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Preparing for the Big Day: A Neonatal RN's Guide to Coming Home from the NICU

8/16/2023

Your baby may have stayed in the NICU for days, weeks, or even several months. No matter what your NICU experience looked like or how long your journey has been, bringing your little one home is a huge deal. Congratulations!

You may be feeling a variety of emotions ranging from joyful and excited to anxious and overwhelmed. All of these feelings are 100% valid and normal. Make sure to reach out to friends and family members who can support you during this emotional time.

As the big day approaches, try to become as independent as possible with your baby. The more time you spend feeding, changing, snuggling, and otherwise caring for your baby, the more comfortable and confident you’ll feel when you get home.

Specific requirements for discharge may vary depending on your hospital and NICU. If the care team has decided your baby is ready to come home, you know that your baby is medically stable and has also met the following general criteria

1. Consistent weight gain
Growth is one of the most important reflections of your baby’s health and development during the first months of life.

Your baby is showing a consistent pattern of weight gain if the doctors are discussing sending him/her home soon.

If your baby isn’t gaining weight, your medical team may need to either increase their feeding volume or boost their calories by including formula in their diet. Formula has more calories than breastmilk and so it is sometimes necessary to supplement with 1-3 bottles of formula per day to get babies the calories they need to grow – preemies in particular.

If you’re breastfeeding and nearing discharge, you’ve hopefully already received guidance and support from a lactation consultant. But, if your breastfed baby is not gaining weight after the first week of life, you’ll want to have a lactation consultant observe a breastfeeding session.

2. Adequate feedings
If you’re nearing discharge, your baby is eating well enough to get the calories they need to grow, develop, and thrive.

In most cases, this means that your baby is eating all of their food by mouth – either by breast or bottle feeding, or a combination of both.

However, some babies may have feeding issues or medical conditions that mean they need to go home with a feeding tube for a few weeks or months in order to safely get the calories that they need. If your baby does need a feeding tube, you will be given all of the necessary equipment and trained on how to manage it at home until you are comfortable and confident.

3. Additional medical needs accounted for
It’s not uncommon for some NICU babies to need oxygen support when they first come home from the hospital. If this is the case for your child, you’ll have the appropriate equipment delivered to you and you’ll be taught how to use it before you go home.

Your baby may need to have follow-up appointments with specialists for the first months or years after coming home from the NICU. Some common areas that NICU babies often require monitoring of are the: eyes, brain, heart, lungs, digestive system, and skin. Your baby could also have a genetic condition that will need follow-up or a congenital issue that requires future surgery.

If your baby will need to have specialist checkups, your medical team will contact those physicians and get these appointments established before you leave the hospital.

Remember that eye appointments are especially important. Retinopathy of Prematurity (ROP) is a condition that affects the blood vessels in the eyes of some preemies and can lead to blindness if left untreated. If your baby is a preemie, they were screened for ROP long before discharge and have been receiving regular eye exams to ensure their condition is stable.

4. Car seat test

Many NICU babies will need a car seat test before they can leave the hospital. It’s usually done in the last few days before going home.

Most preterm and late-preterm infants should have a car seat test, plus those with certain medical conditions or congenital disorders. Specific criteria for needing a carseat test will vary depending on your hospital.

A car seat test means that your baby will sit in their car seat for a set amount of time (usually 1.5 - 2 hours) while nurses monitor their vital signs. Some babies may have issues maintaining their oxygen or heart rate while in the car seat, so it’s important for your baby’s safety that any issues are identified before you go home. If your baby fails his/her car seat test, your hospital may provide you with a car bed to use instead.

Here are some other important points about car seat safety:

Check the expiration date on your car seat. Expired car seats may not be safe to use.
If your car seat was previously used, ensure it hasn’t been in any car accidents
Don’t add anything to the car seat that doesn’t come with it already such as extra inserts or a headrest
Read the car seat manual before discharge day to familiarize yourself with how it works. It’s important that you feel comfortable adjusting the straps yourself.
Never feed your baby in the car seat or take your baby out of his/her car seat while it’s moving

Feeding Your Baby
Most NICU babies, especially preemies, need a bit of extra help and care with feeding. It can sometimes be difficult for babies who are first learning to eat to figure out how to coordinate the ‘suck-swallow-breathe’ pattern that’s required for the baby to safely take milk into the mouth and down to the stomach. Many babies get overly excited while drinking a bottle and will swallow many times in a row while forgetting to breathe. It’s important to always pay attention to your baby while breast or bottle feeding to make sure they’re pacing themselves and taking a breath every 5-6 sucks. If not, you may need to tip the bottle every several swallows so that there’s no milk in the nipple and your baby is forced to pause and breathe. This is called external pacing – if you’re approaching discharge and don’t feel confident with how to do it, ask your nurse to help you practice.

This is one reason why it’s so important to spend as much time in the NICU as you can before you go home. You should feed your baby enough times to learn their unique feeding habits – how much they pace themselves, the little things that help them eat better (frequent burping, for example), and what their particular eating patterns are.

