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In This Issue...
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Health
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Neonatal Unit Serves the Smallest Patients and Their Families
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Neonatal Unit Serves the Smallest Patients and Their Families
High-Level Intensive Care Keeps At-Risk Infants Close to Home
By Linda Fridy
[Editor’s Note: This is the first in a two-part series about Dominican Santa Cruz Hospital’s Neonatal Intensive Care Unit. The second part will appear in the Dec. 26 edition of The Post.]
“I never even knew what NICU meant,” said Aptos resident Bina Mirchandani; in fact, when her water broke 25 weeks into her pregnancy, she had not yet visited the hospital. She hadn’t even started the birthing class she and her husband planned to take. But she soon learned all about the NICU.
After their son, Bradan Ward, was born at only 30 weeks, Dominican Hospital’s Level III Neonatal Intensive Care Unit became the family’s second home for the next 6 1/2 weeks.
Stories like Bradan’s happen every day at the NICU, called the “nick-u” by nurses, docs and parents. The 14-bed nursery is tucked within Dominican’s maternity ward and run as a joint venture with Stanford University Hospital. It takes in about 300 of the roughly 4,500 babies born in Santa Cruz and parts of Monterey County annually, explained Medical Director Magdy Ismail, a neonatologist and clinical associate professor for Stanford.
About half of the NICU’s patients are like Bradan.
Bradan is an infant called preterm, those born after fewer than 37 weeks of gestation, Dr. Ismail explained. These babies need constant monitoring until their natural breathing, body temperature maintenance, heart and feeding systems mature. The other half of NICU infants have problems identified at birth, for reasons ranging from the mother’s health to infections or birth defects.
As a Level III facility since 2002, Dominican’s NICU provides 24-hour care to all but the most critically ill babies, those requiring surgery and care by sub-specialists, Ismail said.
“We can keep 85 percent of all the babies who were previously transferred over the hill,” said Ismail. “That’s 250 babies who used to leave their families and now can stay here.”
Having Stanford-level care locally makes a world difference for families. Mirchandani was able to live at home and see her son usually three times a day. She had spent the five weeks from the time her water broke until her labor in a bed at Stanford, but was delighted that Bradan could come back to Santa Cruz County with her when she was released only two days after the birth.
“[Keeping him at] Stanford would have been kind of rough,” she said. “Stanford is a much more intense environment.”
More than Medical Support
The babies are not the only ones getting care at the NICU. Along with three neonatologists, nurses and specialized therapists, the team includes licensed clinical social workers. The social workers are paired with families, sometimes even before the birth, to guide parents through the often-overwhelming emotional experience of the NICU.
“People are really scared,” said Chris, one of the social workers that support NICU patients. “They have no idea there’s something like an intensive care nursery. Most people anticipate that they’re going to have a healthy pregnancy and take home a healthy baby. It throws them for a loop when that doesn’t happen.”
“The social workers were great,” Mirchandani recalled. “I remember my first day â€" we’d brought him in and I just started crying in front of the cube. There’s something about seeing your baby behind Plexiglass that just isn’t right. We hadn’t even met and [Kim] just came over and gave me a hug.”
Mirchandani said that social workers do more than answer questions.
“They’re there for everything from emotional support to paperwork to [helping pick] pediatricians,” she said.
The social workers continue to check in with families, tracking health and development sometimes for several years after the birth. And the NICU holds a reunion each fall for its “graduates.”
While the doctors and nurses are highly trained in the needs of at-risk babies, families say they are equally adept at communicating with and involving parents.
Terri Primavera, who gave birth to premature twin boys last year and required extended hospitalization herself, remembered the extraordinary measures the staff took to let her see her newborn sons.
“I didn’t get to see them for 48 hours,” she said, recalling how nurses would visit with updates and pictures. “It was 3 a.m. when I finally got to see them. They wheeled my bed down and moved things out of the way so I could get to them.”
Mirchandani was struck by how much time and information she was given by the neonatologist when her son developed a hardened stomach, and remembered how the nurses would photograph and make notes about any milestone parents may have missed.
“It made me look at the profession in a whole new light,” said Mirchandani. “I don’t know that I’d ever thought about it before. I think it attracts really good people. I don’t work with anyone in the corporate world like that.”
Ismail beams when he hears comments like these, and clearly agrees.
“These are remarkable people,” he said of the NICU team.
What Babies and Parents Need
The most common environmental elements can threaten a premature baby. Exposure to air with oxygen can cause babies’ retinas to develop unnecessary blood vessels, Dr. Ismail explained, and gravity pulls hard on underdeveloped muscles used to floating in the womb. The NICU regulates the oxygen in each baby’s incubator and provides physical therapy to optimize muscle development.
Parents are welcomed and encouraged to be involved as much as possible. Perhaps the most important role they play is in feeding.
“We are strong advocates here for breastfeeding. It is really the preferred nutrition,” Ismail said.
This can be especially challenging with the smaller babies, who cannot instinctively combine breathing and eating. A lactation specialist works with mothers to help them succeed. Developing this bond is equally important to both mother and child.
“That really makes a huge difference â€" that the mom is making a difference in the healing of her baby,” he said.
Ready To Respond
A woman with a high-risk pregnancy will be directed to Dominican, where surgical delivery is literally steps away from the NICU. However, members of the NICU team also attend every birth, allowing them to respond instantly to problems.
Additionally, Dominican maintains its own specially trained NICU transport team, Ismail noted, which will bring in babies referred from Sutter Maternity Hospital and Watsonville Community Hospital of the Monterey Peninsula and other locations as needed. When neighboring NICUs are full, Dominican has treated babies from as far as King City and even Clovis.
“It’s fabulous for our community to have such a high level of care,” said social worker Chris.
“This is a big community for home births, and it’s good that [homebirth families] are close to a [NICU] hospital so that if they need immediate intervention they can get it.”
While the national average for preterm births is about 12 percent, Ismail credits Santa Cruz’s health-conscious population with keeping local numbers down.
“Our rate of prematurity is low because of the great prenatal care available here,” he said, praising the local obstetricians and medical community. “When you have good prenatal care, any concerns can be addressed early.”
Sending Home a Healthy Baby
While Mirchandani acknowledged it was difficult to leave behind the monitors that had watched over her son, the goal of the NICU is to give parents a baby that requires only normal care.
“Fifteen years ago, infants 26 to 27 weeks had a difficult time and often had developmental issues,” Ismail said.
While Ismail can’t promise that every preterm baby will be healthy, rates are improving.
“We are not only trying to save a life, but also provide a normal, long life for a son or daughter that was premature,” Ismail said.
Ismail said that he is very happy with his practice.
“I love my job very much. It makes it so worthwhile when I see a picture of a five-year-old wearing these cool sunglasses. That’s what I do. It’s the most rewarding thing,” he added.
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