The NICU Nurse and Preemies

Alexander describes herself as a mental health specialist for babies. How does a preemie who weighs 13 ounces communicate while intubated and on paralytics? How does he tell you that he’s there? These are the goals of a developmental specialist.

A preterm baby, according to Alexander, doesn’t possess the neurological or physical capabilities of a term baby and therefore uses another language to communicate his wants and needs. “With a crying term baby, a parent usually knows what the infant needs,” Alexander says. “But it’s difficult for a one-pound micro preemie to communicate because he or she is too weak.”

One NICU baby is described as an “ankle crosser,” and once he’s in position, he breathes better and his O2 sats go up. If he isn’t allowed to cross his legs, he gets angry. “It not only gives him an awareness of self, but it maintains a posture that allows his lungs to expand, he uses less energy because he’s comfortable, it increases his blood flow, and he has less risk of intracranial bleeding,” Alexander says. “The NICU nurse always looks for idiosyncrasies, or ‘cues,’ which are an integral part of the plan of care.”

Giving back

The NICU nurse happiest moments are when families bring their babies back to the unit and show them off. An enclosed glass case in the NICU features photos of smiling faces, some freckled with a twinkle in their eyes; in other photos, children wave hello to nurses who cared for them during difficult times.

Sydney Sherman, a literal handful at birth (one pound, 13 ounces), is one of those success stories. Four years ago, Julie Sherman, system director of brand services at Banner Health, was hospitalized at 27 weeks with HELLP (hemolysis, elevated liver, low platelets) syndrome. Mothers are often given “the talk,” as Julie likes to call it, shortly after they’re admitted. “Doctors scare the heck out of you,” she says. “They tell you the odds and talk about intubation, brain bleeds, etc.”

For three weeks, Julie took steroids and held on to her baby girl, but at 30 weeks, Sydney’s condition deteriorated. A decision was made to “grow” baby Sydney on the outside, since she had stopped growing in the womb. According to Julie, the 30-week gestation period allowed Sydney’s lungs to develop, and “gave her survival skills.”

Now, four years later, Sherman heads a support group at Banner Desert for parents of NICU babies called Raising Special Kids. She listens to their fears and provides encouragement and understanding as she matches parents with others who have experienced similar circumstances.

The fragility and strength of preemies

“The sickest babies aren’t only the tiniest,” Alexander says. “But certainly our tiny babies can be very sick.” A meconium aspiration baby is fighting for his life. This is a term baby, robust in utero, who inhaled caustic stool into his lungs. Alexander describes the feeling as “inhaling sand.” The infant is treated with gas transfer along with antibiotics. “Our mortality rate is very low,” Alexander says. “Our 24- and 25-week babies have a 90% survival rate.”

Preemies are fragile beings. When a nurse suctions an adult, he or she coughs, may lose a few brain cells, and then recovers. But it’s different with preemies; they can’t afford to lose any brain cells. “If we alter their brain structure, we’ve affected them for life,” Alexander says. But it’s not only physical fragility that NICU nurse (s) are so aware of; it’s also the importance of the parents’ emotional connections to the infants. “Family interaction is vital to all infants,” says Alexander. “Babies born compromised can also have good outcomes, provided the family has the financial, social, and emotional resources.”

When asked what makes working in a NICU so rewarding, Alexander and Studenberg both agree: The level of caring is huge. “It’s a team approach from the physician to the nurse, to the social workers and case managers, to respiratory therapists, and back to the family,” Alexander says. “We’re all focused on the same goals — supporting, teaching, and involving families with their babies’ care.”

Terry Ratner, RN, MFA, is a freelance writer in Phoenix who compiles “Bookcase” for NurseWeek and Nursing Spectrum This is a true story about the life of a NICU nurse and what it takes to be an travel NICU RN