Body Builders
Tampa Tribune, The (FL) – March 9, 2006
Garrett. Leighann. Tyler. Jaylanique. Alexis. Jordan. Marcus. Each of them and hundreds of other newborns started life too frail to survive. Their lungs were unable to breathe, they couldn’t swallow, they had brittle bones and other complications. For 22 years, nurses at Brandon Regional Hospital have strengthened fragile preemies for their new world.
By SUSAN M. GREEN
Tribune Staff Writer
BRANDON – What’s startling about the newborn nursery on the second floor of the Women’s Center is the quiet.
Every now and then, the resident “big boy” – today it’s Otis Jenkins IV – puckers his face and tries to blast the world with his frustration at life. He’s 2 days old and weighs more than 7 pounds, but the sound comes out as feeble as a kitten’s cry.
Two beds away, there’s someone smaller, someone who kicks with a foot an inch long and waves a fist the size of a marble. “Mini Munchkin,” nurse Elizabeth Alley calls him. At 1 pound, 13 ounces, he probably could muster a wail, Alley says, if he didn’t have tubes in his throat.
Only eight days old and born four months too soon, he nevertheless has communication skills.
“He hates the diaper change. He hates this,” Alley says, holding up a thermometer. “He smacks my hand. He lets me know.”
She scolds him for thrashing out of the position medical experts recommend for building muscle strength. Then, with a parting, “You are so cute, by the way,” she moves on.
She likes to talk to the babies. She confers with another nurse in the room, Chhay Ngov, about medications and feedings. Occasionally, the high-tech monitoring equipment will blip or squeal.
Quiet reigns, but that doesn’t signal a lack of urgency in the neonatal intensive care unit at Brandon Regional Hospital.
Baby beds with special sensors, suction masks, IV poles and drip bags, ventilators and electrodes etched with a lamb’s likeness await the next patient. Almost everything is specially ordered. Size: tiny.
At least one bed must be available at all times, often stocked with duplicate items.
“You never know what could happen,” Ngov says. On this day, he’s actually set to bottle-feed a baby: Max Anthony Monte, another of the big boys, full-term but the survivor of a lung collapse shortly after his birth the day before.
Usually, Ngov works among the preemies offering nourishment by tube.
“We’re sort of the fix-it station for all kinds of illnesses in newborns,” says Nancy Landfish, the unit’s medical director. “Some stay two days. Some stay seven months. … The cost is astronomical, but when the outcomes are great, they’re priceless.”
The hospital recently held a reunion for families whose babies came through the NICU during its 22-year history. More than 250 families came.
“People said, ‘You saved my baby. I love you,'” Landfish recalls. “It was kind of scary. … You realize you have an impact on people’s lives.”
Medical miracles
In the world of human procreation, 23 is a magic number.
Babies are supposed to stay inside the womb, developing muscles and bones and organs, for at least 38 weeks.
Get an infant to 23, though, and neonatologists have a shot at using medicine and technology to finish the incubation nature intended. Another week and their chances swell: Statistics show about half the babies born at 24 weeks’ gestation survive, and the odds improve dramatically at 26 weeks.
Artificial surfactant, a moist coating, helps lungs mature. Tubes and IV lines feed babies too young to suckle and swallow. Ventilators keep them breathing. Warming beds and monitoring equipment regulate body temperature. Therapists coax strength into brittle bones that didn’t get the calcium spurt of late pregnancy.
Longtime nurses say they have seen what appear to be miracles, courtesy of medical advances.
“Kids that didn’t make it 20 years ago make it easily now,” says Pat Lynch, who spent the first half of her two decades in neonatal nursing in Wisconsin before joining the Brandon staff.
A little more than 40 years ago, Landfish says, the best medical care available couldn’t save the infant son of former President John F. Kennedy. Born a month early, the boy died at two days old, suffering from a form of respiratory distress that today is considered highly treatable.
Landfish, a neonatologist for 15 years, has overseen Brandon’s NICU for six years. She sits on a national committee of specialists assembled by the hospital’s parent corporation, HCA, to press for improvement in medical treatment of newborns.
Though small, she says, the Brandon unit has piloted some practices later adopted nationwide and consistently ranks in the top 25 percent of similar U.S. facilities for favorable outcomes.
Landfish designed the 23-bed NICU, which replaced a previous unit tucked away on the third floor of the maternity ward. She divided the second-floor space into five pods that have computerized monitors, a system for double-checking prescriptions and doses, and the latest equipment for struggling newborns.
