Rocking their babies to sleep, two mothers chat about their current home-away-from-home, Central DuPage Hospital’s NICU (neonatal intensive-care unit) in Winfield.
“Nathan was born at 34 weeks, so early that we didn’t even have any diapers yet,” says Nathan’s mother, Kristen Bruhnke of Glen Ellyn. Since their 4-pound, 13-ounce baby was born, Bruhnke or her husband, John, has dashed to and from the hospital every three hours for Nathan’s feedings.
In the eight days since his birth, Nathan has progressed from a feeding tube to a doll-sized bottle and from an incubator to an open bassinet.
“Jack was born full-term, but his breathing rate was too high so he had to stay,” Mary Morrisey of South Elgin says of her baby. “It was so hard to go home without him. The staff said I could call anytime, so I called three times the first night.”
Across the room, nurse Darcie Schroeder watches over another member of the Class of 2016, a 5-hour-old baby girl in one of the NICU’s high-tech, intensive-care beds. While the baby’s mother recovers in her room from a C-section, Schroeder adjusts the oxygen hood that muffles the infant’s soft cry and checks monitors tracking her pulse, heart rate, skin temperature and oxygen level.
“We’re keeping an eye on her because her breathing is too fast and she was born too warm,” says Schroeder. “We’ve got her on antibiotics, and we’re giving her fluids in an IV. But I doubt she’ll be here for more than a week. Already she’s so strong, she pulled out an IV.”
Tucked out of sight from the public, behind the well-baby nursery where chubby newborns perform for visitors watching through a viewing window, the 12-bed NICU differs from other hospital units. Here, the tiny patients, their families, nurses and doctors form an ever-evolving family, sharing troubles and triumphs.
The majority of the NICU’s babies are premature (fewer than the full 37 weeks gestation), including multiples, who tend to arrive early. Following a national trend, Central DuPage Hospital cares for more multiples each year, 64 sets of twins and one set of triplets in 1997.
“Most people don’t know we’re here until they need us,” Schroeder says. “They think they’re going to have a healthy, normal baby. Then suddenly they’re here with a baby hooked up to all kinds of tubes and monitors.”
Schroeder says she softens the babies’ high-tech looks by putting bows in their hair and booties on their feet. “That helps them look more babylike,” she says. “I encourage the parents to take pictures, even though some don’t want to because of all the tubes. I tell them they’ll want them later.”
Central DuPage Hospital has one of several Level II nurseries in Kane and DuPage. Although not all Level IIs have neonatologists on site, Central DuPage Hospital has nine who rotate shifts. A Level II is better equipped than a Level I (healthy baby nursery) and not as high-tech as a Level III (see accompanying story). Central DuPage Hospital has applied to the state for Level III status; hospital spokesmen say they hope to announce the change in the spring.
Outside the NICU is a bulletin board with snapshots and thank-you notes from its alumni and their families. Stickers indicate birth weights, many less than 3 pounds.
Once a year, Central DuPage Hospital hosts a reunion. Among the regulars is 17-year-old Sarah Ditore of Wheaton, the NICU’s first patient and a current Central DuPage Hospital volunteer. Born 12 weeks early at 2 pounds, 11 ounces, Sarah is an athletic student with a B average at Wheaton North High School, where she’s a senior. “Feisty from the start,” says her mother, Marilyn.
Although low birth weight usually guarantees an NICU stay, weights as low as Sarah’s are no longer as alarming as they were when she was born, the staff explains.
“Technology has changed so much in the last 20 years,” says NICU nurse Susan Leston. “The greatest advance is the use of surfactants, synthetic drugs that keep premature babies’ lungs clear and replace or reduce the need for oxygen, which can cause multiple problems. Also, we can monitor the babies with less invasive procedures now, fewer needle pricks and IVs.”
In the last few years, doctors have learned more about the babies’ memory of pain, says Dr. Carlos Torres, a Central DuPage Hospital neonatologist. “We know more about the connections between pain and stress and how they affect healing,” he says. This affects their treatment, he says, including the use of pain relievers.
But the most noticeable change is the parental involvement. A generation ago, families had minimal contact with their sick babies. Ten years ago, parents were invited in during specific times to hold them. “Now, we encourage the families to be here as much as possible,” Leston says. “More cuddling helps them grow and heal faster.”
Unlike adult intensive care units, there are no visiting hours here. A round-the-clock parade of parents joins the staff at the scrub sink outside the NICU. As the parents come and go, the staff cultivates a homey atmosphere, with soft music and dimmed lights in the evening and an ever-present “family” circulating chit-chat around the table in the middle of the room. Like visiting relatives, the parents weave in and out of staff conversations and are entertained by “in” jokes. “The nurses have to pick on the doctors,” Leston says as she teases Torres. “That’s the law.”
