If today were Christmas or the Fourth of July, the staff of the Clarke Neonatal Intensive Care Unit (NICU) at FirstHealth Moore Regional Hospital would probably have all the premature babies it could handle.

“Nobody knows why, but there are certain times during the year, historically December and July, when there are more premature births and sick babies,” says Judy Fedder, NNP, who coordinates the hospital’s neonatal nurse practitioners. “We will have other hospitals calling to ask if we can take one or two of their babies. There have been times when we’ve had babies from the coast and the mountains.”

The NICU’s first priority is to care for babies born at Moore Regional and at FirstHealth Richmond Memorial Hospital. While the unit can accommodate up to 16 infants, the number on any given day is typically eight or 10. As a Level III NICU, the unit admits babies with a gestational age of at least 28 weeks. The staff of neonatologists, neonatal nurse practitioners, specially trained registered nurses and respiratory therapists is supported by state-of-the-art technology.

Depending on their medical problem, babies are in the NICU anywhere from a few hours to many weeks. The average length of stay is about one week.

“A good many of the babies we see have transitional problems,” says Nicholas Lynn, M.D., a board certified neonatologist and medical director of the Clarke NICU. “That is, they need a little help transitioning from being in their mother’s womb to being out on their own. They sometimes have a little fluid in their lungs, and it takes a few hours or a couple of days to clear that up. That’s the most common problem we see.”

Because the lungs are the last major organs to develop, babies born prematurely often have respiratory problems. But premature infants can have many other types of medical problems including heart, gastrointestinal, neurologic and orthopaedic issues.

“It seems that Mother Nature intended for babies to develop for about 37 weeks before being born,” Dr. Lynn says. “So, regardless of what the problem is that brings them to the NICU, they often need to be here until about 37 weeks.”

Sucking, swallowing and breathing
Along with respiratory problems, premature babies sometimes have trouble feeding, Fedder says.

“It’s hard for them to suck, swallow and breathe all at the same time before a certain gestational age, which is usually 33 to 34 weeks,” she says. “If they are born earlier than that, we might have to feed them by other means for a while.”

Infants can be fed through a tube that is slipped down the throat to the stomach. Fluids and medications can be given intravenously.

Inserting feeding tubes and IV lines can cause babies a moment of pain, as does sticking them with a needle to draw blood for lab tests. Nurses in neonatal ICUs didn’t used to worry too much about the occasional pain that babies might feel, but that is no longer the case.

“We have come a long way in our sensitivity to pain,” says Maggie Maness-Craft, R.N., director of Women & Children’s Services at Moore Regional. “Our NICU staff does a lot to prevent pain or support the baby during a painful procedure.”

One of the most effective ways nurses manage pain is surprisingly low-tech and doesn’t involve drugs: They give the babies sugar water.

“We give it with a pacifier prior to a procedure that may be painful,” says Beth Michelow, R.N., assistant director of Women & Children’s Services for the NICU and pediatrics. “The sugar and sucking release a lot of endorphins (brain chemicals) that reduce the pain. I couldn’t believe it would really work, but it does. It’s neat when you give babies sugar water before you start an IV and they don’t even flinch when you stick them.”

Neonatal nurse practitioner care
While neonatologists have overall responsibility for the care of babies in the NICU, the hospital’s four full-time and three part-time neonatal nurse practitioners handle much of the hour-to-hour medical management. They are licensed to write prescriptions and perform practically any medical procedure a baby might need.

Neonatal nurse practitioners at Moore Regional are present for all C-section deliveries, which sometimes present a greater risk for the baby.

“It takes a special kind of person to take care of premature babies and support their families,” Maness-Craft says. “When babies are very premature, it can seem like they are doing really well and then all of a sudden be in crisis. It’s constantly up and down emotionally for the families. In our continuing education for NICU nurses, we focus a lot on families and their emotional needs.”

Parents can visit their babies in the NICU as often as they want and can stay as long as they want. With the parents’ permission, grandparents and other relatives may visit at any time, as well. Siblings are especially welcome.

“After all, that’s their brother or sister, and we feel it’s important that they start bonding while they are here,” Maness-Craft says.

In addition to the care given by physicians and nurses, respiratory therapists provide mechanical ventilation for babies who are not yet able to breathe on their own. Physical therapists are available to assess and work with infants whose muscles or joints aren’t functioning quite the way they should.

“With some babies, their muscles are very tight and contracted, and physical therapy helps loosen them up and stretch them out,” Dr. Lynn says. “With other babies, the muscles are kind of loose and limp, and the therapy helps them start developing muscle tone.”

If a baby is having problems that might be caused by a heart defect, a neonatologist can order an chocardiogram, which provides images of the heart. Those images are transmitted electronically to UNC Hospitals in Chapel Hill, where pediatric cardiologists analyze them.

“We can have the results back in an hour,” Dr. Lynn says. “If there are structural abnormalities that need attention, we can send the baby to UNC, Duke or some other large medical center that does neonatal heart surgery.”

A national trend
The NICU staff at Moore Regional cares for about 200 premature and sick newborns each year. Unfortunately, given national trends, that number might well go up. Despite more women receiving prenatal care, more babies are being born prematurely than ever before.

The U.S. Centers for Disease Control and Prevention reported last fall that the premature birth rate rose 18 percent between 1990 and 2004, and the rate of lowbirth-weight babies—5.5 pounds or less—rose 16 percent. Of all the live births recorded nationally in 2004, nearly 500,000 babies—12.5 percent—were premature.

The good news is that, in specialized neonatal intensive care units like the Clarke NICU at Moore Regional, premature and sick infants receive the best possible care and the best chance of going home and growing up healthy.

“We have some of the most highly skilled neonatologists, nurses, neonatal nurse practitioners and respiratory therapists, and our obstetricians are outstanding,” Maness-Craft says. “Our patients get the highest level of care, because we have a staff of people who are extremely good at what they do and want to make a difference.”