Born too soon: caring for premature infants

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By ABBY WEINGARTEN, staff writer

Lucia Ingram was born prematurely the day after Thanksgiving in 2012, and spent four weeks in the neonatal intensive care unit at Sarasota Memorial Hospital.

"It was a very long, strenuous journey," says her mother, Alison Ingram, who brought Lucia home with husband Jerry just before Christmas that year. "With preemies, you never know what to expect from day to day. Every day, you wait."

Alison, Jerry and Lucia Ingram's first family portrait was taken in the hospital's neonatal unit.. (Photo provided)

Alison, Jerry and Lucia Ingram's first family portrait was taken in the hospital's neonatal unit.. (Photo provided)

For the past five months, that wait at Sarasota Memorial's NICU has been a whole lot easier for patients and parents.

A new unit opened on the Courtyard Tower's fifth floor in early November, replacing the ward-style space that was built in 1952. What was previously a pair of open rooms with hardly any privacy has been transformed into a state-of-the-art, 33-room area with one-on-one care.

The unit is the only Level III intensive care nursery in the area, and it offers multidisciplinary specialists and around-the-clock monitoring. The maternal-neonatal ambulance is staffed with nurses and respiratory therapists, and rapid transport to All Children's Hospital in St. Petersburg is available for babies requiring lung, heart or gastrointestinal surgery.

Sarasota Memorial also has a strong alliance with All Children's, where Dr. Anthony Napolitano serves as the senior neonatologist. For the past 23 years, he has been the medical director of the hospital's neonatal and pediatric critical care transport team.

"Premature babies still present a very big problem in the U.S., and it's a much bigger problem for mothers who don't seek prenatal care," Napolitano says. "Life begins around 24 weeks, and we now have the ability to save these babies, but the best rates of survival are for babies beyond 27 weeks."

Two-week-old Julian David Walters was born 7 weeks premature at Sarasota Memorial Hospital. (Staff photo by Dan Wagner)

Two-week-old Julian David Walters was born 7 weeks premature at Sarasota Memorial Hospital. (Staff photo by Dan Wagner)

A baby is considered premature when born before 37 weeks gestation. In Florida, the March of Dimes -- a national nonprofit organization devoted to improving the health of mothers and babies -- has been pushing to decrease C-sections before 39 weeks, Napolitano says.

"President Kennedy's baby was born at 33 to 34 weeks, and that baby died because we did not have the technology to save it back then. Today, at 34 weeks, the survival is greater than 90 percent (up from 1960)," Napolitano says. "Babies born at less than 34 weeks' gestation have a greater risk of developing breathing problems and developmental delays."

A QUIET PLACE

Sarasota Memorial delivers about 3,000 babies annually and promotes "kangaroo care," natural birth and breastfeeding. The hospital's new maternity wing has transformed the experience of an at-risk birth, says Debbie Harman, the clinical manager of the NICU and maternal-neonatal transport.

Lindsay Walters with her baby, 2-week-old Julian David Walters, has a private room in the neonatal intensive care unit at Sarasota Memorial Hospital.  (Staff photo by Dan Wagner)

Lindsay Walters with her baby, 2-week-old Julian David Walters, has a private room in the neonatal intensive care unit at Sarasota Memorial Hospital. (Staff photo by Dan Wagner)

"It has been wonderful for families. The new NICU has private rooms, like an ICU, so every baby has its own room, which allows the parents to stay in the room 24-7," Harman says. "There is a recliner, a place to shower, a family lounge, two computers, kitchen amenities (a toaster oven, a coffee pot). One mom was actually there for 42 days straight. I've noticed that the parents feel more comfortable having privacy, especially for breastfeeding and pumping."

The new unit has a weekly sibling education class with a childlife specialist, who meets with brothers and sisters between the ages of three and 12. There are 52 nurses on staff, and about seven to eight nurses per shift. Every morning at 8:30 a.m., interdisciplinary rounds involve a neonatologist, nurse, discharge planner, pharmacist, nutritionist and respiratory specialist. The nurse presents the baby's story and the family is invited to ask questions.

There is an average of 18 filled rooms at any given time, and the unit recently hit a record high of having 29 of the 33 rooms occupied, Harman says.

"It's so different than it used to be. You don't hear the phones ringing anymore. It's so quiet. That's what we wanted. I think it has improved communication for the whole team," Harman says. "It's like going from an apartment to a mansion. It's good to know that, in this community, we have a very experienced staff that provides the latest and greatest technology and an environment for families to have the best possible outcome."

A PREVALENT ISSUE

In 2011, the national rate of prematurity was at 11 percent, and Florida ranked No. 41 in the United States with a rate of 13 percent, Napolitano says. The survival rate for all premature babies at All Children's is greater than 85 percent.

"At 24 to 26 weeks, survival is not as good and the risk of long-term complications are higher," Napolitano says. "We try to prevent mothers from delivering at that point because the mother makes a better incubator. When you look at the cost of healthcare, it can be very expensive" -- at 24 weeks, the medical costs could be anywhere from $250,000 to $500,000.

"The best way to avoid prematurity is to get prenatal care, don't smoke or do drugs and keep yourself healthy," says Napolitano. "The earlier in your pregnancy that you come in, the earlier the physician can monitor you."

Alison Ingram, currently the 2014 mission family mother for Manasota's March of Dimes, remembers what it was like to be monitored while carrying baby Lucia.

Ingram found out she was pregnant in May 2012, after 10 years of trying. The pregnancy progressed normally, she says, but at 21 weeks, she learned that she had an incompetent cervix. Due to many years of fertility treatments, her body was unable to sustain the ever-growing weight of the pregnancy.

She was placed on bed rest and only permitted to be upright 10 minutes a day for nine weeks. She went into early labor, was rushed to the hospital and medicated for nine days before Lucia was born at 31 weeks, with defects that limited the use of her left leg.

"It's a very hard experience to go through. Now I'm able to share how courageous my daughter was, and how babies like her can thrive and prove us wrong every day and defy the odds," Ingram says. "Any time I get the chance to not only share Lucy's story but to have other parents share their stories with me, it brings to light how prevalent this prematurity issue is. You realize everybody is touched by prematurity somewhere along the line."

ison, Jerry and Lucia Ingram, one year later. (Photo provided)

ison, Jerry and Lucia Ingram, one year later. (Photo provided)

Last modified: April 21, 2014
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