It’s also helpful to practice feeding while in the NICU without checking the monitor – just your baby. Many NICU parents get so accustomed to the monitor over the course of their baby’s hospitalization that they start to rely on it and watch the monitor during the feedings instead of their baby. Ask your nurse to turn the monitor facing away from you for a few feeds so that you can’t see it if you might find it hard to resist the temptation to look. Watch your baby for signs of distress such as coughing/choking or their skin turning blue or dusky-colored. You'll feel more confident feeding when you get home if you know what you’d see if something was wrong.

One really common question is how to tell if your baby is getting enough milk when you’re at home and don’t have nurses closely tracking each feed and weighing your baby daily. A great, objective way to determine feeding adequacy at home is to count the number of wet diapers per day. There are diaper log sheets available online that you can print out and use, as well as apps you can download on your phone or tablet. If your baby isn’t having 6-8 wet diapers per day, he/she may not be drinking enough and could be getting dehydrated. Call your pediatrician to schedule an appointment ASAP.

Your pediatrician will also be closely watching your baby’s weight to make sure that they’re growing appropriately, and therefore eating enough. If the nutrition plan is to discharge home from the NICU on formula supplementation, your pediatrician will be the one to determine when is the right time to adjust your baby’s feeding plan. If your baby is gaining good weight, your pediatrician will decide to decrease the calories in your baby’s formula over time and even eliminate formula supplementation altogether.

If your baby is going home with a feeding tube, your pediatrician will also be the one to decide how long the tube needs to stay.

Helping your Baby Sleep Safely & Soundly
It’s critical for your baby’s safety that they sleep in their own simple, dedicated sleeping area, free of any objects that . Adhering to recommended safe sleep guidelines is one of the most important things you can do to reduce the risk of Sudden Infant Death Syndrome (SIDS).

According to the American Academy of Pediatrics1, newborns should sleep on their back, alone, with nothing else in the crib. This means no bumper around the edge of the crib, no stuffed animals or toys, no big fluffy blankets or even a hat – just the baby, one layer of clothes, a single sheet, and their swaddle or sleep sack.

Besides basic sleep safety, uninterrupted sleep is extra important for NICU babies, especially preemies. Premature babies are born before their brains are fully developed, which can cause them to have sleeping patterns that are slightly different from full-term babies. If your baby is a preemie, he/she may sleep for shorter periods but awaken more frequently and startle more easily than a term infant.

Regardless of whether your baby was premature or term, you should do your best to promote uninterrupted, restful sleep as much as possible. Sleeping is when newborns’ most important growth and brain development happens. It comes down to this – if your baby is sleeping comfortably between his/her feeds, don’t bother them. One prime example of this is waking your baby up between feeds to change their diaper. You’ll be doing feedings every 3-4 hours, so it’s best to let your baby continue to sleep and just do the diaper change before the next feed.

This doesn’t mean you should avoid picking your baby up and holding them if they’re sleeping soundly in their crib. Your baby will sleep even more peacefully and happily while resting comfortably in your arms. Not to mention, cuddling a sleeping baby is therapeutic for you, too!

Noise level is also something to be mindful of in order to help your baby get the sleep he/she needs. Depending on how much time your baby spent in the NICU, he/she may have actually gotten used to the noisy hospital environment. Some parents say that when they finally come home from the NICU, their baby has trouble sleeping in the much quieter and more peaceful home environment! Put a white noise machine or shusher close to the crib and see if it helps your baby sleep better.

When to Call for Help
Your care team will educate you before you leave the NICU about issues that require medical attention or follow-up. It’s important to understand what requires your immediate action vs. a call to the pediatrician.

Supporting your Perinatal Mental Health and Wellbeing
The journey of pregnancy, childbirth, and parenting introduces significant transformations to both your life and emotional well-being.

The stress, uncertainty, and emotional roller coaster of the NICU experience can cause parents can weigh heavily on parents. If you notice any of these signs, it's crucial to seek help. Reach out to your healthcare provider, or mental health professional. Remember, seeking assistance is a sign of strength and prioritizing your well-being, ensuring you're better equipped to navigate the challenging journey of NICU parenthood and beyond.

• You might be feeling down.
• You may feel more tired than usual, yet unable to sleep or rest.
• You might be less interested in eating. Or eating too much of the wrong things.
• You may get angry and annoyed more easily.
• You might have trouble thinking clearly and making decisions.
• You may worry or get anxious for reasons that you don’t completely understand.
• You might be having thoughts or impulses that feel disturbing, scary, and irrational.
• You may even experience flashbacks or nightmares about past traumatic events.

All these reactions are normal, but they may also be signs and symptoms of a temporary and treatable set of conditions called Perinatal Mood and Anxiety Disorders (PMADs).

For resources, please visit: https://www.nationalperinatal.org/mental-health

As the big day approaches, remember how far you and your family have come on your journey. You are strong, resilient, and amazing, and you’ve already made it through the most difficult part. Remember to try to take time for self-care in the midst of daily life with a newborn – even if just 10 minutes a day. You need to take care of yourself mentally, emotionally, and physically in order to take the best care of your little one.

I think I can safely speak for your nurses when I say – send us a note sometime down the road to let us know how you and your family are doing! It’s the ultimate reward for a NICU RN to see former patients thriving years later as adorable, happy children. Once again, congratulations!

