NICU

Apnea in Prematurity

/ Jordyn Redwood / Leave a comment

Terri Forehand is back to discuss a common malady for premature infants. Good information for an author writing about this age group.

Welcome back, Terri!

Apnea is one of the most frightening symptoms for parents of premature infants. Apnea is a pause in breathing for 15-20 seconds.  It is associated with the infant’s color changing to a pale or bluish tint and with the heart rate slowing for a period of time. It can be alarming for those witnessing an episode of apnea for the first time and requires reassurance and education from the staff for those frightened parents.

The major reason premature infants experience apnea is their immature respiratory center of the brain. Preemies have bursts of big breaths followed by periods of short or shallow breaths or breathing pauses. It is most common in sleeping infants which is also reason for concern for new parents.

Bradycardia or the slowing of the infant’s heart rate is also a common symptom of prematurity and often goes along with the episode of apnea. Other causes for the premature infant to drop their heart rate include during or after a feeding and during a bowel movement.

Treatment for apnea may include medications such as caffeine or aminophylline to stimulate breathing and CPAP (continuous positive airway pressure) or oxygen by nasal cannula. Nasal cannula is the preferred way to administer this treatment and is done with little tubes into the baby’s nose. Mechanical ventilation may be used for very premature infants until they can manage breathing on their own with the assistance of CPAP only.

Most infants grow out of these symptoms close to their original due date as their brain centers mature. If premature infants still are having apnea spells but otherwise could go home, they can go home on an apnea monitor. Parents are trained to apply the monitor and to know how to use it as well as what to look for in their baby if the alarms go off.

Once the premature infant matures and the apnea resolves, it will not come back. Education and reassurance will help new parents of the premature infant to feel confident in caring for their infant during the last few days before discharge and when finally at home with their new baby.
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Terri Forehand is a pediatric/neonatal critical nurse and freelance writer. She writes both fiction and nonfiction, is the author of The Cancer Prayer Book released in 2011. Her picture book titled The ABC’s of Cancer According to Lilly Isabella Lane is due out in 2012. She writes from her rural home in Indiana which she shares with her husband of almost 30 years and an array of rescue animals.

The Bells and Whistles of a NICU

/ Jordyn Redwood / Leave a comment

I’m pleased to welcome back Terri Forehand, NICU RN, and she explains the NICU environment. Great details for any author writing a NICU scene.

Welcome back, Terri!

Understanding the bells and whistles of a Neonatal Intensive Care Unit (NICU) is essential for the nurses and neonatologists that care for these tiny infants but it can be especially confusing for parents of a premature infant and down right mind boggling for those trying to write about a premature infant in their fiction. If you are a writer creating a plot or storyline around a NICU unit there are a few things you need to understand.

First, the NICU can be a unit where there are private rooms for each infant and where parents can spend long hours at the bedside in a more comfortable environment with the door closed. An open NICU unit is a huge room with stations or “patient areas” where there is room for the incubator for the baby, monitors, other medical equipment, and standing room around the incubator for the doctors and nurses to care for the infant. Many times you will see a rocking chair cleverly placed between the equipment so mom or dad can be only an arms length away from their baby. The overall feel of a busy unit may feel too close and crowded for many visitors.

A list of general equipment at each bedside regardless of whether it is an open unit or private rooms includes:

  • Incubator or infant warmer sometimes called an island.
  • Suction canister, tubing, and control gage usually attached to the wall used to assist in clearing the airway of an infant.
  • Monitor and cords that attach to the infant’s chest that measure heart rate, respiratory rate, and another cord that attaches to the infant’s foot, toe, ear, or wrist that measures constant oxygen levels in the blood. The specific term for this particular probe is called oxcimetry.
  • Supply cart or shelf that includes needles, blood collection supplies, extra respiratory equipment, diapers, pacifiers, and anything else the infant might need in a hurry.
  • Blood pressure cords to measure the blood pressure of the infant.
  • Feeding supplies.
  • Many other items specific to each infant and the diagnosis including Intravenous pumps, bilirubin spot lights, and blood infusion pumps.

