Extra Help When Your Baby Needs It

All babies need care, but there are times when some may need a little more than others.
For those newborns, Plantation General Hospital offers an NICU that is not only
committed to providing the best care possible for babies but also to making a trying time
a little easier for parents.
Delivering more than 4,000 babies each year, Plantation General Hospital houses one of
the busiest NICUs in the country. The 31-bed NICU offers a Level III unit for newborns
who need critical care and a Level II progressive care unit for babies who are more
stable. In the Level II unit, parents receive help with discharge planning, as well as
education designed to help them care for their newborn.
For Perri and Neil Trenk whose daughter Alexa received care in the NICU, Plantation
General's up-to-date technology and capable staff were invaluable. "Alexa was born
when I was only 23 weeks pregnant, and she was given a 20 percent chance to make it,"
says Trenk. "Today, she is in kindergarten, and the quality of her life is as normal as it
could be. I'm so thankful she was born at Plantation General--they did a wonderful job."
The Best Care for Baby

Newborns are in good hands at Plantation General's NICU. Five board-certified and
attending-level neonatologists are on staff full time. As an added bonus, a neonatologist is
on-site 24 hours a day, so parents have the assurance a specialist is always available to
provide extra care for their newborn.
In addition to the expertise of the neonatologists, the NICU at Plantation General
employs a top-notch nursing staff. All the nurses in the NICU have been trained in
neonatal intensive care, and they keep up-to-date on the latest advances by attending
seminars throughout the year. In addition to being knowledgeable, the nursing staff is
also experienced.
"One of the strengths of our NICU is its stability," says Barry Chandler, M.D.,
neonatologist and medical director of the NICU at Plantation General. "We've had the
same nursing staff for many years. Because of this stability, we've built an excellent
relationship with one another and function as a truly integrated team. Parents see this, and
they know we are providing their babies with unified care. In a stressful environment, this
has a calming effect on parents."
This integrated care can be seen every Monday in the NICU during group rounds.
"During these rounds, an interdisciplinary team consisting of a case manager, nurse
practitioner, neonatologist, respiratory therapist, nurse and lactation consultant visits each
and every newborn's bedside to discuss the baby's care," explains Donna Nicorgski,
director of Plantation General Hospital's NICU. "All the disciplines are involved and
offer their input. This type of communication has improved the quality of care for our
infants."
Family-Centered Care

When a newborn needs extra care, the staff at Plantation General's NICU knows that it's
not only the baby who is affected. While providing the highest quality care for the
newborn, the NICU staff also seeks to meet the needs of the family in a variety of ways.
Lean on Us

The days, weeks, or months a newborn spends in NICU can be a trying time for parents.
To help ease parents' concerns, the NICU offers a monthly Parent Support Group.
"Parents who had premature babies are invited to come back and talk with parents of
babies who are currently in the NICU," explains Nicgorski. "This gives parents firsthand
experience with people who understand what they are going through."
This level of communication goes a long way to ease parents' concerns, and it isn't just
confined to support group meetings. Families speak with a nurse practitioner every day,
and a doctor is always available when the family has questions or concerns.
The nursing staff at Plantation General works to assure families they aren't isolated from
their newborn just because the baby is in NICU. "Because parents want to be in the NICU
when it's convenient for them, we offer open visitation. Parents can visit any time, night
or day," says Nicorgski. "The only time the NICU is not open is during a shift change or
in an emergency."
Open visitation gives parents the opportunity to interact with their newborn and learn
how to care for their baby. When babies are more stable, this interaction may take the
form of Kangaroo Care.
"Studies have shown that skin-to-skin contact helps babies grow, stabilizes their
temperatures, and provides important bonding time with parents," explains Nicorgski.
Aptly named after the kangaroo's practice of carrying its newborn close to its body in a
pouch, Kangaroo Care at Plantation General offers parents the opportunity to sit in a
private area and hold their newborn next to their bare skin.
Breastfeeding Options

A baby in the NICU may not be able to breastfeed immediately. To assure that babies
start with mothers' milk, women who plan to breastfeed can store their pumped breast
milk and colostrum in an on-site freezer until it's needed.
Plantation General also has a lactation center. To assure that moms who haven't been able
to breastfeed immediately are successful, lactation consultants are available to work with
new moms one-on-one. Lactation consultants offer "Breastfeeding Your Baby" classes
before delivery, and upon request, they meet with new moms after delivery.
CPR Classes

The staff at Plantation General's NICU wants parents to feel confident caring for their
baby at home. To increase parent's confidence, Plantation General holds infant CPR
classes once a week for families with babies in the NICU. "A large number of the babies
in our unit were born premature," says Nicorgski. "These classes, led by nurses certified
in teaching CPR, help parents feel more comfortable when they take their baby home."
More Than A Day's Work

"Working in the NICU has been very rewarding," says Dr. Chandler. "In 1986, for
example, we cared for the smallest, surviving premature baby --she was only 21 weeks
gestation. Now she's 14 years old."
Nicorgski agrees that the rewards of the job are many. "All the nurses in the unit love
their work, and it shows in how they care for the babies," she says. "It's extremely
satisfying to work with these babies so they can go home with their parents. It's
especially rewarding when parents come back with their children to visit us."

