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Woman And Infants
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Woman And Infants
Patient:
Daniel

Treatment:
Neonatal intensive care

Category:
High Risk Obstetrics/NICU

Organization:
Women & Infants

Special Care for Special Needs

 After 10 years of marriage, Lisa and Kevin Dupre were finally expecting their first child. Excitement, joy and, yes, a little bit of trepidation, surrounded them as the pregnancy progressed. But at 21 weeks, Lisa was hospitalized, and on February 11, 1999 at 24 weeks and two days pregnant, just more than half-way through a normal pregnancy, Lisa delivered Daniel.

Weighing just 1 pound 10 ounces, Daniel came out screaming and kicking. "He was a fighter from day one," commented Lisa. But his condition was still precarious. And like other parents of children born very prematurely, Lisa and Kevin were scared. Fortunately, though, Daniel was born at Women & Infants Hospital, the site of one of the finest neonatal intensive care units (NICU) in the country.

Each year, Women & Infants admits nearly 1,300 high-risk infants to its Special Care Nursery, 15 percent of whom are transferred from other area hospitals. According to James Padbury, MD, pediatrician-in-chief at Women & Infants, 60 percent of the babies in the NICU are admitted for problems related to prematurity; 20 percent are full-term babies with infections or problems adjusting; and 20 percent are babies with birth defects, metabolic disorders or surgical problems.

Women & Infants' survival rates for premature babies is excellent. According to Dr. Padbury, babies born at 23 weeks gestation have a 46 percent survival rate; 24 weeks gestation have a 59 percent survival rate; and 25 weeks gestation have a 82 percent survival rate. "It just goes to show how important each week - each day even - is in the life of a developing baby," commented Dr. Padbury.

But where Mother Nature leaves off, the hospital picks up. Among leading academic medical centers in the Northeast, Women & Infants' NICU boasts the highest survival rate of babies born weighing less than 750 grams (1 pound, 6 ounces).

Born so early and so small, Daniel Dupre is certainly a success story. Like many premature babies, Daniel was born with some very serious health consequences and therefore, spent the first 95 days of his life with the help of the sophisticated technology in the hospitals' Special Care Nursery -- not to mention the specialized expertise of a highly qualified, interdisciplinary team of practitioners. That team includes highly trained nurses, neonatologists, neonatal fellows, pediatric residents, radiologists, respiratory therapists, nutritionists, social workers, pharmacists, nurse practitioners, and administrative staff.

In Daniel's case, his lungs weren't fully developed, so he needed help breathing. And his digestive system wasn't fully mature, so he developed reflux and had a difficult time eating. Like many "preemies," Daniel needed laser eye surgery to correct vision problems that sometimes result from prematurity.

"Some of the more unstable babies come in requiring respiratory care, surgical intervention, intravenous lines, antibiotics and ventilators. They are fed by IV and then, after two or three days, by a gavage tube in the nose," commented Dawn Andrews, RN, MS, nurse manager of Women & Infants' Special Care Nursery. "Once the babies get bigger and stronger, we start to decrease the IV feedings and move them to total gastric feeding."

Once stable, many babies are transferred to Women & Infants' Continuing Care Nursery. Still part of the Special Care Nursery, this area really focuses on parent participation. Parents are encouraged to become as involved as possible in the daily care of their baby, including feedings, changing, bathing and basic care.

"Toward the end of a baby's stay, the parents do the majority of the work, with the nurses teaching and guiding," said Dawn Andrews. "Before the baby goes home, it's really important that the parents feel comfortable and confident being on their own."

And although the parents are on their own, the nurses and staff in the Special Care Nursery are just a phone call away. Day or night, staff are available to the Special Care Nursery "graduates" to answer questions to just provide some needed support and encouragement.

Today, Daniel Dupre is still on oxygen at night and still takes Zantac for his reflux. But he's developing like a normal child. "Daniel is developing normally for his adjusted age of 8 months and he's very smart," said Lisa. "Some of his physical development needs a little help, so a physical therapist comes to our house weekly to work with him."

No one expects to have a baby that will need the sophisticated services provided in a NICU environment. But according to Dr. Padbury, each year about 11 percent of all babies born at Women & Infants Hospital are admitted to the NICU. Of those babies, more than half of the parents had no indication that they were carrying a baby who would require such sophisticated levels of care.

"No one wants to be in the position we were in," said Lisa Dupre. "But the staff in the Women & Infants' NICU are like family, and they take you under their wing. They truly are our angels from heaven."

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