The staff encourages grandparents, aunts, uncles, even older siblings (at least 12 years old) to fill in while parents rest. “Especially if Mom has a C-section, she needs help,” Leston explains. “The more we snuggle and talk to the babies, the better. Some relatives are reluctant because the babies are so tiny and seem breakable. Then they find out they’re little but mighty. And each has a different personality, just like bigger kids. They don’t know they’re pre-term.”
Although most of the NICU babies are premature, some are full-term babies with breathing or eating problems or irregular heart rates. “We also get some super-big babies born to mothers with diabetes, which causes side effects for the babies,” Torres explains. “Others are full-term babies who go home, then return with jaundice. Some are post-mature babies with meconium (fecal matter) aspiration; their stool enters the amniotic fluid before or during birth.”
A neonatal nurse is more than a nurse, explains Carol Nejdl, who oversees the neonatal unit at Good Samaritan Hospital in Downers Grove. “You have to continue to learn about the new, high-tech equipment,” Nejdl says. “At the same time, you have to have a true love of the babies and a genuine compassion and understanding of the family dynamics. The parents are scared to death, and you need to respond to that and help them cope.”
Neonatal nurses double as educators, teaching parents how to bathe, swaddle, bottle-feed and nurse their babies, who have an average stay of 6.3 days. Parents who have had other, full-term children learn that caring for preemies is different, say the nurses. Baths must be swift because they get cold quickly. Breast-feeding isn’t easy for babies still learning to suck.
Parent care begins when the baby arrives, says Judy Smith, who heads maternity services at Geneva’s Delnor-Community Hospital. “Everyone expects a Gerber baby. When the baby isn’t a Gerber baby, it can cause shock, grief, disappointment,” she says. “Dad is confused. Mom’s hormones are out of whack. Many don’t have extended families in the area to help. They need support.”
At Delnor, support includes a 24-hour hotline for parents to call nurses with questions, plus low-cost hospitality rooms for mothers to stay near their babies after the mothers are discharged.
Leston says parent care includes reminders to eat and rest. “They are so worried about their babies, they tend to forget about taking care of themselves,” she says.
Each neonatal staff says it aspires to discharge its patients as soon as it can. “Home is better,” Leston says. “We used to wait until they reached 4 or 5 pounds, but now we know if they’re less than 4 pounds but thriving and eating well, they’ll be better off at home.”
Discharges trigger mixed feelings for the staff, Leston says. “When a baby goes home, it’s sad but happy,” she says. “We miss the baby and parents, but we’re happy to see them go home and become a family.”
Parents go home with a greater appreciation for the frailty of life and the nurses and doctors who sustain it.
Told she can take her baby with her this afternoon, Morrisey says, with tears of relief running down her cheeks: “Jack isn’t as sick as some of the others, but it’s still scary. People who have healthy babies have no idea how lucky they are. Now, every time I go by a neonatal unit, I’ll pray for everyone in there.” Kane and DuPage County residents are fortunate, says Dr. Stephen Saunders, the Illinois Department of Human Services’ associate director. “All of the hospitals in these counties have state-designated Level II neonatal units,” he says.
Level I nurseries receive normal newborns and those with simple health problems. Level II units accept babies with more complex problems and pre-term babies weighing at least 2 1/2 pounds. Level III nurseries handle extremely premature babies and those with complicated illnesses.
To confuse matters, Illinois hospitals’ trauma (emergency room) levels are the reverse. Level I is tops.
The range of capacity and services at the Level II nurseries varies, Saunders says. Some have neonatologists on site 24 hours a day; others have them on call. Saunders notes that the level designations not only reflect the neonatal unit’s capabilities but also the extent of the hospital’s resources such as laboratory services and surgery subspecialties.
Each Level II hospital has a transfer agreement with a Level III hospital. There are no Level III units in Kane or DuPage. Very sick babies from Central DuPage Hospital, for example, are transported to Level III units at Lutheran General Hospital in Park Ridge or Christ Hospital and Medical Center in Oak Lawn. Delnor-Community Hospital in Geneva usually transfers them to Lutheran General. Good Samaritan Hospital in Downers Grove calls Christ Hospital.
As their babies’ health improves, many parents move them from Level IIIs to Level IIs to be closer to home.
As hospitals improve their offerings and apply for higher designations, Saunders says, they share a common goal: to transfer sick babies as little as possible. Although Mother Nature still calls the shots, advanced prenatal care is the real coup. “In the future, ideally, more at-risk babies will be identified before birth so they can be delivered at Level III centers when appropriate,” he says.
