Caring For The Smallest Patients

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When she would check in at the front desk to visit her prematurely born twin girls in the new CHOC Children’s neonatal intensive care unit (NICU) at St. Joseph Hospital, Mary Aguilar typically would be greeted with expressions of concern from hospital employees.

Aguilar would respond, “Actually, it’s cool up there.  I never feel like I’m going to a sad place.”

“Up there” is the 13-bed, CHOC Children’s-staffed-and-licensed Level IIB neonatal intensive care unit that, since opening Feb. 11, 2013, has been making life a lot easier for mothers, families and their newborns at CHOC’s adult hospital neighbor—and their newborns who need specialized care.

Aguilar’s girls, Lily and Ella, born just shy of 32 weeks, were among the first patients and the first set of twins to be cared for in the CHOC NICU at St. Joseph Hospital, whose opening coincided with a new mother-baby unit at St. Joseph.

Never far from mom

The NICU, staffed by a team of CHOC neonatal experts, is designed for newborns with low to moderate medical needs—typically, premature babies suffering from respiratory and circulatory problems. Newborns needing a higher level of critical care are sent to CHOC’s 54-bed NICU, located in the CHOC North patient care tower.

Lacy Pester, BSN, RNC-NIC and clinical manager of the CHOC NICU at St. Joseph Hospital said that prior to the opening of the new NICU, it sometimes was inconvenient for mothers to have to make the trip to CHOC’s NICU.  At nights, if there were no volunteers available to accompany them, mothers were not allowed to make the trek, Pester said. No longer.

Now new mothers like Aguilar are only steps away and can visit their babies easily.

The NICU provides accommodations for parents after a mother’s discharge as well.

For 27 days, Lily and Ella—who both weighed around 3½ pounds at birth—were cared for by a team of newborn intensive care nurses, respiratory therapists and physicians who relied on sophisticated monitoring equipment to closely follow their vital functions around the clock, including heartbeat, respiratory status, temperature and blood pressure.The girls got the Twin Room—the only two-bed room among the 12 rooms that make up the new NICU.

Choosing to have her babies at St. Joseph Hospital was easy for Aguilar. Her mother worked there as a security guard in the 1980s and her grandmother was a housekeeper in the emergency department. When her twins arrived early, Aguilar was grateful to hear that her babies would be receiving care in the new NICU.

annual-report-2013-caring-for-the-smallest-patients-2“I was excited, thinking we would have more privacy and our own nurse,” Aguilar says. “It was fantastic. We were in the corner of the unit and everything happened in one room. I loved it.”

Lanky Lily, kind of silly and prone to making pterodactyl noises, and chunky Ella, a happy baby with a sweet disposition, now are healthy babies closing in on 20 pounds. Aguilar, who lives with her husband, Ramon, and their twins in Corona, credits the expert team of neonatal specialists at the CHOC NICU at St. Joseph Hospital, including Christine E. Bixby, M.D., with her babies’ health.

“They always had the girls’ best interests in mind,” Aguilar said. “They are all very loving people. I feel like all the care they received helped set up my girls for success.”

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Event Raises Awareness of Kangaroo Care

Snuggling a newborn is one of life’s greatest pleasures, but did you know the practice also has lasting health and emotional benefits for parents and infants?Kangaroo

Giving a sick or preterm baby skin-to-skin contact – usually against a parent’s chest – is called “kangaroo care,” a cute name for a vitally important practice.

To raise awareness of the method, CHOC Children’s at Mission Hospital recently held a week-long “Kangaroo-a-thon,” during which parents were encouraged to snuggle their babies as much as possible. The event was held in collaboration with Mission Hospital and March of Dimes, and recognized November as Prematurity Awareness Month.

Studies have shown that kangaroo care can help maintain an infant’s body temperature, contribute to higher blood oxygen levels, and improve sleep, breast-feeding and weight gain, says Liz Drake, a clinical nurse specialist at CHOC at Mission.

Further, parents develop stronger bonds with their new babies and gain parenting confidence, and mothers often show improved milk production, she added.

During the Kangaroo-a-thon, parents in both hospitals spent 4,550 minutes — about 76 hours — cuddling with their infants, Liz says.

The method has been adopted worldwide, and, of course, at all three CHOC Children’s neonatal intensive care units. CHOC experts promote skin-to-skin contact with even the most fragile little patients, including babies with extremely low birth weights and those on ventilators.

Technology and medicine have brought many advances in neonatology, but the touch of a parent remains a key tool in the care of sick and preterm babies. Kangaroo care is one more technique contributing to a supportive environment that helps premature babies mature and develop as they would in their mother’s womb.

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A Bright Future: Parker’s Story

So far, my 50-week gratitude tour at CHOC is going great. Already, I’ve met many other people who also have CHOC to thank for making their future bright.

Today, I wanted to share one of these stories with you. Let’s learn more about Parker, who recently celebrated her first birthday – thanks to CHOC.

photo-67A year ago, a first birthday party was an uncertainty for Parker Evans, who was born weighing just 1 pound, 1 ounce after only 23 weeks gestation.

So, when the milestone approached after a long fight in CHOC’s Small Baby Unit (SBU), it was only appropriate that the Evans family would throw a blowout bash for their miracle baby.

“We said it was like a celebration of life,” says mom, Kristina.

Parker is one of scores of micro-preemies who have received special care inside the SBU since it opened in 2010. In the unit, infants born at less than 28 weeks gestation and weighing less than 1,000 grams receive coordinated care by specially trained staff.

“We ended up falling in love with the small baby unit – the nurses, the consistency, the environment,” Kristina says.