About the Author

Bailey Deal, RN is a neonatal nurse at one of the top-ranked children's hospitals in the United States. When not at work caring for babies, she’s a freelance health writer and blogger at www.babynursebailey.org.

References
https://www.nationalperinatal.org/mental-health
https://www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-updates-safe-sleep-recommendations-back-is-best/

5 Things NICU Nurses Want Parents to Know

9/2/2022

It's a terrifying moment when your baby needs to be in the Neonatal Intensive Care Unit (NICU). It's overwhelming and can be downright devastating. Admission to the NICU may be completely unexpected, or you are already aware that your baby will require intensive care after birth. Either way, it is a scary and stressful situation.
There is so much fear of the unknown. What will happen to your baby? Who will be caring for them? When can you see your baby? The questions and concerns are endless. Your NICU team is your ally, and they are that guiding hand of support you will reach out to for the following days, weeks, or even months.
The neonatologists, respiratory therapists, dieticians, social workers, and nurses are the experts who will help you through this difficult time. Your NICU nurses are with your baby all day and all night. They are like guardian angels and are the advocates you will be closely working with during your time in the NICU.

Here are 5 things that your NICU nurses want you to know:

1. Self-care is extremely important.
You can't take care of others if you are not taking care of yourself. Following the birth of a baby, mothers need rest, sleep, nutrition, and a lot of support. Hormones are raging, your body is healing, and you are likely dealing with pumping every couple of hours. It is exhausting. Fathers/partners often feel helpless because they do not know what to do or how to help.

Tensions are high, sleep is deprived, and emotional breakdowns are common. Ask family and friends for support like helping with meals, laundry, chores, and transportation. Don't be afraid to ask; be sure to talk to your nurse too! They aren't just there for the babies but for parents too.

2. Patience is a virtue.
There are moments in life when being patient is crucial, and your time in the NICU is one of them. You will feel like you have lost all control, which will be frustrating. You cannot control many things while your baby is in the NICU, so don't dwell on them. Take a deep breath and know that this too shall pass. Be patient with yourself, with your partner, and also your baby.

NICU babies work very hard every day, especially when they are learning to eat. It takes an immense amount of energy for them to breastfeed/bottle feed. Getting all the nutrients they need without requiring an IV or gavage feedings will be their most complex challenge yet. Take each day at a time.

3. Sleep is essential for babies to grow.
Sleep and minimal stimulation are why the NICU almost always has a schedule for your baby. By allowing babies uninterrupted sleep, they will grow and thrive. Try to arrive before your baby's scheduled feeding time. Participate in their diaper changes and temperature checks, help feed your baby, and place them back in their crib or hold/kangaroo them for as long as possible. This will allow for uninterrupted sleep. The longer they are permitted REM cycle sleep, the better their health and growth will be.

4. Don't stare at the monitor.
All babies will have wires placed on their body that attaches to a monitor which displays their heart rate, oxygen saturation, breathing pattern, and blood pressure. It is a helpful tool, but don't obsess over it. Not only will this cause you undue anxiety, but you will also start to depend on that monitor to tell you if something is wrong. When your baby is discharged home, you no longer have a monitor to stare at; you only have your baby's cues and appearance to let you know if something is wrong.

Make it a habit to watch your baby closely, especially while they are feeding. Pay attention to their breathing patterns. If you notice they stop breathing during feedings, you can gently rub their back as a reminder for them to take a breath. This will prevent them from turning dusky (the bluish/dark color that appears around the eyes and mouth due to low oxygen levels).

5. Your involvement is vital
It may seem like you are getting in the way sometimes, but know that your involvement is important in your baby's care. This is especially true when your baby is in the grower-feeder stage of the NICU – when they are in an open crib and are learning to breastfeed/bottle feed. However, if you do have to be away from the NICU to take care of yourself and family, know your baby is in the best hands and the NICU team will be your partner in caring for your baby.

Always remember that your NICU team is there to help. They understand the emotional rollercoaster of the NICU. They have witnessed the trials and tribulations of NICU parents time and time again. Talk to the nurses. Listen to them. You are an essential member of the team, and everyone has the same end goal of getting your baby home as soon as possible.

References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6992410/
https://www.nicuawareness.org/blog/feeding-in-the-nicu#:~:text=Gavage%20Feeding,be%20trickled%20into%20baby%27s%20stomach.
https://www.marchofdimes.org/baby/kangaroo-care.aspx
https://www.saintlukeskc.org/health-library/skin-color-changes-newborn

The views and opinions expressed in the NICU Awareness blog are those of the authors and do not necessarily reflect the official policy or position of Project Sweet Peas.

About the Author
April Rowe, RN, is a freelance health writer at RNtoPen.com. She has over fifteen years of experience as a Registered Nurse in the NICU (Neonatal Intensive Care Unit), Pediatrics, Home Health/Hospice/Palliative Care. She lives in South Carolina with her husband, children, and three dogs.

Discussing Loss in the NICU

8/30/2022

I am both a NICU mom and a loss mom. My daughter Colette died at nine days old after spending her short life in an incubator. The first time my husband and I got to hold her was as she died in our arms.

