signaling that she’s not ready to eat. Instead of trying to enforce a strict feeding schedule, the nurse following NIDCAP will feed the baby later. Cooper’s NICU is one of only nine NIDCAP training centers nationwide.
Even in its design, the Cooper NICU is sensitive to preemies’ unique needs. “Keep in mind that in the third trimester their nervous systems are still developing,” Dr. Stahl says. “They’re used to being in a womb. They’re not expecting to be in a loud, bright, open space typical of most hospital units.”
“Neurologically, preemies expect to be in an environment that is relatively quiet although not silent, fairly dark, and pretty confined,” he said. To make the NICU preemie-friendly, the Cooper team makes sure the noise level is low, the lighting is soft and the bedding gives a comforting sense of being “nested.”
Parents, like preemies, are made to feel nurtured at Cooper’s NICU. “For those six weeks, the NICU was like my home,” Mrs. Gonzalez says. “I was so glad that Leo was at Cooper, and I hate to think of what could have happened if he was not there.”
“My experience there is something that will be in my heart forever,” she says.
To make an appointment with a Cooper University Hospital physician at an office near you, please call 1-800-8-COOPER (800-826-6737) to speak with a member of our physician referral and information service.