What Parents Might Expect If Your Child Is In the NICU
Speaker 2: 00:08 Hey everyone. Welcome back to the latest episode of the best health podcast from wake forest baptist health. I'm Justin Gomez. I am here with Dr Sheree Welch today. Welcome Dr. Welch. Thank you, Justin. How's it going? Great. Good. Um, so we are talking today, um, very important topic. Uh, once again, it's a topic that we can spend a lot of time talking about, um, but we'll try and kind of narrow it down and just spend a few minutes talking about, um, our brand new neonatal intensive care units and the care that we offer for premature babies and other, um, other babies and some of our tiniest patients that might have to spend some time in the NICU. And Dr. Walsh is gonna help us navigate through that process and, and maybe explain, you know, how a parent might navigate through this process as well. So, um, we're excited to learn a lot from Dr. Welch today, but before we get into that, Dr. Welch, you just start off by telling us a little bit about yourself. Um, how long you've been here at wake forest baptist and how you got into medicine.
Speaker 1: 01:17 Oh, that's, that will take a long time. Well, I've been here for 17 years and I've been the medical director of the NICU since for about 13 years. And the medical director, basically what that is is, uh, I am involved in the operations of the NICU and basically, um, making sure that we're providing the most evidence based care based on the latest research and looking at the quality and safety of our care and continuously improving that.
Speaker 2: 01:44 Okay. Um, so going a step further back, um, were you in college, high school, Middle School, elementary school, when you were like, Hey, I'm going to be a doctor.
Speaker 1: 01:56 Actually, I was a junior in college and, uh,
Speaker 2: 01:59 what got you interested in, in, um, being in the medical field?
Speaker 1: 02:03 Well, I'd never really thought about it before, and this is, again, a longer story, but I'm one of those people that just comes into your life. Actually a guy on an airplane that I just struck up a conversation with said, you know, you should be a doctor. It sounds like you're really smart and you make good grades and, and it just sort of happened from there. I was already basically premed without having known it since I was interested in science already in. And so I looked into what I needed to do and it was just taking the MCAT. And so I did pretty well on that and ended up getting admitted to Stanford Medical School and finished up there and then came back to Chapel Hill. I'm from Charlotte originally, so came to Chapel Hill for a residency and fellowship. So a total of 10 years of training and then had finally got my real job here 17 years ago. Well,
Speaker 2: 02:46 there you go. You never know, uh, who you're going to sit next to on an airplane. Um, so just transitioning, uh, you know, maybe some people have heard about it. Hopefully some people have heard about it. Um, but maybe some people have not. Um, but here at wake forest baptist health, um, here in Winston Salem, uh, the campus, you know, we have several hospitals all over in northwest North Carolina, but here in Winston we just opened the new NICU. Um, so if you wouldn't mind just talking to people for a brief moment, um, and just tell them a little bit about the new NICU and um, what all it it offers to some of our, our tiny, tiniest and cutest little patients.
Speaker 1: 03:25 Absolutely. Yeah. So it's, it's the state of the art NICU basically with a single family room design. Okay. Where families can be families in the NICU with their baby. And again, this is an intensive care unit, but we encourage the whole family to be here and particularly the mom and dad and they can spend the night with the baby and be involved in the care and, uh, interacting with the team and participate in decision making and learning how to take care of their babies so that by the time they go home, they're fully comfortable and confident in doing that. Sure. Okay. And there are 51 rooms here. There are 53 beds, 51 rooms. We have two twin rooms, so 53 beds total.
Speaker 2: 04:02 Fantastic. Um, and uh, for anyone that might have to make a trip here, um, to this campus, um, it's up on the 11th floor in the Ardmore tower and um, is um, adjacent to our brand new labor and delivery units. Yep. We're right across the hall, right across the hall. So that's very convenient. Um, Kudos to ever did the design and construction on that. Um, which is also has fantastic state of the art amenities as well. So, um, what I want to talk about now, Dr. Welch is, um, I'm assuming a fair percentage of the babies that have to come to the NICU for a little while are, um, premature babies. So we've been talking, um, in arguing and continue to talk and have, um, some podcasts related to the mom. Um, pregnancy burdening post-birth process. Um, we're going to have several of these podcasts talking about a range of topics all in around moms and babies. Um, so, um, when, um, you know, that obviously a lot of times a mom is not expecting to go into labor prematurely. Um, and there's a number of factors that I'm sure can, can, uh, cause that to happen. So, um, if a baby is premature, um, I guess talk about how y'all do an initial assessment of the baby and, and bring them up here to the NICU and, and kind of what, what, what happens first when a, when a baby first arrived at the NICU?