Advantages for the private room concept are privacy for parents and more room for staff to work on each infant. It is considered family centered and parents and grandparents seem more satisfied with these newer creative NICU units that at times can appear more like a plush hotel rather than an intensive care unit for sick babies. The biggest disadvantage for nursing staff is that you can only eyeball one baby at a time, feeling like you cannot keep the best eye on the infants in your care because of the walls between each incubator.

An advantage for the open unit style is easier management of patient care for the staff. It is easy to watch a monitor for one infant and be feeding an infant in close proximity. The nurse can see, hear, and know all about her babies because there are no barriers between patient care areas. This can also mean that private conversations between parents can be over heard by other parents making it more stressful.  The disadvantage is that it can be noisy and more overwhelming for parents not only with mixed conversations but the clanging of alarms from every direction is frightening.

A newborn between 23 and 36 weeks has no place to go but the NICU.  Gestational aged infants between 23 and 28 weeks have the additional complication of breathing issues many times requiring a ventilator. (More on that in another post) The need for extra equipment to support breathing takes up more room, adds more stress to the parents, and adds more alarms to the already frightening atmosphere. It can also be a complication in the plot of a good story.

Parents may be astonished at how complicated a NICU patient area can appear when they first see their tiny infant in that setting. Those of you writing a scene to include a NICU can appreciate how complicated the scene looks to an outsider. It also may offer the possibility for many clever or mysterious scenarios in combination with your imagined family relationships, after all babies are born to the rich, poor, good, bad, honest, and criminal characters both in real life and in the life of your imagination.

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Terri Forehand is a pediatric/neonatal critical nurse and freelance writer. She writes both fiction and nonfiction, is the author of The Cancer Prayer Book released in 2011. Her picture book titled The ABC’s of Cancer According to Lilly Isabella Lane is due out in 2012. She writes from her rural home in Indiana which she shares with her husband of almost 30 years and an array of rescue animals.

Micro Premies: Terri Forehand

/ Jordyn Redwood / Leave a comment
I’m pleased to host neonatal nursing expert Terri Forehand. She will be doing several posts on the unique problems as it relates to gestational age. This is very important for writing medical accuracy into novels as to what these tiny charges and their parents face.
Welcome, Terri!

The neonatal intensive care unit is a frightening place for most visitors. Infants from 23 weeks gestation and older can be found attached to as many tubes and wires making the technical and medical environment confusing and overwhelming.

In the midst of the confusion of an NICU is an awesome atmosphere of healing and growth. The sole purpose of such a place is to mature these tiny creatures into healthy infants who suck, swallow, and breathe without mechanical assistance. In short, is nothing but amazing.
Follow us here to learn about each gestational stage of such infants whether for your own information or for details for your next novel. Today, we’re starting with micro premies.
Gestation: 23 weeks.
Most medical professionals consider a fetus over 23 weeks to be viable, meaning they can be assisted to grow and mature into a full term infant outside of the womb. No one that I know would ever guarantee an infant this young will mature without many hurdles and without the risk of complications that go along with prematurity. But there are many success stories over the course of years of researching neonatal care and progress is outstanding.
The fetus born at 23 weeks gestation will have loose thin skin. Skin grows faster than fat develops and at this stage the fetus doesn’t show much fat development so they are all skin and bones.
After 23 weeks the fetus will begin packing on pounds and increasing in weight. The fetus at 23 weeks is approximately 8 inches long and just over one pound and growth is rapid for the next few weeks.
The essential problem with survival of a 23 week fetus outside of the womb is breathing. Lung development at this age is very immature and the lining of the lungs is stiff making the exchange of oxygen more difficult. One of the main goals of the NICU team at this stage is to promote adequate oxygenation with supplemental oxygen and a variety of mechanical adjuncts to assist with breathing.
Another classic characteristic of a 23 week gestational infant is the eye lids most often are still fused closed. The combination of loose thin skin, extra hairy limbs, and fused eyelids make for increased anxiety for new parents and an overwhelming fear of what comes next.

Have you ever written a NICU scene for your novel?

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Terri Forehand is a pediatric/neonatal critical nurse and freelance writer. She writes both fiction and nonfiction, is the author of The Cancer Prayer Book released in 2011. Her picture book titled The ABC’s of Cancer According to Lilly Isabella Lane is due out in 2012. She writes from her rural home in Indiana which she shares with her husband of almost 30 years and an array of rescue animals.