Neonatal Intensive Care Unit (NICU)

The birth of a baby is a wonderful yet very complex process. Many physical and emotional
changes occur for mother and baby.

A baby must make many physical adjustments to life outside the mother's body. Leaving the
uterus means that a baby can no longer depend on the mother's circulation and placenta for
important physiologic functions. Before birth, breathing, eating, elimination of waste, and
immunologic protection all came from the mother. When a baby enters the world, many body
systems change dramatically from the way they functioned during fetal life:

* The lungs must breathe air.

* The cardiac and pulmonary circulation changes.
* The digestive system must begin to process food and excrete waste.
* The kidneys must begin working to balance fluids and chemicals in the body and excrete
waste.
* The liver and immunologic systems must begin functioning independently.

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Your baby's body systems must work together in a new way. Sometimes, a baby has difficulty
making the transition to the world. Being born prematurely, having a difficult delivery, or birth
defects can make these changes more challenging. Fortunately for these babies, special
newborn care is available.
What is the neonatal intensive care unit?
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Newborn babies who need intensive medical attention are often admitted into a special area of
the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced
technology and trained healthcare professionals to provide specialized care for the tiniest
patients. NICUs may also have intermediate or continuing care areas for babies who are not as
sick but do need specialized nursing care. Some hospitals do not have the personnel or a NICU
and babies must be transferred to another hospital.
Although about 9 percent of all newborn babies require care in a NICU, giving birth to a sick or
premature baby can be quite unexpected for any parent. Unfamiliar sights, sounds, and
equipment in the NICU can be overwhelming. This information is provided to help you understand
some of the problems of sick and premature babies. You will also find out about some of the
procedures that may be needed for the care of your baby.
Which babies need special care?
Most babies admitted to the NICU are premature (born before 37 weeks of pregnancy), have low
birthweight (less than 5.5 pounds), or have a medical condition that requires special care. In the
US, nearly 12 percent of babies are born preterm, and many of these babies also have low
birthweights. Twins, triplets, and other multiples often are admitted to the NICU, as they tend to
be born earlier and smaller than single birth babies. Babies with medical conditions such as heart
problems, infections, or birth defects are also cared for in the NICU.

The following are some factors that can place a baby at high risk and increase the chances of
being admitted to the NICU. However, each baby must be evaluated individually to determine the
need for admission. High-risk factors include the following:

* maternal factors:
o age younger than 16 or older than 40 years
o drug or alcohol exposure
o diabetes
o hypertension (high blood pressure)
o bleeding
o sexually transmitted diseases
o multiple pregnancy (twins, triplets, or more)
o too little or too much amniotic fluid
o premature rupture of membranes (also called the amniotic sac or bag of waters)
* delivery factors:
o fetal distress/birth asphyxia (changes in organ systems due to lack of oxygen)
o breech delivery presentation (buttocks delivered first) or other abnormal presentation
o meconium (the baby's first stool passed during pregnancy into the amniotic fluid)
o nuchal cord (cord around the baby's neck)
o forceps or cesarean delivery
* baby factors:
o birth at gestational age less than 37 weeks or more than 42 weeks
o birthweight less than 2500 grams (5 pounds, 8 ounces) or over 4,000 grams (8 pounds,
13 ounces)
o small for gestational age
o medication or resuscitation in the delivery room
o birth defects
o respiratory distress including rapid breathing, grunting, or apnea (stopping breathing)
o infection such as herpes, group B streptococcus, chlamydia
o seizures
* hypoglycemia (low blood sugar)
* need for extra oxygen or monitoring, intravenous (IV) therapy, or medications
o need for special treatment or procedures such as a blood transfusion

Who will care for your baby in the NICU?

The following are some of the specially trained healthcare professionals who will be involved in
the care of your baby:

* neonatologist - a pediatrician with additional training in the care of sick and premature babies.
The neonatologist supervises pediatric fellows and residents, nurse practitioners, and nurses who
care for babies in the NICU.
* respiratory therapists
 * occupational therapists
* dietitians
* lactation consultants
* pharmacists
* social workers
* hospital chaplains

The members of the NICU team work together with parents to develop a plan of care for high-risk
newborns. Ask about the NICUs parent support groups and other programs designed to
encourage parental involvement.