The SBU’s space differs from a traditional neonatal intensive care unit: Tiny babies lie inside shrouded incubators that keep light away from their underdeveloped eyes. Even a whisper is harsh for these babies’ ears, so families and staff members speak in a gentle “library voice.” The goal is to mimic the womb’s environment as closely as possible so that infants can focus on growing.

“You never think this would happen to you, or that this world exists – that is until you’re in it,” says Kristina. “I’m so lucky that CHOC has that unit.”

Parker was delivered by cesarean section after Kristina suffered blood loss attributed to placenta previa, a condition where a woman’s placenta is too close to her cervix.

Transferred to the SBU nine days later, Parker remained there for 132 days until she was well enough to go home to south Orange County.

About a year later, Parker is growing and thriving. Parker does receive physical therapy, but she is on track developmentally and physicians foresee no future disabilities.

Kristina credits the SBU and its staff with ensuring a bright future for her daughter.

“I’m not going to lie: Having an extremely premature baby is the hardest thing a parent can ever go through, but everyone in that unit made a huge difference,” she said. “We fell in love with the Small Baby Unit.”

More stories about CHOC patients:

  • CHOC Patient Inspired to Become CHOC Doc
    At 6 years old, Vanessa Avina was more interested in viewing the monitor for her echocardiography (heart ultrasound) than watching a cartoon during her doctor’s visits. Her CHOC pediatric cardiologist ...
  • CHOC Walk in the Park: Justin’s Helpers
    As it celebrates its 25th anniversary, CHOC “Walk in the Park” has raised more than $24 million to fund education, research and adoption and utilization of the latest technologies to ...
  • A Bright Future: Ian and Micah’s Story
    Even though I’ve been hanging around CHOC Children’s for a long time now, I am continually surprised by the courage, tenacity and strength of the patients I meet. It’s especially ...

New Webcam System Connects Parents with Babies in the NICU

No parent imagines having to leave the hospital without their newborn. For those parents who have to keep their little ones in the neonatal intensive care unit at CHOC Children’s at Mission Hospital for treatment, however, there is now special technology to ensure families can be together and bond with their newborns when they can’t be at the bedside.

Baby Peyton Valentine and family were among the first families to enjoy the new NICVIEW webcam system in the NICU at CHOC Children's at Mission Hospital.
Baby Peyton Valentine and her family were among the first families to enjoy the new NICVIEW webcam system in the NICU at CCMH.

CHOC Mission is proud to be the first children’s hospital in California to offer the new NICVIEW webcam system. The system allows families to see real-time, live video of their infant remotely, from anywhere they can log on to the Internet.

“This takes family-centered care to a higher level,” said Liz Drake, clinical nurse specialist in the NICU at CHOC Mission, where the system went live on Aug. 21.

Katie and Andrew Hock of Ladera Ranch were among the first parents to benefit from the NICVIEW webcam system. Their daughter, Madeline, spent time in the NICU at CHOC Mission to be treated for respiratory problems after she was born on Aug. 16. The couple logged on to the webcam right away using their iPhones, and were able to look at their baby when they weren’t at the hospital.

“The camera gave me a sense of security, which is nice. I could see if she was still sleeping and her IV was still in,” said Katie, who along with her husband shared the password for their daughter’s video feed with their parents and siblings, including Katie’s sister who lives in Hawaii.

“The grandparents were addicted to seeing her all hours of the day,” Katie, a first-time mom, said with a laugh.

The NICVIEW webcam is easy to use with any major Internet browser. The information and video are secure, and only the baby’s family can allow other users to access the live video.

Users can view the baby at any time except when the baby is receiving nursing or medical care, or having a procedure. A webcam is mounted at every bedside in the NICU and families can opt in or out at any time, so use of the camera is up to them.

In addition to the bonding benefits of the NICVIEW webcam, there are also health benefits for the new parents and their newborn.

“If you can decrease the anxiety of a parent, you can reduce the overall stress of a hospitalization,” Drake said.

“Another benefit is for nursing mothers. It’s best for a mom to pump breast milk in front of her baby or a picture of her baby as this can help the mom produce more milk. When our moms are at home or can’t be here, this can help them pump with their babies in view. We’re creating a connection where they didn’t have one before,” Drake explained.

She added that the webcams are wonderful tools for military parents who are deployed overseas, and for out-of-state grandparents who can’t visit. It helps siblings at home who want to see their new baby brother or sister. They’re also great for moms who are visiting Orange County, and happen to give birth early or unexpectedly, and have family in another city or state who can’t visit.

Further, the webcams will help families bond with newborns in the NICU during flu season, when only the babies’ parents are allowed in the NICU for health safety reasons, Drake said.

“It’s wonderful. It’s amazing how far we’ve come with technology,” Katie said.

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CHOC Children’s Surgical NICU Offers Coordinated Treatment Approach

Newborns with surgical needs require special attention, and a feature of CHOC Children’s neonatal intensive care unit (NICU) provides just that.

CHOC’s Surgical NICU, a dedicated space within the NICU, utilizes a comprehensive method to care for these tiny patients with special needs. A coordinated treatment protocol – used in many adult intensive care units nationwide – has shown to result in fewer patient complications, improved outcomes and faster discharges.

At CHOC’s Surgical NICU, babies are grouped together to receive consistent and coordinated care from a multidisciplinary healthcare team. This team includes neonatologists, nurses and surgeons, as well as clinicians ranging from respiratory therapists to nutritionists.

An additional element rounds out the Surgical NICU healthcare team: parents and family. Here, a patient’s family joins clinicians to discuss care plans, share information and make care decisions.

Because the entire CHOC team works together to improve care and communication, each of our patients receives a well-coordinated and consistent treatment plan.

To learn more about the CHOC NICU, please visit http://www.choc.org/nicu/.

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