Care for Yale New Haven ICU’s newborns even more special
NEW HAVEN — Soon, when a new parent hears a baby cry in Yale New Haven Children’s Hospital’s Neonatal Intensive Care Unit, they won’t have to guess who’s in distress.
The new two-floor NICU, whose first tiny patients will arrive from their former unit Tuesday, not only has 32 single-baby rooms but has eight “couplet rooms,” in which a mom who has just given birth or needs medical care can stay in the same room with her baby.
“This solves a lot of problems that we deal with in the ICU,” said Dr. Matthew Bizzarro, medical director of the unit. “The existing space we have really has no room for families.” The old NICU had 10 or 12 infants per room.
Having privacy not only gives the family a more serene experience during a stressful time — some of the infants in the NICU are extremely premature or have serious congenital conditions that require surgery — but “this allows them to be here, to be a part of the care and the decision-making,” Bizzarro said.
Yale New Haven Hospital opened the first newborn intensive-care unit in 1960. The new unit includes a procedure room so a newborn who needs surgery doesn’t have to go farther than down the hall. “It enables us to get major or minor procedures for the most fragile kids without moving them off the floor,” said Dr. Mark Mercurio, director of newborn services at the Children’s Hospital.
Each of the top two floors of the hospital has three pods with patient rooms surrounding the central nurses’ station. A monitor displays the vital signs of each baby on the floor.
The NICU has the latest in technology, including smartphones carried by the doctors and nurses with an app called Mobile Heartbeat. A panel in each room connects to the app and can summon a caregiver on the spot. “We’ve built in a lot of what we hope are fail-safes and safety nets,” Mercurio said. In the future, the NICU will have a neonatal brain MRI scanner.
Having separate rooms for each baby — there are 10 rooms that are big enough for two babies if the hospital needs the space, and which are ideal for twins — does prevent some challenges. “We don’t want them to become to isolated from each other either, so we’ve created some communal space,” Bizzarro said.
The doctors said they recognize that the new unit brings a “change in culture for us,” especially for the nursing staff.
“It’s been a lot of work and it’s going to be a lot of work,” Mercurio said. “This is a really different care model.
“This is going to be better in the long run, but it’s going to be work,” he said. Now, “you’ve got a few big rooms with 10 or 12 kids in each room.” A nurse “works all day surrounded by her colleagues and they’re going to be a little more separate.”
The unit can accommodate 68 babies, with an average population of 53.
There is some communal space, including a respite room for families, with “non-hospital furniture and a non-hospital kind of feel to it,” Bizzarro said. “We don’t want them to become too isolated from each other either.”
However, besides reducing the chance of infection, having the babies in their own rooms will make for a better environment for newborns. “They hear their child’s ventilator and they also hear their alarm going off, but they’re also hearing nine other ventilators and nine other alarms going off,” Mercurio said.
“Overstimulation is not good for the development of premature babies,” Bizzarro said.
The couplet rooms offer “a much nicer way for the mother to spend the first couple of days with the baby,” Mercurio said. “To our knowledge there’s no other academic medical center that’s doing this yet.” It will enable better skin-to-skin contact and promote healing, the doctors said.
The rooms also make it easier to begin breast-feeding. “We’re hoping that this becomes a model of care that other intensive-care units adopt moving forward,” Bizzarro said.
Among the innovations is the Barbara Sabo Simulation/Educational Center, named for a longtime clinical nurse specialist who “trained all of us. She was a magnificent resource,” Mercurio said.
“We’ve built a space that is identical to a patient room,” Bizzarro said. “It allows the simulation team … to monitor and create scenarios for the critical [care] teams to run through. It really improves communication and teamwork.
“If you mimic the environment as much as possible, it’s the more effective way to do it,” he said.
The NICU also has a milk room, where mothers can store their expressed breast milk that can then be given to their baby when the mother isn’t at the hospital. “Sometimes we have to add things to the milk for the individual babies,” Mercurio said. “Some of these kids are here for months at a time. So [mothers] can pump at home and bring it in here.”
Many premature newborns need to be fed through a nasogastric tube because they’re unable to suck or swallow. “Human milk is the best nutrition for these babies, so we’re trying to find new and better ways to make that available to the babies and as convenient as possible for the mothers,” Mercurio said.
Finally, the NICU includes a 24-hour-a-day pharmacy.
“The truth is, nine out of 10 babies are going to be born and do just fine. We’re here for the one out of 10,” Mercurio said.
Contact Ed Stannard at firstname.lastname@example.org or 203-680-9382.