Even as Sunnybrook’s NICU staff are helping premature babies win the fight to survive, they take care to nurture their early relationships with the parents.
Laura Dundas was worried her son – born dangerously premature at just 25 weeks – was not going to do well. She felt disconnected from Adam; he seemed almost untouchable where he rested in his incubator.
All that changed on his third day when a nurse in Sunnybrook’s Newton Glassman Charitable Foundation Neonatal Intensive Care Unit (NICU) offered to help Laura “kangaroo” her son. She held him skin-to-skin against her chest and her fears melted away.
“It was a really sensational experience,” she recalls. “It felt so calm and so natural; he curled up into me when he was placed on my chest, and it was a really lovely, fantastic moment.”
It’s actually much more than a wonderful moment; kangaroo care – that warm, loving connection a parent and baby make when they’re skin-to-skin – has very real, clinical benefits for both. It’s especially important for premature infants in the NICU, already at risk for serious developmental issues. Research suggests kangaroo care helps stabilize the baby’s heart rate and oxygen absorption and decrease the risk of infection. The connection reduces baby’s stress and aids brain development at a critical time.
It’s good for the mother, too, decreasing her stress and boosting her ability to produce breast milk.
“Mom holding her baby just hits those hormones responsible for making milk,” says Luisa King, an NICU Breastfeeding Resource Nurse. “So many moms report that they struggle with artificial pumping until they connect with their baby. Then it’s not a big deal anymore – that simple act of skin-to-skin contact spurs that whole process on.” It boosts parents’ confidence, too, because baby is no longer seen as a fragile china doll.
“And NICU dads are at a real risk for depression,” adds Kate Robson, Sunnybrook’s NICU parent coordinator. “Holding their babies is one of the things that can really help them.”
Kangaroo care fits perfectly into Sunnybrook’s family-centred approach to caring for its tiniest patients, who sometimes stay in the NICU for months. The NICU team – including Kate and Luisa – recently held Closer to the Heart, a weeks-long celebration of parental touch. Launched on Valentine’s Day, the campaign kicked off with a party for staff and families and featured education sessions and events to raise awareness of the value of skin-to-skin contact. The campaign was beyond successful, Kate says, with some 600 hours of skin-to-skin contact logged in just two weeks.
“In an environment based on patient-centred care, anything that puts the baby and family at the centre is a good thing,” explains Kate. “And so we wanted parents to be comfortable asking about kangaroo care, and requesting it. We wanted nurses to feel more comfortable offering it, and for everyone to really understand why it’s so important.”
Perhaps surprisingly, it takes a state-of-the-art NICU like Sunnybrook’s to facilitate this kind of back-to-basics care. Although the unit is equipped with the latest high-tech equipment and systems, the team’s focus is on minimizing interventions whenever possible and promoting parental contact.
Here, technology exists to keep care natural. Sunnybrook’s NICU, the only one in Canada that consists entirely of single-patient rooms, allows parents the privacy needed for longer kangaroo care sessions with their babies. In-room sound-proofing and muted lighting throughout the NICU offers the right environment for brain development, and reduces the mental fatigue brought on by louder, more chaotic NICUs.
Parents are welcome around the clock, and private entrances with key card access means they never have to ask to enter. Incubators are positioned so parents always have free access to their baby on one side even if a nurse is in the midst of care on the other.
With breast milk for each patient a top priority, each mom has free access to pumps at home and in-hospital as long as their baby is in the NICU. Mother’s milk is then prepared on-site by a team nurse King lovingly calls the “Dairy Queen.”
“When we had the opportunity to design this unit, our approach was very deliberate in creating a setting where the environment would be more appropriate for premature patients,” says Dr. Michael Dunn, staff neonatologist, whose input helped steer the design of Sunnybrook’s NICU, which opened in September 2010.
“There’s been a very big shift in neonatology to try to interfere less and facilitate natural development as much as possible. This facility allows that to take place much more effectively.”
“Our technology is a tool that we have to enhance what the baby is created to do, which is to bond with the parent,” says Ms. King. “When it comes right down to it, babies grow and thrive when they’re with their moms or dads. All our technology is focused on putting these babies back to where they belong – with parents – and the impact that has on their families is immense.”
