As a NICU nurse, I will be taking care of little Ava who is 25 weeks old
Monday: The alarm clock goes off early again
Phew, 6 AM, that takes some getting used to. Last week I was on the night shift, had the weekend off and was busy with fun social activities. Now reality is knocking again and I have to get ready to go to work. I get in the car around 6:30 AM heading to the AMC. Once arrived, I walk towards the locker room and change. We wear green uniforms, not the standard white ones. These green uniforms feel like pajamas, which in this case might not help much in waking up properly. We always start the shift in the coffee room. Students are paired with supervisors and the patient allocation is discussed. Then everyone heads to their units.
I am taking care of the 25-week-old baby
Units 1 and 3 are Intensive Care Units, where the children need the most and most intensive care. Then there is Unit 2, where children who need slightly less intensive care are located. Today, I am on duty in Unit 3. I enter and greet the night shift; they are happy to see us! They had a busy night and are eager to go to bed. I am informed that I have to attend to the delivery of a 25-week-old baby in the delivery rooms soon. Mrs. S. is about to give birth, so I hurry to the obstetrics department, which is located opposite the neonatal ICU. The fact is, as neonatal ICU nurses, we support the obstetrics department during the resuscitation of an extremely premature baby (24 to 26 weeks). Once I arrive at obstetrics, I walk to delivery room 3 and head towards the baby room. This is a space that is kept extra warm and where all kinds of equipment are set up to support the baby during the transition from inside the womb to the outside world. After a few minutes, the neonatologist arrives with a crib carrying a little girl. Right behind them, the maternity nurse and the girl's father walk in.
little Ava has trouble breathing
We quickly place the girl, named Ava, in the incubator and assess her physical functions, such as: breathing, heartbeat, oxygen level in the blood, temperature, color, and responsiveness. As is often seen with extreme premature births, Ava's breathing is struggling to start. We encourage her to breathe by touching her and she is given an oxygen mask by us to ensure that her lungs expand nicely. I, together with the neonatologist, ensure that Ava's physical functions are monitored and then Ava is given an IV. Now I introduce myself to Ava's father and congratulate him on the birth of his daughter. The father is overwhelmed by everything but looks super proud at his little girl. When we see that Ava is breathing well on her own and her physical functions are stable, we take the incubator towards her mother. She has had little chance to see her daughter. With pride, but also with some fear, she looks into the incubator. We explain to the parents that we are taking her to the neonatology department. Ava's father walks with us to the ward.
Father is completely overwhelmed
Once on the unit, Ava gets her own 'little spot'. There are 8-10 spots on a unit, and Ava's spot becomes bed 6, 'the Donkey'. Each spot has an animal symbol with us. Together with a colleague, I make sure that we check all physical functions and values. Ava receives CPAP support, which ensures that her lungs stay nicely open. She also receives medication that ensures this. It has the same effect as soap suds: it creates a layer in the alveoli, so they can no longer collapse. When you're born as small and young as Ava, you still lack that substance. We also weigh Ava in the incubator. Father takes a picture of the weight as a beautiful memory. We also insert a feeding tube into the stomach because babies this small cannot drink on their own yet. We check the temperature and want to leave Ava alone for now to rest a bit. We turn her onto her tummy, so she can breathe more easily and doesn't have to 'fight against gravity' to breathe. Now that Ava is lying quietly, I ask how the father is doing. He is overwhelmed by everything, but super proud to be the father of this little girl now. I tell him that he can touch her, but preferably not 'stroke' her, as this actually makes her restless. She can't process those stimuli well yet, so it's nice for her if father lays his hands calmly on her. His voice will probably be recognized by her. Father lays his hands down and says: 'Dear brave girl, keep it up! Me and mom are already proud of you.' As he says this, I think about what these parents might still have to go through to take this sweet girl home. This could possibly be a long ride on a rollercoaster with positive and negative experiences. You can't prepare for this. This is something you wouldn't wish on anyone to experience. Ava will need to develop and grow in the coming time. This way she becomes a little less vulnerable, but when you're as small as Ava is now, you can quickly become seriously ill and even die.
Father will at some point go back to his wife to give her an update. Later today, the doctor will also talk to the parents about the admission and how the upcoming period might unfold. Later in the day, further examinations and procedures will follow to assess Ava's condition and to stabilize her. The doctor will perform an ultrasound of her brain, as her brain is so vulnerable and susceptible to bleeding that it will be checked frequently during the first week. In addition, she will receive long intravenous lines through her umbilical cord, so that we can administer IV nutrition, monitor her blood pressure, and also perform blood draws. All in all, a busy day for Ava.
I see hope and fear among parents
Parents come together to the unit a few hours after birth to see their daughter. The mother sits in disbelief and completely overwhelmed next to the incubator, she too speaks to her daughter and lays her hands on Ava. The mother asks me hopefully: 'How long do you think she will have to stay in the hospital?' Unfortunately, I cannot answer this frequently asked question. I say: 'Unfortunately, I can't tell, Ava will show this herself. We will have to live day by day and sometimes hour by hour, no day will be the same. We can only hope that Ava turns out to be a strong girl.' The father and mother nod and look at each other. I see hope in their eyes, but at the same time also fear. This is going to be an anxious time for this family.
LISANNE, NIENKE AND DEMI (click here to peek at their Instagram)
