NICU Babies in the Era of COVID-19

by DeeAnna Serna, RCP, RRT-NPS, AE-C

Hello there, let me tell you a little about me before I get into all the details of this topic.

My name is D’Anna I am a respiratory therapist with about 20+ years of experience, I’ve been a NICU therapist since 2000.  I now work in the outpatient setting as an Asthma educator and Cystic Fibrosis specialist.

So … Fortunately I know about respiratory diseases, this virus is novel thus the N in 2019-nCoVand we are learning on the daily.  

What we do know.

The symptoms may appear 2-14 days after exposure.* source

  • Fever
  • Cough
  • Shortness of breath  

The best way to prevent illness is to avoid being exposed to this virus.

While that may go without saying… here is a link with information on prevention and cleaning CDC-Covid-19 prevention

I state this information for background.  

Now what does this mean for our babies in the NICU?  

The short answer is that there is not enough information out there, because we have (fortunately) have not gotten report of an exposure of Covid-19 in a NICU.

As this is an emerging virus most of the information is based on effects on pregnancy and newborns (term gestation).  

There is a small amount of data regarding delivery of infants to Covid-19+ mothers and the outcomes following delivery.  Covid-19 pregnant women-and-impact-newborns

 What we as a team can do (family & medical) is prevention.

Strict visitation policies, effective hand washing and cleaning of equipment.

Staying home if you feel ill and clean handling of breast milk if one does have symptoms.

While this may seem like repetition … it is because we all need daily reminders.  

I am grateful that I have heard no reports of this organism in a NICU and we must all work together to keep it this way. When more information becomes available I will be happy to update.

So I close saying … stay strong and vigilant. These little ones are being born into a very different world.  You as always make the difference and we as your NICU team are here to help and support you in any way we can.

Be well and take care of each other …

DeeAnna Serna is a Respiratory Therapist in Southern California. She has worked in the NICU and is currently the Lead Respiratory Therapist for the Pediatric Pulmonary & Sleep Medicine Clinic as well as the Adult & Pediatric Cystic Fibrosis Clinics.

HELLP Us with a Preemie: A Military Family’s Journey

by Kristen Barton

At the beginning of my pregnancy, I had recently separated from the military. My husband and I were both Hospital Corpsman in the United States Navy. We thought we were knowledgable and prepared. I took Lamaze, breastfeeding classes, and baby boot camp. You see, I am an A-type personality with hardcore planning goals. My pregnancy of our first child was perfectly healthy until my third trimester. My troubles started with Gestational Diabetes. I was then scheduled for a 38-week induction due to babies usually measuring larger with this condition. I was ok with this until one of the worst things possible happened. I was 34 weeks and two days, when my headache wouldn’t go away. I knew headaches were associated with blood pressure so we went to triage. It turned out I was right, and my blood pressure was severe Preeclampsia. Then my room became full of midwives, nurses, and doctors. I knew this was not normal. 

HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) a rare disorder that occurs in less than 20,000 cases a year. My husband and I had never heard of it even with my past work experience in OBGYN and Maternal-Fetal Medicine. After they explained my condition, I then realized I wasn’t going home, and I was having the baby that weekend. Remember, when I said I was a planner? Well, my original birth plan was gone. I thought once we had the induced c section, the scary part was over. The hardest, most painful part was to come.                                   

My son had all the symptoms of early birth. Lack of lung development, feeding challenges, reflux issues, and heart rhythm irregularities. I understand why medical providers don’t usually want to bring these topics up to parents during pregnancy. Why make people worry when there is no need, right? My husband and I are the parents who want to know as much as possible. I wish we had been educated, even if briefly on what could happen and how to adapt. Not having family close made our experience that much more difficult. I still remember laying in the hospital bed after surgery, not being able to hold my son. It was twenty-four long hours before I could go to the NICU to hold my child. My husband often went to see him, and I was left laying there with feelings of jealousy and anger. I just wanted to breastfeed and hold my son. 

