Michael O’Brien, NICU Nurse Manager at AdventHealth talks about the challenges premature babies face and how the babyleo helps them.
Interview conducted by Ivanhoe Broadcast News in November 2018.
Tell me a little bit about your background, how long have you worked as a NICU nurse?
Michael: I started working as a NICU nurse probably in nineteen ninety two, nineteen nine one or ninety two up in Newark. And then I moved down here with my family in nineteen ninety three and I started working in the NICU here at Florida Hospital in Orlando and I’ve been here ever since.
So you’ve seen the changes?
Michael: Yes, when I first came here we had seventeen beds and now we’re up to a hundred and one beds.
You’ve been here since nineteen ninety three so you’ve seen the changes.
Michael: Yes, as central Florida grew so did we. We went from a seventeen-bed unit and we have a hundred and one beds now.
Is there a need, do you see more babies being born at earlier ages and surviving?
Michael: Yes, absolutely. There’s been big changes even since the nineteen nineties and what they can do now to save the babies. Things such as surfactant, giving steroid shots to the mother to help mature the baby’s lungs if they’re going to be born early. Just a lot of progress in saving babies lives.
Talk to me about some of these challenges, the health challenges that some of your patients face.
Michael: Premature babies, the one great challenge with them is infection. The mother’s body controls the infection. When the baby stays in the placenta it is sterile. And the baby’s immune system is not really developed until the baby is close to term. So when the babies come out early they don’t have the ability to fight off infection. One of the things that really helps is we try to get all our mothers breast feeding. The moms who have the premature babies we have them pump, we have lactation nurses that help them pump and we give their milk to the babies through a little tube and that helps the babies immune system. Because anything that the mom got through her life she has built up antibodies to it, it goes through the milk and it gets to the babies and it helps the babies.
Infection is the one big thing. Talk to me about needing to control temperatures because they’re not the normal size. Is it difficult for them to regulate their body temperature?
Michael: Absolutely. What happens inside the mother the last trimester of the pregnancy when the baby gets up close to term is when the baby develops all the fat on the body. And it’s called brown fat. That fat is what helps keep infants warm after they are born. They’re wrapped in a blanket they can keep themselves warm. The premature baby on the other hand doesn’t have the opportunity to build up the brown fat that to keep themselves insulated and warm. So even if you take a baby and wrap it up in blankets, it will still get cold.
The premature baby they don’t have that fat, that stored fat?
Michael: Yeah, that premature baby doesn’t have it because that fat is built up on the baby in the last trimester of the pregnancy. The very end of the pregnancy is when the baby is all completely done inside the mother but it’s just getting all this fat on their body and getting big and strong to be born.
What is the challenge for nurses and for doctors and staff for monitoring these babies? Is there a certain temperature they have to stay?
Michael: After the baby is born the thermal regulation is a very important thing, because the babies will get cold right away. What we do is we take the babies and we put the babies as soon as they’re born, dry them off and put them in a radiant warmer. Now what a radiant warmer is, it’s an open bed and heat blows down from an overhead source on to the baby to keep the baby warm until we can get IV’s started. Because premature babies can’t eat yet so we have to give them all their nutrition through the IV fluid. We can give them fats, electrolytes, vitamins, everything through the IV fluid. But we have to get the line started in the tiny little premature baby. We usually start it with the umbilicus, we put the lines in to the umbilicus and start to feed the baby the same way the mother did, through the umbilicus, nothing through the mouth yet. Thermal regulation is very important. At first they’re in the radiant warmer then after we get them all set up, we get the respiratory equipment on and we get the IV’s in place we change them from the radiant warmer in to a isolette. An isolette is completely enclosed with little portholes and we can regulate the heat in there by putting a sensor on the baby’s body on the skin and the machine itself, the one we use is called the babyleo, it will keep tabs on the baby’s temperature constantly and it will bring up the heat as the baby’s temperature starts to drop and when the baby is at ninety eight six it will keep it the same. And then if the baby starts to get too warm it will turn itself down.
I’m going to re-ask you that last question. Tell me about the babyleo, how that’s important in regulating the temperature.
