NWRHA: NICU staff committed to babies' care

THE North West Regional Health Authority (NWRHA) has said the staff in the neonatal intensive care unit (NICU) at the Port of Spain General Hospital are committed to ensuring the care and well-being of the babies they are responsible for.

The authority made this statement in a newspaper advertisement published on April 22.

Seven babies died of a bacterial infection at the PoSGH's NICU between April 4-9.

The NWRHA said, "The team of nurses is of paramount importance in creating the environment of the NICU as they provide round-the-clock care for all the babies in NICU.

"These nurses work long shifts, which could be as long as 12 hours at a time."

During their shift, the nurses provide care for three to four babies per shift.

The authority said sometimes this number is higher.

A pair of head nurses, trained in neonatal nursing, lead the nursing team in the NICU.

The NWRHA said. "The nurses are responsible for the day-to-day provision of care for each baby, feeding them, giving them medication, cleaning, suctioning, tidying the incubator or cot."

The authority added these nurses are "great advocates for babies and parents alike..."

The NWRHA sought to explain prematurity and premature babies.

A full-term baby is delivered between 39 and 41 weeks.

The NWRHA said, "A baby is said to be early term between 37 weeks to 38 weeks and six days."

All babies born before 37 weeks gestational age (the time between conception and birth) are considered to be pre-term.

The NWRHA said, "Babies born pre-term have many challenges to overcome since they are not fully developed and may need more help and support after delivery."

Within the definition of pre-term babies, there are further divisions ranging from late pre-term ( babies born between 34 and 36 weeks, six days of pregnancy) to extremely pre-term ( babies born at or before 25 weeks of pregnancy).

The authority said pre-term deliveries happen for many reasons.

In some situations, medical conditions in the mother cause the obstetrician to deliver a baby earlier to prevent further complications to the mother during pregnancy due to a worsening pre-existing medical condition such as diabetes, hypertension, renal or cardiac disease.

In other cases, a pre-term delivery is necessary due to a worsening medical condition with the mother that arose only in pregnancy, such as pre-eclampsia (high blood pressure during pregnancy) or an acute fatty liver.

The NWRHA said some twin pregnancies may have to be delivered pre-term.

"When twins are sharing a placenta, the two umbilical cords can get entangled, creating knots and cutting off the blood and nutrients to one or both of the foetuses."

To prevent a bad outcome for either twin, the authority continued, these babies may be delivered earlier, around 33 to 34 weeks.

The NWRHA said there are many other reasons why a mother may deliver her baby prematurely and not all of them are fully understood.

"Some of the reasons may be due to infections, trauma, multiple gestation (twin and triplet pregnancies) and genetic abnormalities of the foetus, just to mention a few."

Concerns for the health of pre-term babies centre around the fact that their internal organs are immature and complications can arise in several of them, with some complications being more detrimental than others.

The NWRHA focused on four main concerns for pre-term babies: lungs, brain, feeding and infection.

The lungs are the first concern in a premature delivery.

The authority said, "When the lungs are immature, they lack a special chemical called surfactant."

This is produced from 25 weeks in very small quantities, increasing steadily to moderate quantities by 34 weeks and at normal levels at 38 weeks.

When there is a surfactant deficiency, the baby needs support on a ventilator to keep its lungs inflated.

The analogy of trying to blow up a balloon was used to explain a pre-term lung.

The NWRHA said, "When you initially start, the pressure you have to push into the balloon is very high and your cheeks even puff out as you are met with resistance in the new balloon."

After the first few hard breaths, the balloon becomes easier to inflate.

The NWRHA said, "In going from liquid to air without adequate surfactant, each breath the baby takes after delivery is like trying to blow up a new balloon each time. That is a lot of work for a small baby who may weigh just one pound."

The brains of premature babies, the authority continued, are very sensitive.

"The more pre-term the brain, the more the risks of bleeding, cerebral palsy, deafness, blindness and other developmental disorders."

The NWRHA identified bleeding in the brain as a particular concern for premature babies.

"These bleeds are unpredictable and can happen at any time after delivery. When infection and low blood pressure are seen in some pre-terms very early, there is an increased chance of bleeding."

The NWRHA said pre-term babies can be ready to feed soon after delivery.

By the second to third day of life, depending on the stability of the baby, feeding can be started usually via a feeding tube passed through the baby's mouth or nose into the stomach.

The authority said, "As the developing brain is very sensitive to a lack of sugar (glucose), it is very important to ensure that blood glucose levels are optimal to prevent any unwanted complications."

On the issue of infection, the NWRHA continued, pre-term babies are "undoubtedly at increased risk of infection from bacteria, viruses and fungi."

The World Health Organization (WHO) has listed sepsis (infection) as the number one cause of neonatal mortality in the world.

The authority said, "Preventing infection in pre-term babies is therefore of vital importance and starts even prior to delivery by the obstetric unit who may start the mother on antibiotics while still pregnant if she shows any worrying signs such as fever, early rupture of the water-bag (premature rupture of membranes), foul smelling discharge or amniotic fluid, urinary tract infection or maternal bacterial bloodstream infection (sepsis)."

After delivery, most pre-term babies are screened for infection and have blood taken for microbiological evidence of infections.

The NWRHA said, "These babies remain at high risk of infection until they are mature. Therefore, strict hand hygiene and environmental care practices must be continued in hospital and even at home after discharge."