After almost two weeks of recovery and NICU support, we were able to take my son home. While I know I am fortunate compared to some who have longer NICU journeys; I still have intense negative emotional distress remembering those weeks. To make matters worse, I had constant breastfeeding issues and panic attacks in my sleep for months. I know now, I probably had post-traumatic stress disorder. There is literature about NICU parents, both male, and female, having PTSD (Clottey & Dillard, 2013). Why is PTSD not a standard screening for both parents?

My message to other parents is that you are not alone. You will get through it.  It’s okay to feel anger, joy, sadness, love, anxiety, frustration, and loneliness. Just know that you are amazing. You went through something traumatic and beautiful at the same time. My son is one of the best blessings I have ever received, but it was still traumatic. Going home alone without your child may feel like one of the hardest things you ever have to do. However, know that it is best for them.

My message to family is that no matter how much we say we are ok, keep trying to stay connected with us. The best thing you can do is listen and help with little things. If we don’t call or post photos on Facebook, don’t harass us. Maybe taking pictures of our baby with an NG tube hurts us or a NICU day didn’t go well. No matter what, know we appreciate you; it’s just difficult sometimes. For HELLP syndrome, women are high risk for future pregnancies, and recently, researchers discovered the risk of potential cardiovascular disease for the mother (Muijsers, Maas, Heijden, & Frings-Dresen, 2018). The risk taken on, to have more children, is a personal decision between a couple. Please respect peoples’ wishes not to have any more children and don’t push your opinion on them. Unless you went through that experience, you may never truly understand the endless fear that could be caused by dangerous pregnancies. 

My message for medical providers is, please educate parents more on preemies. Having that educational opportunity is better not used than not being equipped at all. Please share resources, like the Graham’s Foundation with NICU parents. During a NICU experience, one resource could make all of the difference for support, especially for military families. For military families, please learn about the Fischer house or Ronald McDonald house, and refer us even if we don’t need it. Depending on the military base, we may have to drive hours every day to bring breast milk to our child or children in the NICU. So not being able to do that, can you imagine the parental guilt, because we know breast is best.

On that note, I want to thank Naval Hospital Camp Lejeune. I will always be grateful to the fantastic NICU, Labor/Delivery, Lactation Consultants, and Mother-Infant Care unit staff for keeping Killian and I thriving. Without all of these teams working together, we wouldn’t be here. I also want to thank my family/friends for all of the love and support. It truly makes a difference. 

Baby Eric

by Sarai Coronado

My husband and I met in Bible School in 2013. We soon started dating and got married in January of 2016. February came around and we found out we were pregnant! We were excited and so happy to be soon sharing our lives with a baby. We went for a sonogram and the tech tells us “well I’m glad you both are sitting down, look there, you’re having two of them!” I instantly started crying, I was going to have two babies come October! Our family and friends were all excited with us and we celebrated every chance we could. In June we all came together and found out we were going to have a Girl and a Boy! And then came July…

I started having contractions and went to get checked. My then OB said it was nothing to worry about and it was only ligament stretching. We went home trusting they knew what they were talking about only to be in labor 12 hours later. I gave birth to two amazing beautiful babies via emergency C section on July 20th. They went to the Children’s hospital down the street to stay in the NICU. Both babies were doing so good, our Sofia and Eric were fighters since the beginning.

The doctors and nurses were very impressed on them both and how well they were doing. Exactly two weeks after birth, a Wednesday, we went to the NICU to see them only to come in and see our sweet Eric crying. We didn’t think anything of it so we smiled, recorded and laughed at how cute he sounded. A few minutes later the nurse found out something was not right, and she jumped into action. They checked and examined him and realized he had NEC. Within the next few hours our room was full of nurses and doctors and surgeons and everyone talking to me about what was about to happen.

We went into surgery the next morning. Once they realized it wasn’t getting any better, he went into surgery once again. He had several blood transfusions, he had all kinds of medicine going, and was now on the ventilator. My baby wouldn’t move much anymore, you could see and hear the pain he was in, it was heartbreaking.

Two weeks we spent in prayer and two weeks of doctors trying everything they could to save my babies life until there was no more that could be done. We gathered our family and told them it was time to take our baby off the ventilator. Our Eric passed away Thursday August 18th at 6:36pm. We held him, we sang to him, we worshiped with him and then we let him go. 