Speaker 1: 05:39 Well, first of all, we try and talk to the moms prior to birth because they're obviously pretty traumatized by what's about to happen and wondering is their baby gonna live and what's going to happen? What's, what does this mean? Cause like you said, a lot of times this is completely out of the blue unexpected. And so we try and give them a little bit of heads up about what's about to rock their world and, and what to expect. And obviously that conversation is ongoing after birth and throughout the ensuing weeks and months. But, um, but we will, we'll have a whole team that will come to the delivery room and uh, be there right when the baby's born. And we have a nurse practitioner, retros, respiratory therapist, and um, generally a physician, especially for the really tiny babies. Sure. We can take care of babies born down to 22 weeks gestation.
Speaker 1: 06:22 Again, 40 weeks is terms. So just over halfway. And then, um, our smallest baby that we've taken care of is about 12 ounces size of a coke can. Goodness. Yeah. So they're, they're tiny. And so the limits be beyond or being smaller than that or just the equipment is just too big even, um, that's about as small as we can go with our equipment. Very interesting. Yeah. So often the premature babies, especially born at the, the tiniest ones, their lungs are just very immature and they can't breathe very well just due to strength. But also brain maturity. Their brains just aren't reminding them to breathe constantly and their lungs collapsed because they don't have the proteins that keep our lungs open when we breathe all the air out so their lungs will collapse. At the end of their exploration interests. So they often have to be on breathing support and breathing machine sometimes for weeks and months. Sure.
Speaker 2: 07:11 Um, so when you, um, when the baby comes in and the initial assessment is done, um, uh, I would think y'all would put together, um, kind of a, a health plan for that baby depending where they are in the premature range. If they're, you know, three or four weeks premature, eight weeks premature, um, y'all kind of put together a plan of how to, to help move a little baby along. Correct.
Speaker 1: 07:36 Absolutely. Yeah. And in fact, for the tiniest babies, generally 26 weeks and under, we have what we call the golden hour and even the golden days. So the first three days of life are really critical in terms of keeping them warm and providing the, the respiratory support they need, but not, um, giving too much that could actually injure their lungs. And then also just protecting their brains from, um, any injury during that really vulnerable time. So, yes, we, we pay a lot of attention to those tiniest babies cause everything has to just be done very gently and, and very precisely. And then, um, certainly for the, the baby's born even bigger. We, we take them as they come and sometimes they need some respiratory support and sometimes they don't. Sometimes they come out and they're breathing just fine and, and they just need to learn how to eat by bottle or breast. And oftentimes they're, um, can do all the things that they're too little to keep themselves warm. So they just need an incubator for a little while. So as you, as you alluded there, they have different needs as they mature. And so when they're born at different gestational ages, they, we ex anticipate that they'll need less and less as they are born at more and more mature ages.
Speaker 2: 08:40 Sure. So what are some of the other common services that you might have to provide, um, to, um, these cute babies here and they make you, um, as well as, what are some of the common support services that you find yourself and your team? Um, supporting with the family of, of that baby. So what are the more, more common services, I guess, for lack of a better term, that, that y'all offer up here in the name?
Speaker 1: 09:08 Absolutely. As you've heard to raise a child, it takes a village and certainly in the NICU it is a huge village of, of people that come together in a multidisciplinary team to look at every single organ system and every, every aspect of the baby. Okay. And so on, we have three teams now running simultaneously and so on, on those teams we have a nutritionist and a pharmacist, uh, that round with us every day. Okay. And then in addition to that, we have speech therapist who actually obviously the babies aren't speaking, but, um, they help with the feeding and the oral skills and, and bottle-feeding and babies. And then occupational therapist who, um, also help with positioning physical therapist as well. Um, and of course all the lab personnel, the radiology personnel, and then all the subspecialists. So the, every, um, specialists that you would see as an adult, cardiologists, pulmonologists, nephrologists, we have that in pediatric forums. So we have pediatric specialists, sub specialists that come and help see these babies right from, from the get go can talk to the moms prenatally if there's some diagnosis that we know ahead of time that is going to require their services. And the Nice thing about Brenner is that the, those subspecialists get to know these families and these babies in the NICU and then they follow them throughout their childhood. Sure. Starts right from the beginning.