Though keenly interested in scientific research aimed at saving more infants, Landfish puts that second to the importance of family in the day-to-day care of critically ill babies.
“Mostly, neonatal intensive care is about family,” she says.
Rocking chairs are interspersed throughout the pods. Nurses said they see the calming influence of parental voices on fussy babies.
Most infants sleep with a “scenty doll” fashioned from a receiving blanket.
“Mommy sleeps with it, and it gets her scent on it,” says clinical nurse manager Deborah Bruton. “That seems to be a great source of comfort” to the infants.
The unit also has three bedrooms available for parents to stay overnight. In some cases, they may have their babies there with them, knowing the nurses are nearby, Landfish says.
Born too soon
The rooms have been a comfort to LaToya Archie, of Brandon. Her son George Jr. came into the world 10 weeks early. Two weeks later, he underwent back-to-back surgeries for an infected colon.
Archie says her older son, Jamariyea, 3, also was born prematurely when she and her husband were living in Miami. Jamariyea had to stay in the NICU there for three months, but he did not need surgery.
George Jr. was another story.
“George gave me a scare,” Archie says. “He stopped breathing on the [operating] table.”
Archie had been discharged from the hospital but was able to stay near her son for two nights during the frightening period.
“I was up at 3 o’clock in the morning. I don’t think I got any sleep,” she says. “I kept praying everything would be OK.”
The NICU staff offered comfort.
“When I was depressed and crying, they said they would do the best they could for him,” she says. “It’s like a big family there.”
Nurses are coaching her in feedings and changing the colostomy bag that George Jr. will wear until he’s strong enough for another surgery to rebuild his bowels. The baby is expected to go home on Archie’s due date: March 20.
She visits her baby daily. Her husband, who works long hours at a milk-processing plant, visits when he can. Her older son receives therapy for developmental delays, but he is healthy and excited about being a big brother.
“He loves to go out there and see” George Jr., she says. “He loves to hold the bottle and do the feeding.”
A wall near the NICU entrance is covered with photographs from grateful parents. The pictures show how yesteryear’s diminutive bodies grew into their names: Garrett. Leighann. Tyler. Jaylanique. Alexis. Jordan. Marcus.
Landfish says the nurses started the display to give new families hope.
Sometimes, on high-stress days, it’s the doctor’s mainstay.
“This is kind of my light at the end of the tunnel,” Landfish says, fingering photos and remembering when the fate of the child pictured was in her hands.
“You look at these pictures, and you say, ‘Wow.'”
Every baby is special, she and the nurses insist, but there are some who stand out: the infant who looked normal but would have suffered severe brain damage if Landfish hadn’t performed a spinal tap on a hunch; the twin with kidney failure who was adopted by an NICU nurse.
Sometimes the patients most remembered aren’t the success stories.
Sad little room
At the end of a hall is a room marked “consult room.” The nurses call it the bereavement room. Furnished with a love seat and plush chairs, it’s the place where parents say goodbye.
“It’s a sad little room,” Bruton says. “Parents can come in here and cry or hold their babies for the last time.
“Everybody handles it differently. Some people want to hold their babies. Some want to leave. Some hold their babies for hours.”
Lynch, dubbed “Nana” on the NICU floor, knits booties, hats and shirts in sizes that parents of premature infants won’t find in stores. She hopes her little charges will wear them home, but she believes they become even more of a keepsake for those who don’t.
“It gives the parents something if the baby doesn’t make it.”
Ngov, an NICU nurse for five years, says he started his career in pediatric nursing but switched to critical-care infants. The field appeals to him because of its fast pace and need for quick thinking, but also because he can be more detached from his patients.
Nurses have to leave the sad stories at work when they go home to their families or they won’t last, Ngov insists.
The baby that haunts him, however, was born at 26 weeks’ gestation and stayed on life support for weeks without making progress. The parents wouldn’t let go.
“It was consult after consult,” Ngov says. “Eventually the parents came to accept it. … The baby pulled the tube out himself and the parents didn’t reconnect.”
Across the room, Mini Munchkin’s eyelids flutter open for the first time. Alley spies the blue irises and runs for the antibiotic eye rub.
“I’m the first person you see,” she coos as she dabs the baby’s eyes. “Your daddy is going to be so excited.”
A minute later, she says: “There are lots of moments like this. I love it. I wouldn’t be anywhere else.”
Photo credit: Photos by JIM REED