Tyler's Trek

The Neonatal Intensive Care Unit (NICU) at Winnie Palmer Hospital is the fourth largest unit in the United States. Our NICU is capable of the highest level of care for high-risk newborns, and is organized to provide highly skilled, life-saving interventions to critically ill newborns.

 The Neonatal Intensive Care Unit (NICU) is one of the most crucial departments in the services array for Winnie Palmer Hospital.  It was established in 1975 at Orlando Regional Medical Center and transferred to Arnold Palmer Hospital for Children when it opened in 1989. Since then, the NICU has cared for more than 28,000 babies and consistently demonstrates the best outcome statistics in the state for low-birth-weight babies.;

Providing special care for sick and premature babies:

There have been many advances in the care of sick and premature babies, not just in technology and medicine, but also in meeting the special emotional and developmental needs of these babies. In the NICU, babies are often subjected to tests, procedures, noises, and lights - very different from the warm, dark, comfort of the mother's womb. Some babies are too sick to be held or have difficulty comforting themselves when not being held. Premature babies especially need a supportive environment to help them continue to mature and develop as they would in their mother's womb.

What is developmental care?

The practice of developmental care is used in many NICUs to meet babies' special needs. Developmental care involves many aspects: from meeting comfort needs and helping babies feel secure and develop normal sleep patterns, to decreasing stimulation from noise, lights, or procedures. Research into developmental care is finding many benefits for babies, especially for premature babies, including shorter hospital stays, fewer complications, improved weight gain, better feeding, and enhanced parent/infant bonding.

Developmental care includes changes in:

• the overall physical environment - changing the physical surroundings to provide normal day/night cycles and decrease noise and stress.

• the baby's immediate environment - providing cushions for supporting the baby's position and keeping the baby's arms and legs in proper arrangement to help with development and comfort.

• the way care is provided - using signals from the baby to plan care at times when the baby is awake and least stressed rather than interrupting sleep patterns or performing procedures when the baby is at a high stress level.

What is Kangaroo Care?

Kangaroo Care is a practice that originated in Colombia in the late 1970s that has been adopted worldwide because of the advantages for premature babies. Kangaroo Care means holding an NICU baby skin-to-skin (against the parent's chest) for varying lengths of time. Premature and sick babies that "kangaroo" appear to relax and become content. Numerous studies have shown that Kangaroo Care has many health benefits that include the following:

• higher blood oxygen levels

• improved sleep

• improved breastfeeding

• improved weight gain

Kangaroo Care also helps parents feel close to their baby, and gives them confidence in their ability to meet their baby's needs. Mothers who "kangaroo" also show improved breast milk production.

What monitoring equipment is used in the NICU?

NICUs are equipped with complex machines and monitoring devices designed for the unique needs of tiny babies. There are mechanical ventilators (breathing machines), oxygen, medications, and supplies for medical care. Furthermore, there is technology to monitor nearly every system of a baby's body including body temperature, heart rate, breathing, oxygen and carbon dioxide levels, and blood pressure. The following list includes some of the monitoring equipment often used in the NICU:

• heart or cardiorespiratory monitor
  This monitor displays a baby's heart and breathing rates and patterns on a screen. Wires from the monitor are attached to adhesive patches on the skin of the baby's chest, abdomen, and leg.

• blood pressure monitor
  Blood pressure is measured using a small cuff placed around the baby's upper arm or leg. Periodically, a blood pressure monitor pumps up the cuff and measures the level of blood pressure. Some babies need continuous blood pressure monitoring. This can be done using a catheter (small tube) in one of the baby's arteries.

• temperature
  A temperature probe is placed on the baby's skin with an adhesive patch. A wire connects the temperature probe to the overhead warmer (or isolette) to help regulate the heat needed to keep the baby warm.

• pulse oximeter
  This machine measures the amount of oxygen in the baby's blood through the skin. A tiny light is taped to the baby's finger or toe, or in very tiny babies, a foot or hand. A wire connects the light to the monitor where it displays the amount of oxygen in the baby's red blood cells.

• transcutaneous oxygen/carbon dioxide monitor
  This machine measures the amount of oxygen and carbon dioxide in the baby's skin. A small circular pad is taped on the baby's skin. The pad warms a small area of skin underneath and measures oxygen, carbon dioxide, or both. A wire connects the pad to the monitor and displays the levels. Because the transcutaneous monitor heats the skin, it must be moved to different places on the baby's skin periodically. The heating may leave a temporary reddened spot on the baby's skin, but this will fade. Transcutaneous oxygen levels are usually lower than levels of the pulse oximeter.

• ultrasound
  Ultrasound uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood blow through various vessels. In the NICU, ultrasound may be used to examine the heart, abdomen, and internal structures of the baby's brain. Ultrasound is painless and provides much information about a baby's health.

• x-ray
  Portable x-ray machines may be brought to the baby's bedside in the NICU. X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays are taken for many reasons including checking the placement of catheters and other tubes, looking for signs of lung problems such as hyaline membrane disease, and checking for signs of bowel problems.

• computed tomography (Also called CT or CAT scan.)
  A CT scan is a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. CT scans also minimize exposure to radiation. CT scans are sometimes done to assess bleeding inside a baby's head. A CT scan is done in a special room and the baby will need a sedative medication so that he/she will be motionless for the exam.

• magnetic resonance imaging (MRI)
  MRI is a diagnostic procedure that uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of organs and structures within the body. Like a CT scan, MRI is performed in a special area of the hospital. It is often done to examine a baby's brain stem, spinal cord, and soft tissues. The baby will need a sedative medication so that he/she will be motionless for the exam.

• endotracheal tube (ET)
  This tube is placed through the baby's mouth or nose into the trachea (windpipe). The ET tube is held in place with special tape and connects to a mechanical ventilator (breathing machine) with flexible tubing. An x-ray is used to check the tube's placement. When a baby has an ET tube, he/she is unable to make sounds or cry.

• respirator or mechanical ventilator
  This machine helps babies who can not breathe on their own or who need help taking bigger breaths. High frequency ventilators give hundreds of tiny puffs of air to help keep a baby's airways open. Ventilators can also deliver extra oxygen to the baby.

• continuous positive airway pressure (CPAP)
  Through small tubes that fit into the baby's nostrils, called nasal CPAP, this machine pushes a continuous flow of air or oxygen to the airways to help keep tiny air passages in the lungs open. CPAP may also be given through an ET tube.

• extracorporeal membrane oxygenation (ECMO)
  This is a special technique for babies with respiratory disease that does not respond to maximum medical care. With ECMO, blood from the baby's vein is pumped through an artificial lung where oxygen is added and carbon dioxide is removed. The blood is then returned back to the baby. ECMO is only used in specialized NICUs.

Source:  Orlando Health/Winnie Palmer Hospital website:  http://www.orlandohealth.com/winniepalmerhospital/index.aspx