Thursday, April 28, 2011

Infant Massage

Wednesday, April 27, 2011

Noise in The NICU

As developmental care in the NICU continues to become a stronger force the high noise levels are coming into question. In my research I've come across the following article that confirms this is not a new idea, "Like libraries, hospitals used to be considered quiet zones. In her 1859 book "Notes on Nursing," Florence Nightingale railed against unnecessary noise, calling it "the most cruel absence of care." The article states that hospitals use to be quiet zones but as technology rapidly advanced so did the noise. It is proven that premature babies in a NICU environment have lower stress levels, thrive, and have a shorter recovery time when they get optimal rest and uninterrupted sleep. Although a baby may not "wake up" by opening their eyes and looking up at the world around them, when beeps are constantly going off their brain patterns reflect this stress. In addition to non stop beeps you get the occasional voice that may be a little on the noisy side, crying babies who may be "rooming" in, and the loud (to the preemie anyway) tapping on the incubator. All reasons why private rooms are proving to be most beneficial for developmental care. I came across another website that sells NICU noise meters. These things are selling! The website states that, "Noise from visitors and staff is best dealt with using a device such as the SoundEar as it is not influenced by the complicated human perception of noise". This makes sense and it seems to be a simply way to keep the noise under control.

Neonatal units, like most hospital environments, tend to be very poor acoustically due to hard, reflective surfaces. Beds are often closely spaced, visitors can talk loudly (especially the younger ones) and staff have to work quickly and move equipment about. Add to this the incubators being opened and closed, occasional tapping on the lid and items dropped accidentally and the noise levels soon become unpleasant for the baby. One of the biggest culprits is the alarm, which is clearly essential, but as the background noise levels get higher the alarm has to be louder still. A quieter background allows for quieter alarms.

Another article states that, "current literature supports the theory that neonates, particularly premature infants, are not sensory deprived but receive a bombardment of large amounts of stimulation. This stimulation is often noxious in nature and contributes to "overload." This article written in 2011 continues on to explain a study conducted where the NICU staff was educated on noise reduction and forced to change their speaking habits to be lower. In addition monitors were turned down and clipboards were not allowed to be placed on or near incubators. When comparing the data from before the study and after, they found the decibels decreased from an average of 70 dB to 68 dB in the NICU environment. Although, this is only 3 points it represents a 50 percent reduction of perceived noise intensity to a sick baby. These are great results. They continue on to state, "clearly, there are obvious benefits of reducing noise in the NICU. Decreased noise helps to improve infants' physiological stability and growth, the inci-dence/severity of hearing loss may be reduced, as well as long-term perceptual difficulties. A quieter, more nurturing NICU environment helps support the development of a well-regulated infant behavioral state. Moreover, noise reduction can promote infants' bonding with relatives and extend parent visitation. Additionally, staff members directly benefit, with the possibility of stress reduction." I think what is most interesting about the study is that these are very simple cost efficient changes that can be made and they are having a positive impact on the babies' development. Even in a semi-quiet NICU environment, like I would compare mine to, positive changes can me implemented. I distinctly remember numerous times a false alarm was sounding and a nurse let it go on for longer than it should have because she A) knew it was false and B) was busy with something else. In the womb a fetus is only exposed to low frequency sounds then when they come out they are then exposed to high frequency. If we could bring down all noise levels, even talk in a lower tone consistently, it seems it would be more comparable to the womb. It may get to a point where it seems extreme, especially when you are in the NICU environment all day long, working and parenting, but if the obvious goal is for these babies to thrive, develop at the fastest rate possible, and decrease the time they have to be in the hospital, as time goes on we may witness more and more noise control. Shhh!! You are about to enter a quiet zone....