Even years later, Sunnybrook has a special place in the hearts of NICU ‘graduates’ and their parents. Much of that is due to the fact care doesn’t stop when infants are discharged; patients are followed through Sunnybrook’s NICU Follow-Up program for as long as six years.
Sunnybrook’s NICU experts assess infants’ physical, motor and cognitive development, making referrals to community services and specialized professional consultation when needed. Parents are made part of the health-care team early on, learning to manage the stresses of the NICU and focus on their babies.
And Sunnybrook’s follow-up clinic is like no other in Ontario, treating patients up to six years old where others stop at two. Here, former NICU parents talk about what Sunnybrook meant to them.
Maggie weighed just one pound when she was born 15 weeks premature. Barely larger than a block of butter, she fit into the palm of her dad’s hand.
It was a stressful start to life, to be sure. An emergency C-section at just 25 weeks had saved Maggie’s life after she stopped growing in the womb, but landed her in a potential minefield of complications. Maggie had one thing going for her: Sunnybrook’s NICU was her home for the first four months of her life.
“I think about it every day, and I’m grateful for Sunnybrook every day,” says Kate, Maggie’s mom. “Maggie is wonderful, and she wouldn’t be if Sunnybrook hadn’t been there.”
Kate is now Sunnybrook’s NICU parent coordinator, a role that sees her sharing the knowledge she learned first-hand as a NICU mom with parents experiencing the same challenges today.
“Sunnybrook is very good at developmental care,” says Kate. “It’s not just about keeping babies alive; it’s about giving them the best possible future.”
Six years later, Maggie’s biggest concerns are whether to take ballet or breakdancing, and where she should focus her career within the arts. You know, kids’ stuff.
Thomas has come a long way since March 2000.
Born after an emergency C-section at 24 weeks, Thomas weighed less than two pounds and suffered from frequent lung infections. He spent the next four-and-a-half months in the neonatal intensive care unit, struggling to adapt to new ventilation techniques.
Today, he has dreams of being a professional snowboarder, can pitch a baseball at 77 km/h and plays the bagpipes.
“He’s been playing four years and loves it – and it’s not an easy instrument to play,” says Joanne, his mother. “He’s also a strong swimmer and plays hockey – all these lung-dependent activities – and he has absolutely no problems with them.”
Much of that success is no doubt due to Sunnybrook’s extensive NICU Follow-Up Clinic. With a follow-up rate of 85 per cent and seeing up to 200 babies and children a month, the clinic is designed to ensure preemies – many of whom develop physical, behavioural and learning disabilities – receive the best start in life.
“We are the standard of excellence. We spend years with our families and share their ups and downs,” says Dr. Paige Church, director of the clinic and one of only two pediatricians in North America – and the only one in Canada – with a combined fellowship in neonatal-perinatal medicine and developmental behavioural pediatrics.
“Not a day goes by that we don’t think about where he started,” says Joanne. “Sunnybrook was our lifeline as much as his. The compassion they had was incredible and they were there for us every step of the way. For us, to have them as an extended family was key.”
MOM AND BABY BOTH DOING FINE
“I saw the nurse’s smile and knew everything was going to be OK,” recalls Natalie. But while Natalie and her baby were being cared for separately, they connected early thanks to Sunnybrook’s focus on keeping mothers and with their babies. In fact, Natalie was able to initiate breast feeding while still in the ICU, and baby Carmine was treated with preventive antibiotics in the NICU.
“They put him to the breast right away,” recalls Natalie. “I wanted to initiate breast feeding as soon as possible and that was as soon as possible – literally.”
That extra effort to make sure mothers and their babies experience the full benefit of being together is an important part of the Sunnybrook approach, explains Sue Hermann, an advanced practice nurse in the Maternal & Newborn and Breastfeeding department.
“That’s just the type of care we do,” she says, adding that Sunnybrook’s Sick Mom, Healthy Baby Program works to keep mothers with their babies together, even when the mother is being cared for in other areas of the hospital or when the baby is discharged first.
Now more than a year old, Carmine climbs the stairs and points to the CD player when he wants to hear music (he likes Katy Perry and Elmo’s Hot & Cold), and his belly laugh is cute and contagious, Natalie says.
Healthy mom, healthy baby.