A NICU Nurse Becomes a New Mom

Ivette Najm has worked as a nurse in the Neonatal Intensive Care Unit (NICU) at Lucile Packard Children’s Hospital Stanford for nearly one year, so she’s well aware of the high-quality medical care that the unit provides to babies in distress. But when she went into labor six weeks early with her first child, she witnessed firsthand the kind of care that her colleagues deliver throughout the Johnson Center for Pregnancy and Newborn Services to babies who need special attention—and to parents like her.

“In the back of my mind, my biggest fear was that my baby would be sick enough to have to be in the NICU,” says Najm. Even though she knew that, at 34 weeks, her newborn daughter would probably be OK, she was distraught at the thought of her daughter being born prematurely. Luckily, she had been getting prenatal care at Packard Children’s Hospital and was in the middle of a shift in the NICU when she went into labor. She only needed to walk down the hall to Labor and Delivery to get the care she urgently needed. Packard Children’s Hospital is one of the few in the country to offer obstetric, delivery, and newborn services all in one place. “The obstetrician did a great job calming me down and reassured me that my baby would be OK,” says Najm.

Soon, she started to dilate, and there was no stopping her baby from coming. So the team gave Najm a steroid treatment, which can help quickly mature a premature baby’s lungs and prevent a brain hemorrhage after birth. A new complication arose: the baby was in the breech position. From there, things progressed quickly, and Najm had an emergency cesarean.

An exceptional continuum

Despite her early arrival, Najm’s baby, Layla, was born without any major complications. But because of her prematurity, there was a team in Najm’s surgical room that included a neonatal hospitalist to attend to Layla right after birth—this precaution is standard at Lucile Packard Children’s Hospital Stanford for all high-risk deliveries.

Najm’s medical team saw that Layla had hypothermia and jaundice. These didn’t require critical care in the NICU, but they needed more specialized care than the Newborn Nursery provides. The team decided that the best place for Layla was the Intermediate Care Nursery (ICN), a stand-alone unit that can deliver intensive neonatal care but is meant for babies whose conditions aren’t as critical as in those admitted to the NICU.

While some hospitals combine ICNs with their NICUs, or don’t have them at all, a separate ICN affords several benefits, starting with its environment. The Packard Children’s Hospital ICN is quieter and smaller than the NICU and allows babies to recover in lower-stimulation surroundings. And since the babies in the ICN aren’t critically ill, there’s a greater opportunity for nurses to foster parent involvement in their baby’s care, and for the parents to visit with their baby 24 hours a day.

“Having various nurseries that provide the spectrum of newborn care is a nice model to have,” says Arun Gupta, MD, director of the Neonatal Hospitalist Program and one of many neonatal hospitalists who oversaw Layla’s care. “In the Johnson Center, our team is able to look at what’s most appropriate for each baby so we can offer the most appropriate individualized care for each patient.”

Each of Packard Children’s Hospital’s nurseries have a singular focus: providing the highest standard of medical care. And together, the neonatal services offer every major medical, surgical, and support service that babies may need. For example, micro-preemies and newborns with critical or special care needs are triaged to the Packard Children’s NICU, which delivers state-of-the-art, around-the-clock care. This Level IV NICU offers the highest level of intensive care available for newborn babies, including extracorporeal membrane oxygenation (ECMO), a modified form of heart-lung bypass for newborns with cardiorespiratory failure. The NICU team is also an early adopter of point-of-care ultrasound, which allows physicians to get answers to their clinical questions right away and monitor certain conditions at a newborn’s bedside. Using ultrasound also reduces the number of x-rays and needle pokes for babies in the NICU.

For the tiniest babies, in the Packard Children’s Small Baby Unit, also known as the Nest, developed specialized ventilator protocols are used to assist their breathing while promoting a gentle approach and minimize later breathing complications. And the Cardiac and Respiratory Care for Infants with BPD (CRIB) Program was established to address heart-related complications of prematurity.

The babies who are at risk of brain injury are cared for in the Packard Children’s Neuro-NICU. Just one of a few in the country, this unit provides the latest in neuro-protective care for newborns. As they grow and get healthier, babies may “graduate” from one of these intensive care settings to the Level II ICN, where Layla stayed, before heading home.

The spectrum of care for newborns extends beyond Packard Children’s Hospital’s Palo Alto location through partnerships with other NICU providers in the Bay Area and Central Coast.

True family-friendly care

Individualized care continues after babies are placed in the most appropriate unit. In the ICN, care teams expand to include social workers, case managers, developmental specialists, lactation consultants, nutritionists, and physical and occupational therapists. Together, the team keeps tabs on how the family is coping with the situation and adjusting to having a newborn.

“We understand that families have a lot going on, and we make an effort to figure out not only how to optimize the baby’s care, but that of the whole family unit,” says Chandani DeZure, MD, a neonatal hospitalist who also cared for Layla. “Our multidisciplinary team touches base to ask, ‘Does this family have a ride to and from the hospital? Are they struggling to visit because of financial reasons, or do they have other kids to care for?’”

No matter what a family’s situation is, the ICN staff take great pride in helping parents to understand all medical matters and to feel comfortable caring for their baby before they go home. This includes learning about everything from their baby’s hunger cues to how to give a baby supplemental nutrition.

Although most babies stay in the ICN for several weeks, Layla only needed to stay for five days. But that was enough time for her mom to personally appreciate the role reversal of being cared for by Packard Children’s Hospital nurses. The team treated her like any other parent—with compassion and respect. “Seeing nurses from a different lens as a new mom, I felt that every single nurse was amazing,” says Najm. “They gave me privacy but were still there for me.”

Lactation consultants helped her with breastfeeding and showed her how to pump on a schedule. They arranged for donor breast milk to supplement Najm’s own supply.

The team also made her husband, a first-time father brand new to the world of newborn care, feel comfortable. “Nurses took the time to explain things to him, even though they knew I could have told him,” she says. ICN nurses gave him details about each treatment, such as the phototherapy to bring Layla’s bilirubin down. And they showed him how to bathe, change, feed, and burp his new daughter.

“They were so patient and took the time to give us every update and call us if we weren’t at the bedside,” says Najm. That made a lasting impression on her. “It felt different getting updates as parent. Now I understand parents’ desire to know every little feeding change, every lab that came back. It might not seem like a big deal to a nurse, but to a parent it is.” Now that Layla is 4 months old, Najm is looking back and feeling grateful for her family’s stay in the ICN at Packard Children’s Hospital. “It turned out to be the best care I could have asked for.”