Sunday, April 3, 2011

A Preemie Prints Story: Jessica and JD

I have 4 kids. Marrisa is my 11 year old daughter, Katie is my 6 year old step daughter, Viola is our 1 year old daughter, and our son Jonathan who is 6 weeks 5 days old today March 24, 2011 (36 weeks 5 days adjusted). I have worked in the Radiology department of the hospital where I delivered my son for the last 7 years.  

Jonathan was born at 30 weeks. He was 2 lbs 13 oz. and 14 inches. At his lowest weight 2 lbs and 4 oz. Four days before JD was born I was at my regular doctor's appointment. I had a UTI and was placed on Cephalexin. Two days later I was having lower abdomen pain and some bleeding. I went to labor and delivery. They did a urine culture again, which came back that of course I had an infection. An ultrasound of my kidneys was done to check for kidney stones. I was told the pain was from the UTI. I wasn't having contractions so I was sent home with bed rest. The next day was pretty uneventful. The morning of the day I had delivered was fairly quiet. I was having very slight pain, but not as bad as two days prior. Around 4 that evening the pain started to come a little more consistent. At 4:30 I called my boyfriend and told him I thought maybe he needed to get home. He was out of the house with the kids so I could rest. The pain kept coming and going. Around 5:30 is when it started to get intense. So I got changed and we headed back to labor and delivery. 

Unfortunately no one was around to watch the kids, so he dropped me off thinking I would just call him when they were getting ready to send me home again. The minute I was hooked up to the machines I knew Jonathan was coming. The amount of activity going on around me was crazy. My doctor happened to be out of town that night, so the head of the department (who had just delivered a c-section and hadn't left the hospital yet) was there. She asked a lot of questions about my previous visit to labor and delivery and didn't seem too happy. My friend Teresa came in to do my ultrasound. I was told she saw his eye very far down. Jonathan wasn't due for another 10 weeks my mother, who was going to be in the delivery room with me, was 2 1/2 hours away and because Lauren was trying to find someone to watch the kids he wasn’t there. Teresa asked me if I wanted her to stay. I immediately said yes and was told “Good because you don’t really have a choice. She never left my side the whole time. She was wonderful and my angel through this quick process!! I got to Labor and Delivery at 6 pm. JD was born at 6:38 pm. Lauren got back to the hospital without the kids at 6:45 pm. Needless to say he was shocked to find his son had arrived 10 weeks early. 

At 11:00 that evening the transport arrived to take my son to a hospital with a NICU. At this point I still hadn't seen him. At 11:40 pm they came in with him in the transport incubator so I could see him for the first time. After they left the NICU doctor came in to talk to me. She was in the NICU when they got the call that Jonathan had been born and drove the 30 minutes to come see him. I was called when the transport team arrived at the hospital and again when the nurses had him settle into his new temporary home. 

The next day I was very impatiently awaiting discharge. Finally at noon the doctor came in to see me and we drove the half hour to see our son. JD was breathing room air and I was told by Myrtle (his first nurse) she wasn't going to tell him he was a white boy! :)

Jonathan did have to be put on a nasal cannula. He was breathing room air, but his lungs just were not developed enough and he kept d-stating, heart rate dropping and having bradys. The nasal cannula came out on March 3, two days before he was one month old. The feeding tube came out on March 21, at 6 weeks 2 days. He has a slight heart murmur, so they did an Echo today, I will get those results tomorrow. As of today he was very anemic, however, his body is starting to fight it. They will be drawing his blood again on Monday if he is any lower they will do a blood transfusion, if he is continuing to fight it they will let him do that.
As of tonight JD is at 5 lbs and 8 oz. His heart rate still drops about twice a day when he is eating, but we are hoping he will be home soon. When we picked Jonathan for his name I didn't know the meaning. I just liked it, but he really is my "gift from God"! (I just received an update from Jessica and JD will be discharged and on his way home this week on the 11th. Wonderful news! Go JD!!)

Thank you Jessica so much for sharing a little big of your long NICU journey with us, we know this story will touch the hearts of many people. ~Amber @ Preemie Prints