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Vital Signs

 
Fall 2011

Family-Centered Care Helps Preemies Transition From NICU to Home

09/16/2011

One in eight babies in the U.S. is born prematurely and may face weeks or even months in a Neonatal Intensive Care Unit (NICU) to address serious medical complications resulting from underdeveloped organs. While the latest “high-tech” strategies continue to improve long-term survival for premature infants at the highest risk for neonatal death, a “high touch” approach is recommended to ensure quality of life and alleviate the anxieties of parents preparing to take their babies home, experts say.

“Parents of premature and other high-risk infants watch their babies face difficulties with breathing, feeding, tolerating breast milk or formula, jaundice and a myriad of other problems that require constant medical attention,” says Sherin Devaskar, M.D., physician-in-chief of Mattel Children’s Hospital UCLA and chair of the Department of Pediatrics at the David Geffen School of Medicine at UCLA. “Their concern is natural and to be expected.”

According to Dr. Devaskar, premature and other high-risk infants are admitted to the NICU and monitored constantly until they are able to suck, swallow and breathe without help from a ventilator and maintain their body temperature. Treatments that support their development include surfactant replacement and gentle ventilation to reduce inflammation to premature lungs resulting from mechanical ventilation, total parenteral nutrition to prevent malnourishment, photo therapy to reduce jaundice, cooling to prevent long-term neurological injury caused by low oxygen or low blood flow before or during delivery, or the extracorporeal membrane oxygenator to assist some babies with breathing during transition from the womb to the outside world.

VS-Fall11-NICU to Home“These specialized techniques used at the beginning of life influence the entire trajectory of the child’s life,” says Dr. Devaskar. “Neonatal health spells adult health.”

When it’s time to transition the infants from the NICU to home, Dr. Devaskar says the neonatal team involves the parents in providing the day-to-day care to babies in order to help parents reach a level of comfort that causes their fear and apprehension to diminish. A key strategy in facilitating this transition is a family-centered intermediate care unit, sometimes called a “step-down” NICU, located away from the main NICU.

“The best thing about the step-down unit is that babies are housed in single cubicles that personalize the environment to meet their individual needs,” says Uday Devaskar, director of neonatology at UCLA. “It’s important to have a calm and controlled environment as parents learn to care for their babies. Once the door of a cubicle is closed, parents find themselves alone with their baby yet have professional help just a call away. They can choose to stay with their babies for longer periods of time without interruptions or unwanted noise.”

The step-down unit is also important to promoting infant development, according to Dr. Devaskar.

“A normal baby sleeps 22 hours per day,” he says. “Most of the secretion of hormones necessary for growth happens at night. That process is hard to replicate in an environment that is not congenial for normal sleep.”





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