Being a NICU mom is a rollercoaster for sure and my own mother, a NICU mom to my younger sister, told me just that when Colette was first born. Her advice was to just hold on and to know that starting a day off badly did not mean it ended badly and vice versa. She said it is a lot of ups and downs every day. I got a lot of similar advice from other NICU moms, nurses, doctors, and the like, but the one thing I never remember hearing was that she could die.

Colette was born at 24 weeks and 5 days, after a diagnosis of severe preeclampsia and intrauterine growth restriction (IUGR) landed me in the hospital at 21 weeks pregnant.

Her birth was amazing and terrifying and although we had not done a tour of our hospital’s NICU (our plan had been to do one the day she was born), I felt prepared to handle all that the NICU threw at me. Since my younger sister and I are four years apart, some of my earliest memories come from her time in the NICU and her general health and illness those first few years of her life.

However much I thought I was prepared all fell away when I realized it was my daughter in that incubator and when I felt the guilt and shame that my body had failed to protect her.

I had prepared myself — or at least I knew it was a possibility that she would not survive the birth. From everything the doctors had prepared us for, I knew there was the possibility that if the smallest tubes proved too big for her, then they would not be able to intervene medically, and we would hold her as she died.

I even understood that the first 24 to 48 hours were touch and go. But, when she survived the birth, when the second to the smallest tube fit her, and when she made it to day three and four, I believed she would come home.

I knew that her coming home would not happen quickly, and I knew that leaving the NICU was just a small step in her journey — a journey that would involve many medical issues, perhaps disabilities, lots of doctor’s appointments, and plenty of scares.

While I was recovering myself from a difficult C-section, dealing with all the ups and downs of postpartum, the guilt I felt, and watching my daughter do well and then not, I was thinking of things like how we could make our house more accessible, or whether she would be able to climb stairs or not, and if we would have to makeshift or build a bedroom on the first floor.

I was planning for multiple doctors’ appointments and medical equipment, never realizing that the reality would be planning for caskets and gravestones.

On the day that Colette died, I still could not believe it. The doctor pulled me aside and told me what I should be prepared for and that I should call my husband and yet, I thought I knew better than all these medical professionals.

Colette was not going to die, that was not in the plan, that was not what was going to happen.

As the day progressed and the truth became more apparent, I still struggled to fully grasp what was happening. Even as the medical team set up our family in a private room and then walked our daughter to that room with us so we could all say goodbye, in my head, I was still in denial. There was no way that this could happen.

In the four plus years that have followed since Colette’s death, I have struggled with this a lot. For as much as doctors and nurses tried to inform us of risks and dangers, I never remember being told that she could possibly die.

I know I heard a lot of numbers and data about survival rates at various gestational ages, but what that really meant was never expressed to me. And for every other loss parent that I have met with a similar story of child in NICU and then their child dies, they all say something similar. I remember bonding instantly with a dad when I said that I never expected this and him saying, "oh my God me either".

This experience is not as reflective of our medical system as it is of greater society. We do not like talking about death at all, but to discuss babies dying is unheard of. When we do hear about it, it is usually couched in more comfortable, digestible terms like “loss,” “survival,” etc. But the problem is that parents like us who go through these terrible tragedies are left not only to grieve, but to recover from the shock of it happening when it never appeared to be a possibility.

We need to do more to help loss parents at every stage and it is well past time to start being real and direct. Tell parents that there is a risk that their child will die. Do it in a helpful, calm manner, but say it. Otherwise, we are left to struggle with even more emotions that grief brings up and as a grieving mom, the less emotions we put on the pile, the better off we are.

The views and opinions expressed in the NICU Awareness blog are those of the authors and do not necessarily reflect the official policy or position of Project Sweet Peas.

About the Author
Michelle Valiukenas is the proud mom of her angel Sweet Pea, who she lost due to miscarriage, her angel daughter Colette Louise who she lost at nine days old, and her only living child, her rainbow baby, Elliott Miguel. Inspired by her journey with Colette, Michelle and her husband founded The Colette Louise Tisdahl Foundation, whose mission is to improve outcomes of pregnancy, childbirth, prematurity, and infancy, as well as aid in the grieving process through financial assistance, education, and advocacy. Their flagship program financially assists families dealing with high-risk and complicated pregnancies, NICU stays, and loss. The organization’s ability to help families relies on donations and grants and they are grateful if you are able to donate. Michelle also participates and advocates on issues of maternal health, maternal mortality, infant health and safety, and pregnancy complications. Michelle lives in Glenview, Illinois with her son Elliott, husband Mark, and dog Nemo.

Your Breastfeeding Journey:During & After Your NICU Stay

10/1/2021

Babies in the Neonatal Intensive Care Unit (NICU) face many different challenges depending on their individual situation, but they often share one...feeding. This may be due to not having fully developed their skills yet, or their condition or medical equipment makes it more difficult.

If you have twins in the NICU, don’t get discouraged. It may take them a little longer, or sometimes further assistance. But with the help of NICU staff & lactation consultants, many babies can breastfeed successfully in the NICU.