Speaker 2: 10:19 Makes Sense. Oh, that's very interesting. Um, that team approach. That sounds really interesting. That's good information. I'm glad you're sharing that. Um, so as the baby is making progress, um, in the NICU, um, is y'all look for different milestones or um, uh, benchmarks that baby needs to um, achieve before they can move along to the next phase to eventually, uh, with the goal being discharged. Correct. So, um, as you're talking with, with mom and dad and the family, um, what are some of the milestones that y'all are looking for? Um, when a baby's here in the NICU?
Speaker 1: 11:01 Yes. So obviously the, the first few days as I mentioned earlier, are, are the most critical. So getting through those first three days and surviving that is the first milestone. Sure. Um, and then, uh, as babies get healthier and more mature and, and, and are growing, they need less and less machines. So initially you'll come into the room of a, say a 24 week baby on day one, and there's all kinds of machines and beeping and, and pumps and things. And as time goes on, slowly those disappear from the room and tell there's just a nasal cannular perhaps in an incubator. And, um, we've got mom in there and providing care for the baby. So the, but ultimately the things that the baby has to do before they go home, are they able to keep themselves warm without an incubator? So just a blanket and a hat and the ones that you basically, you just like, you would have your newborn at home.
Speaker 1: 11:47 Um, they have to be breathing reliably, not having to be stimulated to breathe. Cause as I mentioned earlier, they're, their, um, brains sometimes aren't kicking in the respiratory drive, so they have to be over that. And that's a maturity related thing. Um, ideally they're off oxygen, but if they have to go home on oxygen, sometimes we'll send them home with nasal cannular oxygen. And then finally they have to be able to be bottle feeding or breastfeeding completely and gaining weight with that. And so those are the things. And then, uh, there we can send, babies are surviving and being discharged at smaller and smaller weights, but the car seats are a problem. So the car seats only currently go down to four pounds. So the baby has to be four pounds at least to be able to fit in a car seat to go home. There you go. That's Kinda interesting. Logistical. Exactly right. Yeah. Yeah. We often have babies just waiting to get big enough to go home in their car seat, which is, is a challenge because they're here in an ICU and they could be at home if we just had, uh, a better car seat. Yeah. Interesting.
Speaker 2: 12:44 Um, so you know, if, um, yeah, I have two sons and um, neither of them were preemies and, um, fortunately, you know, they did not have to spend any time in the NICU. Um, but when I would think through just personally, probably, and maybe some other parents have, have this similar thought process when I have this preemie baby, there's maybe a little bit more um, hesitation or there's barriers there that, you know, as the baby strong enough for me to carry this way. How do I carry that? What even, you know, how do I dress the baby more carefully? So, um, do y'all kind of go through that with, with the parents and the family of when the baby's, you know, getting closer to discharge, um, kind of how to, how to care for PME baby. Are there any, you know, special, um, special circumstances that you, that you all talk to the parents about before the baby goes home?
Speaker 1: 13:40 Not really. By the time they're ready to go home from the NICU. Ideally for the most part, they should be treated just like any other newborn baby. Okay. Going home, obviously with any newborn baby, you don't want them to be around anybody who's got a virus or a sick in any way. Cause that could, especially for premature babies, that's more serious. But for any baby, you wouldn't voluntarily but put them in contact with somebody who's sick. Yes. So we try to counsel them about that. But babies in general, and especially NICU babies who have been through weeks of, of NICU survival, they, um, they're pretty resilient. So they, they're a little, they're a lot tougher than you would think and we don't want parents to get into the mode of thinking of their child is extra vulnerable. So that's called the vulnerable child syndrome where they keep them from doing activities even throughout their childhood because they were born premature. But whatever they can do, they should be able to do just, just, um, just like always, you don't need to protect them in any other way except from infections in the first couple of years of life.
Speaker 2: 14:35 This is very, that's very good information. Um, so we, um, here at Wake Forest Baptist health, uh, the, the NICU is a level four NICU and I think that sets us apart from other NICU around region. Um, can you talk us a little bit about kind of what the difference is and why that sets us apart? In some other differentiators here at wake forest baptist of what that means as far as capabilities or services?
Speaker 1: 15:04 Absolutely. It, so level four NICU means that we can provide care all the way from for the tiniest of babies all the way through all any surgery that they might need, including cardiac surgery. Gotcha. And so we, we perform cardiac surgery on children. Um, some, some neonates, but definitely on older children and babies as well. Okay.
