World Prematurity Day 2017
As every year, the days leading up to World Prematurity Day, November 17th, showed an increase in the number of articles on prematurity. In this and the following blog post, I will summarize some of these wonderful articles from this year. In this first post I will discuss prematurity from a statistical or academic standpoint before getting into what different types of NICUs are like here in the US and the emotions you may feel as a parent while your child is in the NICU.
March of Dimes has several research centers (the first of which was launched at Stanford in 2011), that study the causes of preterm birth. As part of its efforts, March of Dimes produces annual report cards for each state. California received a B this year for a preterm birth rate of 8.6%. These grades are determined by “comparing the 2016 preterm birth date in a state or locality to the March of Dimes goal of 8.1% by 2020.” For California, only one of the six counties with the greatest numbers of births improved from the previous year: San Diego. The rates for four of the six counties worsened from the previous year. Unfortunately, the rate of preterm births among black women is still much higher than all other races and ethnicities. In California it was 11.8%.
Racial disparities exist in many other aspects of maternal and child healthcare, including higher rates of sudden infant deaths (SIDS), increased rates of asthma among children, and higher kidney failure rates among people with diabetes, discussed in two separate NPR pieces. As the second article from NPR notes, there have been some breatkthroughs in identifying how racism’s role in healthcare, and how we might be able to decrease some of these disparities.
In addition to these statistical and scientific studies on preterm babies, there were also some more personal accounts in podcasts from people who work at or spent time in the neonatal intensive care unit (NICU). Two episodes that stood out to me this season Navigating the NICU with Sue Hall (The Birthful Podcast, episode 85 and 72 Days in the NICU with Ingrid (Motherbirth, episode 33.
As Sue explains in the Birthful Podcast episode, there are four levels of NICUs that were defined by the American Academy of Pediatrics (AAP) in 2004:
- Level 1: well newborn nurseries that have the capacity to perform resuscitation or stabilize infants of less than 35 weeks until they are transferred to another facility.
- Level 2: specialty care for babies who are born at 32 weeks or more with issues that are expected to resolve relatively quickly. According to the AAP,
“Level 2 nurseries must have equipment (e.g., portable x-ray machines or blood gas analyzers) and personnel (e.g., physicians, specialized nurses, respiratory therapists, radiology technicians, laboratory technicians) continuously available to provide ongoing care as well as to address emergencies.”
- Level 3: By the AAP’s definition, level 3 NICUs provide “subspecialty care for critically ill newborn infants,” primarily those born at fewer than 32 weeks and/or weigh less than 1500 grams at birth or have medical or surgical issues. Sue explains that this can include babies who need help breathing with a ventilator or CPAP, have issues with their blood pressure, or have a constellation of problems.
- Level 4: Sue explains that this is generally a tertiary care center like a children’s hospital, a part of a children’s hospital, or an academic center. According to the AAP, these facilities are able to handle all the issues a level 3 NICU can in addition to having “pediatric medical and pediatric surgical specialty consultant continuously available 24 hours a day”.
After discussing the levels of NICUs, Sue continues to explain that 10% of all babies spend time in the NICU, and approximately 2/3rds of those babies are there for prematurity. Of those, 2/3rds (about 4.4% of all births) are late preterm babies (born between 34 and 36 weeks). Some babies born at term (after 37 weeks) also spend time in a NICU, primarily for issues that occur during labor such as their mother running a temperature during birth or having issues with low blood sugar. These babies also might have jaundice, have shown dips in their heart rate during labor (aka “decels” or decelerations), have had the umbilical cord wrapped around their neck at birth, or just need some time adjusting to life outside the womb. At San Francisco General Hospital (SFGH), where I volunteer, the NICU staff observes any baby born via cesarean section for at least a little while after birth. SFGH has a Level 3 NICU and transfers babies to University of California at San Francisco (UCSF), a level 4 hospital, when necessary.
If you end up in the NICU with your baby, what will it look like?
From what I have seen at SFGH, NICUs often have a lot of machines and cords. Depending on how sick or preterm the baby is, they may be laying in an isolette (an incubator with controlled temperature, humidity and oxygen levels and places for you to reach your hands in to) or they may just be laying on a small bed. Many hospitals (like SFGH) have recliners that parents and visitors can sit in. Some hospitals have beds for parents to sleep in next to their babies. Sometimes these are in the same room with as the baby and sometimes they are in a room nearby. Sue mentions that there may be a Ronald McDonald house near the hospital that you can stay in at a relatively cheap rate. Unfortunately, for a variety of reasons, some parents are unable to stay with the babies in the NICU, and so some hospitals have volunteers hold and interact with the babies as this is very good for their development. This is what I do on occasion at SFGH.
What emotions may you experience throughout your time in the NICU?
Emotions of those whose babies end up in the NICU have often been described as a roller coaster. Many of these emotions can be felt at the same time. Sue mentions the first potential emotion: shattered dreams. Your dreams of having and immediately taking home a healthy baby are shattered. She also mentions that depression is 2/3 times higher and can last up to two years after delivery for NICU parents. Unfortunately parents who are depressed tend not to be as interactive with their babies, which leads to slower development for the baby. NICU parents can also get post traumatic stress disorder (PTSD) with the trauma of intimidating hospital equipment and having a baby in the NICU as just a few examples of reasons for this PTSD. It’s important to talk about the feelings you have while in the NICU.
There are also things that you will celebrate in the NICU that you might not otherwise. In the Motherbirth episode, Ingrid talks about the excitement and joy she felt when she was told she would be able to hold her baby for the first time: running to take a shower and get prepared for the event. The host of Motherbirth describes the feelings as being similar to going on a first date. Ingrid also talks about the power she felt with being able to help other parents go through the situations she had already been through.