Parenting Mighty Littles: Parenting from the NICU and Beyond

The neonatal intensive care unit, the NICU, is a special unit in the hospital that provides care for seriously ill and premature infants. The care of babies is super-specialized, and it requires an entire team of professionals to work together to provide excellent care. For many parents, the NICU can feel overwhelming, loud, and confusing at first introduction. But understanding who is caring for your baby, and who is walking and in and out of the unit, can provide reassurance and relieve stress. Here is a brief overview of who’s who in the NICU.

The people caring for your baby in the NICU are a team. Each person has an important job. They must all work together seamlessly to make sure you and your baby are getting the best care possible. Here are the NICU staff members you may meet during your hospital stay.

During your time in the NICU, you will most likely see your NICU nurses more than anyone. Your baby’s NICU nurse is right at the bedside monitoring your baby from minute to minute. They are the heart of the NICU, the eyes and ears that keep your baby safe. They carry out doctor’s orders, give medications, place IVs, make assessments during care times, and reports changes in status about your baby to the physician team.

In addition to the bedside nurses, there are Clinical Nurse Specialists, nurses who are responsible for ongoing nursing education on the unit, help update policies and work on quality improvement projects. The Charge Nurse is the nurse assigned to supervise the unit, ensure staffing assignments are appropriate, and help out on the unit wherever and whenever it is needed. Finally, the Nurse Manager oversees the unit as a whole, is responsible for hiring nurses, and handles the financials of the unit.

A respiratory therapist specializes in treating the lungs and airways. Under the orders of the physician, they help with the placement of breathing tubes, adjusting ventilator settings, and take care of the breathing equipment and devices needed to help your baby breathe comfortably.

Neonatal nutritionists are trained to help ensure your infant is receiving the nutrition they need for proper growth. They help physicians with optimizing IV nutrition, tracking growth, fortifying feedings and monitoring nutritional labs.

Lactation specialists help mothers with both breastfeeding and milk supply. This involves initiation of pumping to provide milk for your baby, and ultimately breastfeeding when your baby can safely suck, swallow, and breathe.

Occupational therapists help monitor and encourage basic developmental milestones. They work on suck / swallow, evaluate muscle tone, movement and reflexes, and can show parents infant massage and stretching. They are essential in monitoring developmental milestones and making early intervention referrals.

The NICU can be stressful, and social workers and psychologists can help parents process stress, shock, frustration, grief, and fear. But they also help process hope and happiness. Depending on the unit, they may facilitate support groups, provide education to families, provide information about resources, and act as a sounding board for families. They may write letters for employers and insurance companies and make referrals for SSI.

The case manager in the NICU serves as both the liaison to your insurance company and the liaison to home health companies when it comes time to order equipment your baby may need for home.

Some NICUs will be associated with teaching institutions, and you may see medical students, nursing students, NNP students and other medical students. If you are at an academic institution, you may come across Residents and Fellows. Residents are doctors who have graduated from medical school, but are continuing their education in pediatrics under the supervision of attending physicians. The first year of residency, is considered the intern year. After residency, if you are interested in neonatology, you begin a fellowship. All residents and fellows work under the supervision of an attending neonatologist.

PAs have a masters degree and advanced training in neonatology. NNPs are nurses who obtained either a masters or doctorate in nursing and specialize in neonatology. Both NNPs and PAs work in conjunction with and under supervision of attending neonatologist. They can diagnose, treat, create care plans, and help with procedures in the NICU.

This includes pediatric surgeons, cardiologists, pulmonologist, nephrologists and others who specialize in specific organ systems and help care for infants in the NICU.

Neonatologists are doctors who finished medical school, pediatric residency, and fellowship training in the NICU. They are experts in caring for sick and premature infants, and lead the team caring for your baby in the NICU.

Dr. Zimmermann examining an infant in the NICU.

I don’t want to leave out the other professionals that make the NICU function. Unit secretaries greet families and help run the unit. Housekeepers keeps the unit clean and sanitary, Xray and ultrasound technicians to help facilitate studies, pharmacists who ensure medications are delivered safe, and milk bank technicians who deliver and fortify breast milk to provide optimal health for your infant. Everyone in the NICU has their own role in making sure every baby receives the best care possible.

Listen to the podcast to hear about Who’s Who in the NICU below.

For more information, check out these resources:

www.marchofdimes.org

www.accretafoundation.org

www.donate4mothers.org

Mighty Littles is back. We are coming back in September with weekly episodes over the next three months, all releasing on Tuesdays. Today’s episode gives you a preview of what is coming up the next 3 months.

September - NICU Awareness Month.

October - Focus on Words and Labels

November - Prematurity Awareness Month

The podcast is going to have a mix of family interview, organization interviews, shorter quick education and encouragement podcasts, and more.