How you can help encourage your babies to breastfeed while in the NICU:

Photo credit: IG @silkysmoooth

Skin to Skin Contact
This is such an important step while your littles are in the NICU. It helps to maintain their body temperature, reduces their stress, regulates their breathing, strengthens your bond, and by all these things, it naturally helps encourage breastfeeding. It helps initiate feeding cues, like finding your breast. Seek out assistance from one of your NICU Nurses or the LC for some extra one-on-one support during this process to help you learn to support those feeding cues.

Familiarize With The Breast
When you find your baby looking for your breast or showing other signs of feeding, you may be ready to try and introduce it. Expressing breastmilk a tiny bit so it’s on your nipple will help them know where to go. They may not know how, and just want to nuzzle. If they latch, it may only be for a little bit. But all these things will help them learn where the milk is.

Seeking Assistance
The NICU is a wonderful resource of people who can help your babies. Breastfeeding support comes not only from lactation consultants and nurses, but the hospital speech & occupational therapists are also a wonderful source of information. Preemies may not have the simple skills yet required to be successful at feeding- sucking, swallowing, & breathing. OT & Speech therapists may help by finding you the right technique to help your babies be successful & encourage breastfeeding.

Follow Their Cues
If you have a little who’s doing well with feedings, ask your nurse or lc how to help you transition into breastfeeding. NICU babies can get tired easily while feeding. Watch their sucking pattern while feeding to know if they’re getting enough. If they are fast, it probably isn’t giving your baby the nutrition they need. If it’s slower, consistent, and stronger, they are adapting to your flowing milk. When they are full they will stop & be very sleepy or tired. It can be a slow process, but any breastmilk they can get while there will only help them grow stronger.

Medical Equipment & Breastfeeding
Some of the equipment that helps babies’ recovery, can also make it difficult for breastfeeding. If your babies need to be fed via NG tube or g-tube, let them learn to get used to you at feeding times by holding them & giving them a pacifier during it to help get them used to the experience and the pacifier will help build their sucking skills. When babies are on ventilators or other respiratory devices, it may not be safe for them to try to breastfeed. You can still introduce breastmilk by putting it on a swab to get them used to the taste. Once your baby is only using cannula in their nose, you may be able to introduce breastfeeding. Even if your littles are being safely fed by alternative methods, you can still pump your breastmilk & the staff will add it to their feeding tubes.

How you can support your breastfeeding journey after coming home from the NICU:

You are a new mama, not to just one, but two. You are probably surviving on caffeine and baby snuggles, with minimal sleep. This being said, your number one goal for breastfeeding will be to help keep up your supply.

How to keep your supply maintained:

Feed yourself: Make sure you’re eating a balanced diet! Lots of fruits, veggies, protein, & whole grain choices. While breastfeeding be sure to add in 500 calories, your body is doing extra work!

Keep Pumping!: By pumping in between feeding sessions, you are stimulating milk production. It can stay fresh in the refrigerator for 24 hours, or if you’re not using that much yet, pop it in the freezer to save for when you need it.

Drink up!: Don’t go overboard with caffeine (eek!) and try to drink enough nonalcoholic fluids. You should try to have water whenever you feed, during pumping sessions, or whenever you eat Sleep!: This is a hard concept for a new mom (especially a twin mom!) but it’s so important to try and get enough sleep. “Nap when baby naps” may not hold true for twin mamas, so be sure to accept any and all offers from your partner, or any other friends or family members that offer to help.

Handling Breastfeeding & Medical Devices at Home

Your babies may still come home from the NICU with an NG tube or g-tube. You can attempt to breastfeed whenever they are hungry, or you can give them extra breast milk through their tube.

There are some occasions where it may not be safe for a baby to breastfeed if they cannot swallow well. If this is the case for your baby, do not offer breastmilk outside of their feeding tubes until your doctor says it is safe to try other methods. You can still hold them during feeding and offer a pacifier. This will help strengthen your bond and help them adapt to feeding.

About the Author:

Krystal Workman is the inventor of the TwinGo Carrier, the first ergonomic twin baby carrier and the TwinGo Nurse & Lounge Pillow, a feeding pillow designed to support both twins and mamas. Her inventions were born out of personal necessity to care for her own twins, and as a way to emotionally heal from the touchless first few days in the NICU. Today, TwinGo has helped more than 10,000 families around the world keep their babies close.

Safety 1st HD WiFi Baby Monitor Giveaway

9/28/2018

After all that parents have been through with their preemie’s health, parents will want a reliable baby monitor that can give them extra peace of mind anytime and from anywhere. The Safety 1st HD WiFi Baby Monitor was designed to stream high definition, high speed video right to the high-resolution screen on a parent’s smartphone – even on connections with low-bandwidth. The end result is a baby monitor that delivers the sharpest video quality with minimal buffering delays. A wide 130 degree viewing angle lets parents see the whole nursery without ever needing to pan or tilt, and 12 infrared LEDs lets parents see better in the dark.

The true innovation lies in the one-of-a-kind, hands free smart audio device that is sound and motion activated. It lets parents hear their baby from anywhere in the home and allows parents to easily view their baby just by pulling out their phone. And because traditional video monitors have poor battery life, Safety 1st designed the smart audio parent unit to last for up to 12 hours or more on a single charge. The smartphone integration also enables parents to set motion and sound sensitivity levels, communicate via two-way talk, access free 24-hour timeline events, share moments directly to text or social media and provide caregivers viewing access. Additionally, the baby monitor has an on-board enhanced physical encryption chip, which sets up a separate firewall between the monitor and a home’s internet connection to protect privacy.

