NICU Program That Gives Parents Charge of Baby's Care Cuts Stress, Helps Infant

By Ubelacker, Sheryl | The Canadian Press, September 23, 2013 | Go to article overview

NICU Program That Gives Parents Charge of Baby's Care Cuts Stress, Helps Infant


Ubelacker, Sheryl, The Canadian Press


NICU puts parents in charge of baby's care

--

TORONTO - Jennifer Tano slips her hands through the openings in the isolette, gently snugging into place what seems like an impossibly tiny diaper on her infant son Thomas. Her eyes scan an overhead monitor that tracks his vital signs, taking in his pulse and respiration rate with what has become practised ease.

That wasn't the case when Thomas was born less than two months ago. Delivered prematurely by emergency C-section, he weighed a mere two pounds, six ounces after being in the womb just a little over 27 weeks.

"It's so different from having a full-term baby," says Tano, whose 14- and eight-year-old daughters were comparative behemoths at birth, weighing 7-pounds-10 and 8-pounds-6 respectively.

"You see this tiny little baby and you're so afraid to touch him ... his little diapers, worrying about hurting him, he seems so fragile," says Tano, 35.

"But they've taught me how to handle him."

"They" are the nurses and other members of the neonatal intensive care unit at Mount Sinai Hospital in Toronto, which has shifted the paradigm of how premature and sick infants are looked after with its family integrated care initiative.

Parents have long been encouraged to spend time with their babies in the NICU, but they were typically more observers than participants, often feeling helpless and lost as they sat by their child's isolette watching every breath, trying to make sense of the monitors and startling at every bell or buzzer around them.

"With family integrated care, we have done something quite different," explains Dr. Shoo Lee, pediatrician-in-chief and director of the Maternal-Infant Care Research Centre.

"What we've done is to say that for all babies in the NICU, the parents should be the primary caregivers, not the nurses. And the nurses are really teachers to the parents."

The program was instituted following a 2011-2012 pilot project in which the parents of 40 newborns were asked to spend a minimum of eight hours a day in the NICU and tasked with the overall management of their child's care.

That included bathing and changing diapers, monitoring the infant's vital signs, and recording feedings and weight gain on their medical chart. Nurses were responsible for the medical side of care -- looking after feeding tubes, adjusting ventilation apparatus and administering medications.

The babies' progress was compared with those whose care was primarily provided by nurses, and Lee says "the results were phenomenal."

"There was a 25 per cent improvement in weight gain of the babies who were looked after by the parents," he says. "Breastfeeding rates doubled from 40-something per cent to over 80 per cent. Infection rates fell from 11 per cent in the nurse group to zero in the parent group. Treatment errors dropped by 25 per cent. Parental satisfaction went up, parental stress went down.

"So these were good results."

While parents are encouraged to cuddle their infants for periods throughout the day -- skin-to-skin contact not only provides comfort but also promotes a baby's physical and neurological development -- nurses and doctors keep handling to a minimum to avoid transferring germs from one little patient to another.

"Parents are the ones in charge, so nobody gets to touch their baby without their consent," stresses Lee.

Still, he concedes there was initially resistance to the reorganization of duties from many of the nurses in the NICU, which can accommodate 57 underweight or sick infants at any one time and cares for about 1,200 per year.

"Many nurses felt that the parents could not do this job, that this was their job: the parents were not trained, we were trying to steal way their jobs, it was just a trick to try to reduce the number of nurses," he says.

"But during the course of the study, all the nurses were watching, and now the majority think it's the right thing to do. …

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