Tales: a day in Neonatal Pathology

Who I am
Philippe Gloaguen
@philippegloaguen
Author and references

Hi everyone, I'm Veronica, mother of a beautiful baby born at about 34 weeks.
For this reason we were hospitalized in TIN (Neonatal Intensive Care) for 10 days.  I therefore wanted to bring you an excerpt of what neonatal pathology means and how a typical day can be within this very special ward.

WHAT IS NEONATOLOGY
Neonatology is a highly specialized medical discipline that deals with the care and therapeutic conduct of the newborn.
For the newborn, the moment of transition to an independent life determines an important period of adaptation, especially if the baby is premature, ill or in need of special tests. However, it is the preterm infant who constitutes, for the difficult world that revolves around his birth and his care, the real challenge with life, understood not only as survival, but in the full meaning of its meaning. The neonatal doctor and the specialized nursing staff, who work in close collaboration in the neonatal intensive care units, are the professional figures assigned to this delicate task.

WHAT IS DONE IN A NEONATOLOGY
As a rule, within a neonatal ward (obviously the following varies according to the level of specialization of the facility) they practice diagnostic and therapeutic activities concerning the care of the high-risk newborn, diseases associated with prematurity, perinatal suffering and congenital malformation syndromes.
The department provides specialized and immediate assistance to the severely premature infant, to those of low weight and to the term newborn with perinatal distress, who needs resuscitation and assisted ventilation.
The task of doctors and nurses begins in the delivery room where the newborn is received by the midwife, who will receive all the necessary care for the entire hospital stay and sometimes even after discharge. Some centers also offer a Protected Neonatal Transport for the birth centers of the province in which the center is located, both in the region and not, adjacent by territory to the initial reception facility.

THE FIRST TIME IN THE DEPARTMENT
Upon arrival in the ward, for the first time, the parents will be accompanied by the nurses to the place where the newborn is cared for (incubator, heated open bed, cradle) and will be informed on how to enter the ward (washing hands and gowns). Some forms to be signed will then be presented such as the one on privacy and others relating to consents for the use of blood or derivatives in case of need.
In the event that there has not yet been the time for the recognition of the newborn, the new parents will be provided with all the useful information to be able to carry out this procedure and also all the information necessary for the choice of the general practitioner.
On this occasion the doctor on duty will give all the information regarding the baby's health.
If the little one is hospitalized in intensive care, you will find a series of equipment that allows you to monitor the vital functions of the little one. In particular, three are highlighted for size and alarm systems: the incubator to heat it and to supply oxygen; the monitor to record vital signs (heart rate, respiratory rate, transcutaneous saturation to detect oxygenation through the skin) and the automatic respirator to support the baby in case of assisted oxygenation.

EXAMPLE OF A TYPICAL DAY IN NEONATOLOGY (source Carlo Poma Hospital of Mantua)
A department dedicated to intensive care such as that of the Carlo Poma Hospital never stops, perhaps slows down the activity, or rather tries to provide "cluster" treatments by carrying out several treatments at the same time in order to save energy to the child, disturbing him the least possible. The course of care is based on respecting sleep / wakefulness of the little patients, albeit the morning is the time when the main activities are concentrated.
By attending the ward, one immediately senses that each child needs special care, different types of assistance, and that some moments of the day involve the staff more.

Here is an example of how a typical day goes on inside the aforementioned hospital
1) Intensive Care
Morning:
- detection of vital parameters
- blood samples
- therapy administration
- administration of meals
- visit with the doctor
- updating of medical records
- preparation of the parenteral infusion.
Afternoon:
- detection of vital parameters
- therapy administration
- administration of meals
- nursing jobs
Night:
- detection of vital parameters
- baby bath
- therapy
- certain

2) Intensive Care
Morning
- baby bath
- detection of vital parameters
- therapy
- certain
- visit to the doctor
- folder update
- parenteral therapy
Afternoon
- detection of vital parameters
- therapy administration
- administration of meals
- nursing jobs
Night
- detection of vital parameters
- therapy
- certain
- nursing jobs

MORE FREQUENT EXAMS
I blood samples they are those that allow you to collect the greatest number of inherent information: hemoglobin, hematocrit, number and characteristics of white and red blood cells, the value of electrolytes such as sodium and potassium, calcium, creatinine, bilirubin, etc.
Blood gas analysis: it is a sample with which the quantity of oxygen and carbon dioxide present in the blood is determined and therefore helps to understand the respiratory function.
Blood culture (blood culture): detects the presence of any infections
Urine examination: research the dosage of various substances and the presence of germs (urine culture)
Radiographs: they are performed at the patient's bed with a dedicated device and visualize the conditions of the internal organs.
Eye exam: it is performed on premature babies (gestational age <32 weeks and weighing <1.500 kg at birth) after a few weeks of life and, if necessary, repeated until the retinal vessels have fully matured; it is also performed on those newborns in whom there is a suspicion of various other diseases.
Hearing exam: to premature newborns (gestational age <32 weeks and with weight <1.500 kg at birth) the acoustic evoked potentials are practiced, to all the other hospitalized the otoemissions.
Ultrasound: It is a technique that uses the echoes of sound to form two-dimensional images and painlessly evaluates the internal organs and the flow in the main blood vessels.
ECG: is a technique that allows to detect the functionality of the brain through the study of brain electrical activity. As a rule, premature babies need, in the first weeks of life, of continuous and repeated ultrasound checks, due to the high possibility of onset of cerebral hemorrhages due to the immaturity of the brain tissue and the fragility of the blood vessels.
Tac: uses small beams of X-rays that revolve around the baby, while a computer re-processes and constructs the images to visualize the internal structures of the body
MRI (Nuclear Magnetic Resonance): it is an examination similar to the previous one which is based on the interaction between a magnetic field and the atoms that make up the organism and which therefore does not use radiation. This examination allows to obtain very detailed images.

NEONATOLOGY AND PARENTS
The concept of "which".
Care means taking care of, promoting the well-being of the newborn, promote all the potential for physical, neurological and relational development, limiting the stress caused to the newborn by inadequate medical and nursing interventions.
In recent years, to this end, new methods have been developed for the care of newborns. Among these can be mentioned:
- containment at the nest: cotton sheets rolled into a sausage, to ensure that movements are more controlled, fluid and independent between the various parts of the body
- skin containment with rompers, caps, socks and blankets, with a stabilizing and relaxing effect
- kangaroo care (also called baby carrier), that is the contact between the newborn wrapped in a blanket and the bare chest of the parents, in order to favor the relaxation of the baby and also the mother's breastfeeding.

Furthermore, care also means promoting a macroclimate suitable for the newborn.
In this particular journey, parents are indispensable and an integral part of the ward. Because of this they can access the ward at any time of the day in order to allow them to take care of the child in the manner that will be suggested by the medical staff, based above all on the health of the child. The closeness of the parents will certainly serve the newborn but also the parents themselves.

HOW TO STAY CLOSE TO YOUR LITTLE ONE
When a premature baby is born the parents' dreams are abruptly interrupted: it is normal at first to feel amazed, disappointed, saddened or even angry. It can thus happen that the parents unload the anxieties on the health personnel who care for the child; so don't worry because this is quite normal. However, it is important to fight and try to constructively overcome this moment. The newborn is still extremely fragile, he needs the utmost attention from his mother and father as well as that of the staff who are in any case fully available to explain what is happening, trying to make parents as involved as possible.

Veronica Menozzi

Source: Intensive Care and Neonatal Pathology Operating Unit of the Carlo Poma Hospital of Mantua





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