Safety First Travel System Giveaway

9/13/2018

Safety 1st, brand of one of the world’s leading juvenile products manufacturers, Dorel Juvenile, is a proud sponsor of NICU Awareness Month. In honor of NICU Awareness Month Project Sweet Peas is partnering with Safety 1st to offer a give away of their latest lightweight stroller, the Safety 1st RIVA Flex – a 6-in-1 travel system.

Visit our Facebook to enter to win from September 14 to September 20.

The lightest travel system in its class, RIVA Flex is an eco-friendly option that offers parents everything they need for a smooth ride with baby, while reducing their impact on the environment, both today and in the future. On the journey towards sustainability, Safety 1st designed the American-made innovation, which uses recycled plastics including its own recycled car seats, to be lightweight and durable to grow with baby, eliminating the need for multiple purchases and reducing landfill waste.

The Riva Flex Travel System is a wonderful option for even the smallest NICU graduates with the onBoard35 FLX infant car seat and stay-in-car base that was designed with pediatricians to give a better fit from 4 to 35 pounds. Having a 4 pound rating assures that you will have the right car seat with the best fit when your NICU grad is ready to make the big trip home. The harness adjusts easily from the front of the seat with a simple pull for a secure fit for your child, and the stay-in-car base height adjusts for the right fit to your car. Engineering innovations make the onBoard35 FLX incredibly lightweight and incredibly safe.

RIVA Flex Travel System Features

- 6-in-1 Travel System: featuring six modes of flexibility, including forward- and parent-facing in the car seat, stroller and lie-flat carriage, RIVA Flex Travel system comes complete with the pediatrician-designed Safety 1st onBoard™ 35 FLX infant car seat and stay-in-car base for children four to 35 pounds.

-Sustainable Design, Made Here at Home: committed to providing affordable, quality-made products, the Safety 1 st RIVA Flex Travel System is the first recycled stroller made in the U.S.A. with American and imported materials, including recycled Safety 1 st car seats.

-Smooth Recline for Downtime™: parents will never need to disturb baby with this innovative feature that allows for a quick and easy transition from riding stroller to a completely flat recline in carriage mode.

-Lightweight and Easy to Fold: RIVA Flex is one of the lightest travel system strollers in its class, featuring a one hand, self-standing lift-to-fold function.

-Machine Washable, Zip-Off Fabrics: making clean-up easy for parents, RIVA Flex is the only travel system that offers zip-off, easy-to-clean machine washable fabrics for both the stroller and car seat.

-Sun Protection and Storage: the travel system includes multi-position extended SPF 30 sun canopy, flip-flop friendly brakes, a large storage basket and two dual-use parent cup holders, which are top-rack dishwasher safe.

ABOUT SAFETY 1st:

Established as the brand leader in child safety 30 years ago with its little yellow BABY ON BOARD® sign and the first true collection of home safety products, Safety 1st continues to introduce new and innovative products to parents, consistently giving you the power to keep your children safe.

Love, Loss, and Purpose in the NICU

9/26/2017

"Knowing I was giving families hope, and comfort when they needed it most healed me in ways I didn’t know it could. "
-Krystal Roark, Division Coordinator
Project Sweet Peas - Greater Lafayette

When I speak of my NICU experience, sometimes I am brushed off.

Why? Because my NICU experience wasn’t a long one. It can make others uncomfortable.

My NICU experience ended after 8 days. It didn't end in the joyous day all NICU parents look forward to for us. It was the second time that week we were told our daughter had died.

Just 7 days earlier our oldest twin didn’t make it either.

We stood there in shock as we looked around at all the isolettes filled with babies. Our monitors were silent, the screens turned off.

It was like a bad dream looking down at the tiny, fragile, body of my daughter laying there. No tubes, no monitors, just her looking just like her sister did 7 days earlier.

They carefully wrapped her in a blanket and handed her to me. I rocked her and held her close feeling her skin grow colder. I used every ounce of my will to try and warm her again, but it didn’t happen. Nurses and doctors came in and talked to us about various things. I really don’t remember much, I was too busy trying to memorize every detail of her face and hands.

I just sat there and rocked her. Rocking, rocking, rocking.

When it was finally time, I placed her back in her isolette. I didn’t really know what else to do.

What was I to do? They don’t really prepare you for this, nothing does.

I kissed her for the last time, and my husband and I left holding each other up.

I spent days in a waking coma trying to process things. Finally, I had to go through all the stuff from the hospital. All the gifts and other things sent to us.

As I was going through them, I found a green bag with Project Sweet Peas on it. At first, I had no idea what it was. As I opened it, I saw it was a memory box for our first born. It had a little hand mold in it of her hand, tiny diapers, a teddy bear with a Pregnancy and Infant Loss Awareness Ribbon t-shirt on it, forget-me-not seeds, and so much more.

My eyes welled up and I began to sob.