It’s been 3 years and 2 months since and it feels like yesterday. We have learned to cherish each other and our family. To love one another every day since we do not know when it could be our last. We try and live every day as best as we can so one day we can be reunited with our boy once again. We know we could never get over this, but we can survive this and learn to live our lives in a way to honor our son. 

A Moment with Kailor

by Jessica Spradlin

My husband and I have been married for two years, for a year we tried for our baby with no luck and on year one of not trying, God blessed us with a positive pregnancy test.  I was 5 weeks along and we were thrilled. I have three children and he has a twenty year old, so this was a big surprise for him to be expecting a new baby! 

At 12 weeks we did our routine bloodwork and found out he was a BOY! After many long talks and prayers, we decided he would be Kailor Dean. Kailor means “little warrior.” Little did we know how much this was going to ring true for our sweet baby. At 15 weeks I woke up in the early morning having what I was almost positive was a late miscarriage. Rushing to the emergency room and not knowing if there’s going to be a little heart beating when we saw him was terrifying. But after a major bleed, there he was, being his usual spunky little self. He was always sucking on his thumb, rubbing his face or waving at us. They sent me home and said everything looked good, that sometimes this just happens. Relieved, is the emotion we felt. 

After two more weeks and the bleeding continuing with baby boy still healthy and growing as he should I was sent to a Maternal Fetal Medicine specialist a town over. Same diagnosis, this just happens sometimes. We were scheduled to return at 20 weeks to follow up, the bleeding never stopped and honestly, I as well as my doctors were in shock that Kailor was unaffected by this. At 18 weeks, the diagnosis came unexpectedly during a routine ultrasound. A sub chorionic hematoma reared its ugly head. They aren’t even that uncommon actually, but most of them disappear by 20 weeks but unfortunately mine continued to grow instead of disappearing. “It increases your risk of a miscarriage” “You should consider terminating this pregnancy” But I wasn’t giving up on my baby. He deserved a chance, he was surviving against the odds! 

At our 20 week appointment with the MFM, he was not pleased with the size of the hematoma and by now my body was wearing down.  My hemoglobin was low, and I was just not a picture of health. He immediately sent me for blood transfusions, my hemoglobin was 7.2. A normal range is 10+. He said I would be admitted at 23 weeks to start the steroid shots to prepare Kailor for his early arrival. So here I was scared knowing my son was coming entirely too early and after me fighting for my life, he’d be fighting for his. But we were ready, and I was determined we were going to make it to the 23 week mark! We had made it so far and we weren’t giving up on him. Those next 2-3 weeks were the most frightening of my life. I was in and out of the hospital due to blood loss, 20 weeks passed, 21 weeks passed, 22 weeks passed, we were going to make it! He was going to be the baby who made it against all doctor’s predictions. The night that 22 weeks 4 days rolled around I suddenly got very sick and passed out at the hospital where I had been for 3 days. I got 10 emergency blood transfusions. Yes, I said 10! The magnesium drip was started to try to stop labor, I was in indescribable pain (the worst I had ever been).  Pain medications were started but it didn’t do much to alleviate it.  I thought I was dying. But I got the first round of good news, my MFM said to transfer me, he was ready for Kailor and I (this was the NICU).  I was thrilled, even though I was questioning if we’d make it because I was unstable. 

During paperwork and waiting on an ambulance to come get me, they had me upside down in the bed to try to prevent me from having Kailor, he was born at 9:45 am. As rare as it is, he was born fully in his sac, so my sweet boy didn’t even know he had been born. It took seven whole minutes for a pediatrician to make it to him and get him out and it was detrimental to him. His heart was still beating by the grace of god, he was 1 lb 2 oz and 12 inches long, a clone of our youngest son and his daddy but to my surprise the hospital did nothing because he was 3 days too early. Those three days cost my baby his life. We embraced him for 51 minutes until he passed in his mommy’s arms. We are broken and we miss him every single day. I should be in the NICU fighting alongside my son like he fought alongside me when my life was on the line keeping him alive but instead, I’m holding his memory box and visiting his grave. 

I fight for awareness to be brought to these micro preemies. They deserve a chance.

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