Day 2 in the NICU

I walk into the NICU this morning to find a swarm of people huddled around one of the isolettes. It was the 23 week old baby. They pulled a wall around the isolette to create some privacy while the doctors and nurses performed chest compressions to try and get a heart beat going again, but unsuccessfully. All of the nurses and doctors knew this was the inevitable outcome, and it was only a matter of time.

I met my knew nurse Kelli, who had the same two babies I was with yesterday. Throughout the course of the day, she explained in great detail so many things. She took me through one of the 27-week babies head to toe and explained every bell and whistle attached to him that is keeping the little guy alive.

The first numbers she explained were the three temperature measurements. One is the baby's temperature, one is the isolette temperature, and one is the temperature that the isolette could be in order for the baby to maintain his same temperature. Kelli had me stick my hand in the isolette to feel how hot and humid it is, and she explained to me that the humidity allows the babies to maintain their moisture, sodium, electrolytes, and other minerals. A baby born at 23 weeks has skin that is only about four cell layers thick, whereas a fully-grown person has skin that is about 20 cell layers thick–a huge difference. Because of this, it is easy for babies to lose heat and moisture through their skin, so the hot and humid conditions in the isolette help prevent that. As the babies grow and can regulate their body temperature better, the nurses slowly wean them from the isolette by dropping the temperature inside until the babies are stable enough to stay in an open crib.

The first examination she did was of the baby's skin, which should be pinkish-red; pale or blue skin says something isn't right. She then explained the cannula, or the tubes going into the baby's nose, which deliver pressure into the lungs. This, in the long run, can cause some damage to the lungs, but not as much as an oscillator does. Next was the tube going through the baby's mouth, down into the stomach. She explained that the pressure from the ventilator can force air down into the stomach, so the tube helps babies "burp" or release that air. The patches on the baby's back and chest are each connected to a different machine to measure things like temperature and heartbeat, which the machine then displays in numbers. This baby also has an IV, which goes in through the umbilical cord! I didn't know that was something they did in babies, but apparently it decreases the risk of infection. Lastly, the strap with a red light going around the baby's foot measures the oxygenation levels, which the machine displays in yet another number.

One disorder I learned about today was Cystic Fibrosis, which is a genetic disorder that affects the mucus-producing glands in primarily the respiratory, digestive, and reproductive systems. The glands produce abnormally thick mucus, which can cause problems with blockage and infection. I learned about this because one of the babies here often has a lot of mucus in her mouth and nose, so Kelli drew blood today to get tested for CF.

Both of the 27-week babies get chest physiotherapy (CPT) done. I learned that this helps prevent the alveoli in the lungs (which are involved in cellular-level respiration) from collapsing.

One thing I asked about today that was unclear to me was the difference between a brain bleed and a stroke. I didn't know that babies can actually have strokes in utero because of a blot clot or other complications, but that is different from the brain bleeds that a lot of very premature babies get. A brain bleed is bleeding within the ventricles (which is a water system in the brain), and when it gets bad enough, such as a grade IV bleed, blood can leak into the brain itself and cause much more damage to the tissue. However, a hemorrhagic stroke is when blood vessels that oxygenate and feed brain cells rupture and cause bleeding within the brain. Both can cause the same outcome but are not considered the same thing.

Something I have noticed is that the nurses try to check everything on the babies, give meds, change their diapers, and feed them all at the same time so that they don't have to keep disrupting their sleep every ten minutes. Instead, they can do everything at once then let the babies rest for as long as possible, which is when they grow and gain the most weight.

Another thing that I am seeing and hearing a lot is that everything in the NICU has a consequence. For example, being on a ventilator can cause damage to lung tissue, but it is necessary to keep the baby alive. Kelli keeps saying, "The lesser of two evils." That is a really important reality that I am glad I am learning in the NICU.

The three temperature readings 

Timed pumps that administer meds slowly 

Heart rate, respiration, and oxygenation measurements