the neonatal intensive care unit (nicu) takes care of sick, newborn babies. most of them are premature, born at 28, 30, 32 weeks, instead of the 38-40 weeks that they need in the womb to fully develop, to have the defenses against what the outside world will throw at them. they're tiny, weak, and helpless. when their pacifiers fall out of their mouths, they sometimes try to substitute their thumb. but lacking the coordination, they usually end up in the vicinity at best, inadvertently poking their eyes or picking their nose instead.
most of the infants are just small and need support to make sure they're getting enough calories to grow and don't stop breathing when they get tired ('feeders & growers,' as we call them). i watch their tiny chest walls expand and contract with the ventilators, their tiny fingers clench into fists around my little finger as they flex their arms and twist their faces in agitation when i disturb them from their slumber.
but sadly, babies die here, too, and there are few things that are harder to see. some are just too sick to make it. they have had a severe bleed in their brain or their lungs just weren't developed enough; their bowels perforated or they acquired an infection in utero and couldn't fight it off with their weak, naive immune system, even with the help of antibiotics. these are all consequences of prematurity.
we go to the high risk deliveries to be there in the delivery room to resuscitate babies when they come out. i'm often the 'baby catcher,' the one who takes the baby as soon as it's pulled out and bring it over to the resuscitation crib. they are often blue and floppy and not breathing, and though most of them start right up with a little stimulation, it's always a little nerve-wracking at the beginning, no matter how many times you do it. and of course there are always a few that don't start on their own -- be it their breathing, their heart beat, or both -- and that's when we have to start chest compressions and intubate (put a tube down their trachea) them. so far there have only been 2 of the 50 or so babies i've been to the delivery room for that we haven't been able to resuscitate despite trying everything in our protocol, but those are the ones you remember. the normal ones you forget.
when we learn resusitation on adults, we are taught to get down on our knees, straddle the individual, and push both palms, stacked upon each other with fingers intertwined, down on the chest wall with most of our weight behind us to provide adequate chest compressions. with a newborn we use two fingers.
the nicu -- just like any intensive care unit -- is aptly named. there are a minimum of 4 fires to be put out any given moment, it seems, and the key is efficiency and clarity of thought. you cannot forget things, and you cannot afford to miss things. the margin of error is slim. looking at how small the babies are -- 1.2 kilograms, 800 grams, 2.7 kilograms -- it becomes clear why.
call nights, when we are responsible for all 55-60 babies and have to attend and admit all the high risk deliveries, take virtually every ounce of energy from me. post-call it takes an entire day of sleep to recuperate so i can come back early the next morning and do it again.