Michael: The way we used to do it prior to having babyleo is we used to have manual radiant warmers. And the baby would, after they were born, they would hand the baby over to the NICU team. We put them under the radiant warmer. Now that whole bed was open and the heat is just coming down from an overhead source on to the baby, that’s the radiant heat. And we, the doctors, the practitioners, the nurses would get in there, the respiratory therapists and get the babies set up or settled. Start your IV’s to give them fluids and nutrition to keep their blood sugar up and respiratory equipment because remember a premature baby does not breathe inside the mother. No baby does, they’re in amniotic fluid and the mom is giving the babies the oxygen and nutrition through their umbilicus, in to the baby’s umbilicus. When we first get the baby they’re under a radiant warmer but after we get the baby settled and get the lines in and get the baby’s respiratory status settled in we move them from the radiant warmer into an isolette and inside the isolette the baby has a little sticker on the body with a little sensor. And it runs in to the machine itself and the machine will heat up.
You were talking about the sticker.
Michael: There’s a little device that lays on the baby’s skin. It’s like a thermometer, and a little sticker goes over it keeping it on the baby’s skin and it goes in to the isolette. The machinery in the isolette and the computer in the isolette can constantly monitor the baby’s temperature. And as the baby’s temperature starts to drop it will turn on the ambient heat inside the machine. Also the mattress gets warm and it circulates the air and warms the air inside the mattress. The next thing it does is it can re-attach sterile water to the isolette and it will take that water and we can adjust the humidity inside the isolette. Because remember the premature baby was floating in amniotic fluid inside the mother and their skin is not ready yet to be out in the dry, dry air. They need a lot of humidity.
What’s the benefit to having this first of all for the baby and second of all for the staff because would these be things that you would have to watch on a twenty four hour basis prior to having the babyleo?
Michael: I formerly said that the baby would first go in to an isolette and then first go in to a radiant warmer and then go in to an isolette. With the babyleo it serves as both functions. The top of the babyleo comes off, it stays attached but it will raise up and you can have thermal heat blowing down on the baby with all sides down. So it acts as a radiant warmer. And then once we have everything set up we don’t have to move the baby in to an isolette because we just bring up the sides, close down the top and we can set humidity, temperature and everything right at that point.
Again what is the benefit to the baby, I kind of asked that question but I want to ask it again.
Michael: Well the benefit to the baby right off the top is you’re not moving, you want to keep a premature baby especially a very young premature baby very still. You don’t want to bother them you don’t want to jostle them around because they could get a brain bleed. You want to keep them steady. We call it IVH precautions. It’s intraventricular hemorrhage precautions. And we keep the baby in that isolette. Now prior to this we were removing the baby from the radiant warmer in to an isolette. So you were taking the baby, lifting the baby and you don’t want to do that. You want to put the baby in the bed, make a little nest around the baby, you don’t want to move the baby around a lot. And with this babyleo isolette, we can use one bed instead of two.
What kind of a difference is it making?
Michael: I think it’s making a big difference both for the baby’s health and for the family. The functionality of the babyleo, it does many things. First of all it can adjust the mattress up and down, the mattress heats and it can raise it up because we want babies that are premature to be a little bit elevated, about fifteen degrees for the first seventy two hours or so at least. Also the bed can drop down to the level of the mom if the mom is in a wheelchair or laying in bed herself. With a pedal on the floor it will bring the bed right down to the level of the mom. Prior to that moms would come in, in the wheelchair and we’d have to try and stand her up so she could get her hands in and see her baby in the little portholes. Now the bed comes down to her.
Florida Hospital is the first in Florida to have this system, or the first in the country?
Michael: The first in the country to have this system. And we’re still working with the Dragger Company, they come in and we work very closely with them and they’re monitoring how this first roll out goes. And if any changes need to be made they’ll make them.
Anything I didn’t ask you Michael that you want people to know?
Michael: It’s very family friendly. What Dragger did was they brought in focus groups of parents who had babies in the NICU and got them involved in the design of the isolette. It’s very friendly, it’s not real supper clinical looking. It’s family friendly. It has a screen on it, we have a screen that we can use but it can adjust to a family screen. Where it has a little icon like a soccer ball, a teddy bear, flowers that are on there, that are on it, but yet it will give the parents information. It will give the parents the baby’s temp and it will give the parents the last weight their baby was. It has that ability up there but yet it does it in a very soft fashion. It also has ambient lighting around the bottom of the isolette so when we try to keep the babies in a dark space, the premature babies when they’re first born. Because they were in darkness inside the mom so we’re trying to duplicate the womb. But around the bottom of the isolette it has ambient lighting that can adjust to different colors. For example, the nurses usually put it if they know they’re getting a little girl they’ll have it pink lighting. If they know they’re getting a little boy of course they’ll have blue lighting. But the parents can choose anything along the spectrum, yellow, green, whatever lighting that they want for their room.
END OF INTERVIEW
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