Speaker 2: 15:27 Um, so what is, um, some encouragement or advice you could give for, um, you know, if a mom is pregnant, you know, there's a million thoughts that go through her head, you know, and um, you know, a lot of them say you might have family members that have had preemie babies or anything. So, you know, you get to talk to a lot of parents and have talked to a lot of parents. So, you know, what do you, what are words of encouragement or, or reminders do you, do you offer to them, um, when, when their baby is here in the NICU and to help them get through the journey?
Speaker 1: 16:10 Yeah. The parents are, are very scared about what's what's happening and what this means for them. And one of the questions is how do I be a parent in this environment? I had all these thoughts and you know, these ideas about what I was gonna do when I first saw my baby and held my baby. And now this is way different from what I thought. So how do I transition what I, what the ideal was to, to this new reality? And, um, there's lots of things that parents can do. Uh, they can, for one mom's providing their own milk is so, so important and it's the absolute best food that we can get. Baby's formula is not, uh, it's made from cow's milk and it's just not what, um, our bodies are meant to have. We do have donor milk, but, but it's, um, for the tiniest of babies.
Speaker 1: 16:53 But mom's milk is absolutely best for her, for her baby in it. And that's something that none of the rest of us can do. Only the mom can. So that is a huge part of being a parent in the NICU for a mom is to do pamper milk if she can. Now some, some moms can't and that's okay, we can work around that, but sure. But, um, but that's huge. And then just being here and being involved in and learning about their baby and, and being an expert on their baby. We are experts in neonatology, but these parents are experts in their baby and they can tell us a lot about how they think their baby's doing and that's very valuable information for us. And, and um, also just trusting and forming relationships with the caregivers and realizing that we're all on the same team and trying to move things forward and sometimes it gets frustrating cause things aren't going your way, but, but we're all on the same team and we want what's best and we want your baby to go home as soon as possible safely as possible.
Speaker 2: 17:40 Sure. That's, that's really interesting. Dr. Welch. So, um, we'll be wrapping up in just a second here. Um, but before we do, um, I wanted to touch on any, um, once the baby gets discharged. Um, Mike you mentioned earlier, um, they should be at a level where, um, they should be able to, um, uh, continue care with, with a pediatrician at, at their pediatrician of choice. That's correct. Just with normal follow up appointments as a non-premium baby would
Speaker 1: 18:11 yes. In addition to whatever sub specialty care appointments they would need. The absolutely. The pediatrician is still there, their quarterback for their care and um, we'll continue on with all the vaccines and the, the normal, um, regular childhood things.
Speaker 2: 18:24 Gotcha. Well, I'm Dr. Welch, I appreciate you taking the time today. This has been super helpful and informative. Um, hopefully, um, parents out there or soon to be parents, um, will find this information helpful. Um, just talking about the NICU and premature baby process. Um, if someone does have to visit the NICU and rest assured that, um, our experts here way first baptist health, um, can, can help your family and your baby, um, get back to, to being healthy and being at home. I'm sure that's the end goal for all the babies here visiting NICU is, is get them back home with the, with the family. Right?
Speaker 1: 19:08 Absolutely. We, we love to wave goodbye as they're going out the door and we love when they come back and visit us when they're back for their subspecialty appointments. Yeah. Running up and down the hall and, and it's just really exciting. That's what we do this for.
Speaker 2: 19:20 Yeah. I bet that's precious. I bet it's fun to even see as they get ready for discharge or a little personalities develop them. Yeah, yeah,
Speaker 1: 19:27 yeah. And just to see the parents and how far they've come from the beginning as well.
Speaker 2: 19:30 Yeah. That's great. Well, um, just to offer up everyone, if you want more information about, um, the services we offer for, um, babies, um, and the NICU, uh, just go to wakehealth.edu and then there's a search bar. You can search NICU. Um, you can search the birth center as well. There's information about that, uh, the new birthing center on the website as well. Um, or you can always call three, three, six, seven, one six week. And, um, if, if you need an appointment or someone in your family needs an appointment, they can get you taken care of. Um, so I appreciate everyone listening. Dr. Walsh, thank you once again. This has been fantastic pleasure and we will catch you on the next episode. Have a great day everyone. Thanks for listening to this episode of the best health podcast brought to you by wake forest baptist health. For more wellness info, check out wakehealth.edu and follow us on social media. Wake Forest Baptist Health, the gold standard of health care.