Dr. Joanna Parga-Belinkie and Dr. Anna Zimmermann talk about baby heads and why infants may have funny-shaped heads. We discuss both craniosynostosis (early fusion of the bones) and positional plagiocephaly.

More information and education can be found on Instagram @mightylittles. My favorite Instagram account dedicated specifically to positional plagiocephaly is @babybegin.

You can find Carl at https://premdad.co.uk and on Instagram @premdad_uk

Last week, the US House of Representatives Subcommittee on Economic and Consumer Policy released a report on Heavy Metals in Baby Foods - specifically arsenic, cadmium, lead, and mercury. Overall, it is a good report. Well-referenced, filled with easy to read data points, only slightly political, with clear recommendations for moving forward. The headlines about this report are designed to strike fear, to get us to click the story and read articles. As such, this report has mom’s everywhere wondering:

OMG! Did I Poison my kids with baby food? Should I change everything my kid eats? Cook everything? What if I plant a garden in the back yard and grow everything and cook it? I thought organic meant I was protecting my kids?

But, before we all freak out, let’s get a little bit more information - because information and education is THE key to making the best decisions we can for our kids.

In April of 2020, Healthy Baby Food published a report stating that a national investigation finds that
95 percent of baby foods tested contain toxic chemicals that may lower babies’ IQ, including arsenic and lead. This report prompted the US House of Representatives to create a subcommittee to review the findings. The subcommittee, which was set up in November 2020, released its report on heavy metals in baby foods last week, confirming that there are higher than recommended levels of heavy metals in some baby foods. Hence the fear from every parent who has ever fed their child baby specific foods - pouches, jars, biscuits, puffs, etc. It is important to note that this report does not address formula in any way.

In this Podcast, I address some of the background science and research about toxic heavy metals in food, what the congressional recommendations are from this report, and my takeaways. You can see the full blog post for more written details and links to articles I mention in the podcast.

Heather joins me to discuss her experience having Quads at 32 weeks. I think pictures speak a thousand words, so I’m going to give you this great slideshow of photos and the link to the podcast. Tune in for some insight on what it is like to be pregnant with 4 babies and figuring out the logistics of bringing home 4 babies.

Dr. Joanna Parga-Belinkie joins Mighty Littles and Dr. Anna Zimmermann to talk about apnea of prematurity.

All babies born less than 28 weeks, many babies less than 32 weeks and some babies over 32 weeks will have apnea of prematurity. Apnea of prematurity is defined as pauses in breathing lasting 20 seconds or more and associated with heart rate or oxygen saturation changes.

All infants admitted to the NICU are placed on monitors that measure their heart rate, respiratory rate, and oxygen saturations. We know that babies have a typical patter of breathing called periodic breathing and that premature infant can have longer pauses in breathing that lead to apnea.

We typically treat apnea of prematurity with Caffeine, monitoring, providing gentle to moderate stimulation when needed, and a tincture of time. Our biggest takeaways for you:

1. Apnea of Prematurity is a normal occurrence in the NICU. It is something that all parents preemies are encountering and worrying about.

2. Time is your friend. As hard as it is to worry about apnea and desaturations and bradycardia events, preemies grow out of it. Caffeine helps lessen the events, but ultimately, time is what helps because babies mature and ultimately grow out of their “events”.

3. Primary nursing is super helpful. As nurses learn your individual baby’s specific patters, they can better assess and respond to your infant. Some preemies have minimal events. Some preemies have more. And each baby’s baseline will be different. Having nurses that know your baby’s baseline is immensely helpful.

Find Rebecca on IG @babysignnj

I have a confession.

I am mortified. Having a podcast fail to record is literally my worst nightmare, and that is exactly what happened in December during my interview with Ann, Maya’s mom (IG @mightymissmaya). It was a fantastic interview, and I was so excited about airing it. And then I went to download the recording and it wasn’t there. Just a blank drive after the first 6 minutes of the podcast. 6 minutes out of 80. Even my tech savvy husband (tech savvy is an understatement actually) couldn’t help me recover it.

And so, I am embarrassed. And I am sorry. While my husband ordered me more equipment to ensure this will NEVER happen again, I can’t get this interview back.

So… this week’s podcast is going to be a bit different. I summarize very briefly the conversation Ann and I had, review some big wins from 2020 for Mighty Littles, and discuss what is coming up in January of 2021.

January 2021’s theme is Words. Words are powerful - oh so powerful. They can create emotion, bring us inspiration, bring us to tears, uplift us, and humiliate us. Words can become labels - labels that box us into categories and labels that allow us to get more resources. Words are powerful.

So enjoy this shorter than normal podcast, and join us on Instagram this month to dive deep into the power of words.