It was beautiful.

I spent hours holding that teddy bear. It helped fill a gap in my arms. Pulling myself out of my funk, I decided I wanted to add some handmade items to future boxes. I began painting boxes, and filling bulbs with glitter and feathers, making PAIL ribbons. My husband would leave for work and come home and find me at the counter still painting. He didn’t mind though, it was the first thing that had gotten me out of bed in weeks.

Little did I know at the time, that the painting and crafting was slowing helping to heal my heart.

I eventually found a card inside the box and contacted the organization that provided the box to our local hospital, Project Sweet Peas. I was put into touch with Sarah. We talked about love and loss and how healing giving back to the community could be. I talked about our first born’s box and how much it meant to me. We met in the parking lot of the mall, I wanted to drop off the things I had made.

I didn't know why, but I was nervous. I had never met anyone else who had lost their only children before. I didn’t know what to say to her in person, even though, I too had lost all my living children at the time.

It’s ok though, we really didn’t have to do much talking, I was crying mostly and we hugged a lot.

After I handed her the items I had made, she handed me a bag. I was surprised, inside was another memory box for our second born. It matched the other. My heart felt like it exploded. More tears and more hugs followed. It was that day, and through Sarah’s kindness, that I decided to become a volunteer with the organization. It was hard at first, delivering the NICU care packages and memory boxes, but I never wanted what happened to me to happen to anyone else.

Knowing I was giving families hope, and comfort when they needed it most healed me in ways I didn’t know it could.

It got me out of bed and helped me to continue my life. It gave me purpose again.

Every day I live my life, I live it for my daughters.

Every time I give back to the community, it is a tribute to their beautiful lives. As I give back, their spirits are lifted and remembered.

Almost 5 years have gone by now. I still give back and create those memories, and give hope to the families of my community. I’m no longer just a volunteer helper, I am the Division Coordinator of the very local division that gave me purpose again.

They may not know it, but they saved my life. I hope that what I have done, and continue to do, helps save someone else’s too.

Learn more about Krystal and Project Sweet Peas by visiting: projectsweetpeas.com/Greater-Lafayette.

NICU Giving Day: From Mini to Moose

9/11/2017

From Mini to Moose is a unique company that was recently founded by two NICU moms who are trying to make a small difference throughout the NICU community. Inspired by the premature birth of our daughters we both had a strong desire to become more involved in helping other families within the NICU community. After throwing around the idea of forming an Etsy shop, centered around the needs of the NICU community, the idea of taking some of the special onesies that we would be creating into local NICUs was born. From Mini to Moose the Etsy shop soon became only one piece of the puzzle and “From Mini to Moose - Special Delivery" was born. In order for us to make this idea a reality we reached out to family, friends and others in the NICU community for support. The response was overwhelming to say the least and over the course of two months we have received the materials needed to create over 400 of these special NICU onesies .

In order for you to understand why we have a drive to make a difference in the NICU community you'd need to understand who we are. In college we were acquaintances who dated college roommates, and were in the same circle of friends. Fast forward a few years, we both married those same college roommates, and were expecting little girls! Samantha was expecting her first at the same time as I was expecting my second. In March of 2016 Samantha gave birth to her daughter Madison at 27 weeks. Maddie Moose as they called her only weighed a mere 1 pound 15 ounces, and would spend the next two plus months in the NICU. Ironically, a month later, I too found out my pregnancy was going to result in a premature birth and I gave birth to my daughter who we called Quinny Mini was born at just 28 weeks weighing a mere 1 pound 12 ounces.

During this stressful time period I had reached out to Sam with many questions about what to expect in the coming months, and she became a true confidant, and friend. We often talked about things going on in the NICU, and the emotional journey we were both on. When friends and family would ask how my daughter was and I would always say “good” because I just didn't have the energy to explain, yet when Sam asked I would tell her every detail about my day, knowing she was the only other person really understood.

Our First Delivery

The inspiration behind From Mini to Moose began around Mother's Day of this year. Mother's Day happened to be one of the holidays my daughter Quinn spent in the NICU, and I wanted to do something special for the Moms who would be spending time in Quinn’s NICU during that holiday this year. Sam and I often talked about preemie items she could include in her online Etsy shop, and as I often did I reached out to Sam for ideas of things that I could do. Sam had previously created a onesie for Quinn that said #preemiestrong, and somehow the idea of creating NICU inspired bodysuits was brought up. Sam was obviously on board with helping with the project and loved the idea of giving back to the NICU community.

That week she spent hours helping me create 22 onesies for Quinn’s NICU. After dropping off these onesies we both felt awesome about giving back to the NICU community, and couldn't shake the accomplished feeling that we had. We realized that this tiny gesture meant so much to other Moms going through a really difficult experience much like we had.

After our “Special Delivery” A few NICU Moms who received bodysuits reached out to us telling us how much these little onesie meant to them, and from that point on we knew needed to continue our Special Deliveries.

To date we have already completed our Mother’s Day Onesies, 4th of July onesies that encompassed three local NICUs, and have created the majority of beach themed onesies that will be needed for our August delivery. We have big plans for many more upcoming months throughout the year, and eventually we would like nothing more than to expand From Mini to Moose Special Delivery into the majority of NICU’s throughout the Tri-State Area.

We hope that through our monthly project Mini to Moose Special Delivery, that we will be supporting other NICU Moms in any way that we can, even if that means just bringing a smile to their face on special holidays.

Are you also interested in giving back? See our Facebook page for more information! where we donate custom onesies to the local NICUs (for more information visit our Facebook Community page).

Separation and Bonding in the NICU

9/11/2017

ONE of the earliest feelings of my life in the NICU was being separated from my baby. This feeling still prevails within me as I am writing this blog. This feeling of separation can only be felt deeply by the families who have gone through similar trauma in their lives.

Each one of us ended up in NICU expecting the unexpected.

Initially, it was very hard as parents--both me and my husband wanted to be with the baby. At that time, I just wanted to hold my baby close to my skin--in my arms and never let him go. The acknowledgment of the separation feelings were important at that time.

Every day my other kids would rush towards the door expecting our new baby to come home that day. It was painful to tell them that baby was not coming home yet.

A mother's bonding sprouts the day the woman is told that she is expecting. It is a wonderful feeling. During pregnancy you think about what the baby will look like, his birth, first eye contact, first skin-to-skin contact, first touch of holding tiny fingers--all of these are crucial for the families.

In the end, I must say that I am forever grateful to the NICU for letting moms and dads hold babies' hands, use the skin-to-skin method and their cradling program. These programs helped to ease separation and develop a healthy normal bonding with the beautiful child.

What was the first feeling you had when you were in the NICU? How did you bond with your baby?

Blog by
C

Dealing with Pain and Stress in the NICU: from a Neuroprotective Angle

6/8/2017

By Steven Lam

When our babies are in the NICU, it can be greatly stressful for everyone involved. Our babies may often be stressed due to maternal separation, noise and bright lights, procedures, and other events.

The types of pain that our babies can experience in the NICU include:

Acute pain (e.g. from procedures)
Post-operative pain
Inflammatory pain
Visceral pain (e.g. from a UTI)
General chronic pain

Like most infants, preterm infants also have pain responses, although they may be immature and less localized than in older infants. They often experience hyperalgesia (exaggerated pain responses), allodynia (pain from things that are not normally painful) and a longer latency in their responses.

These pain responses include physiological changes like heart rate, blood pressure, and oxygen levels, and hormone responses. They may also display behavioral signs of pain such as changes in their facial expression, body movements and of course crying.

However, it is important to note, that not all responses, like crying, moving, tachycardia, and perturbations in blood pressure are pain responses. Therefore it is important to properly assess infant pain.

Most Neonatal Pain tests usually evaluate for acute procedural pain, and not for discomfort or chronic pain because immature infants have inconsistent responses.

One such test is the Premature Infant Pain Profile or PIPP score. The PIPP score uses gestational age, behavioral state, heart rate, oxygen saturation and facial expressions such as the brow bulge, eye squeeze, and nasolabial furrow.

But how can pain affect our babies in the long-term?

It is possible that pain may affect long-term memory, pain perception and responses, and possibly alter social and cognitive development. Therefore it is obvious to try and address pain and stress in the NICU, especially acute and chronic pain.

Chronic Pain or Stress is much more difficult to assess, and often times may be superimposed by other types of pains like from procedures or inflammatory pain.

When addressing acute pain, due to procedures, it is important to look at the procedure itself and whether it is necessary but also if local anesthetics are available.

While morphine has been used for more serious procedures, the long-term risks may not be ideal. Other sedatives may also have other negative side effects and have been shown to show that there is insufficient evidence to recommend use of them during therapeutic hypothermia.

So if these aren’t working what can we do?

There has been a shift in approach in trying to limit the number of painful/stressful procedures and interventions as well as creating a less stressful NICU environment by involving the parents.

These includes many non-pharmacological approaches from swaddling, pacifiers, music, and family-centered care.

Sucrose has been used as a neonatal analgesia which did result in lower PIPP scores but no changes in pain specific cortical activity or reflexes indicating that it is not pain relief.

However, maternal holding of the infant has shown greater promise in reducing pain.

While this may lead to some issues where nursing staff may seem to be challenged by the parents, dialogue between nurse-parent collaboration may provide the best outcome for young ones. I

Parental participation may prove to be the one of the safest options that can be combined with other methods until more work is done in pharmacological methods where evidence supports positive outcomes.

References:

Pain and Stress in the NICU | Protecting the Developing Brain, Christine A. Gleason, M.D., Professor of Pediatrics, University of Washington/Seattle Children’s
Anand KJS. Management of Pain in the NICU. J Perinatol 27: 2007
Anand KJS et.al. Br J Anaesth 101, 2008
Allegaert K et.al. Eur J Pediatr 168: 2009
Axelin A et.al. J Perinat Neo Nurs 2015
Bembich S et.al. JAMA Pediatr 169: 2015
Wassink G et.al. Sem Fetal Neonatal Med 2015
Wilkinson DJC et.al. “Sugaring the Pill: Ethics and Uncertainties in the Use of Sucrose for Newborn Infants” Arch Pediatr Adolesc Med 166: 629-33, 2012

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