Amelia’s NICU Stay

As some of you know already or have seen in the pictures, Amelia had a stay in the Neonatal Intensive Care Unit (NICU) at INOVA Fairfax Hospital after she was born. We wanted to let you know why she was there, and put to rest any fears you may have upon first hearing about it.

When she was born, Amelia had a little bit of trouble breathing as regularly and as deeply as the nursing staff would have liked. As the nurses worked through getting her washed, weighed, and measured, they kept trying to get her to breathe a little more deeply. Eventually, they put a small sensor on one of her feet which provided an oxygen readout and an estimate of Amelia’s red blood cell count. Apparently, her oxygen levels looked pretty good but her red blood cell count was low.

Geitra, Neil, and Amelia shortly after her birth.About this time, we also noticed a bit of a contusion on the back of Amelia’s head – she had a fairly large buildup of fluid, probably blood, in between her skin and her skull that was about two inches long and one inch wide. Somewhere around this point, nurses from the NICU were called to come up and examine Amelia, and shortly thereafter, the neonatal night physician. They discussed their concerns with us and said that they wanted to take her down to NICU for observation. The doctor noted that the contusion was somewhat common and probably nothing to worry about, but coupled with the extra work Amelia was doing to breathe and the low red blood cell count, the NICU was the best place for her to be in order to be closely monitored. So they bundled her up in her little hospital blanket and hat, gave us some time together for pictures, and then I followed the nurses as they went down to admit Amelia to the NICU while Geitra stayed in her room to recover a bit more.

My first thoughts on getting into one of the NICU wards was, “My God, how do these people work here?” The ward had about 10 or 12 different bays, with tons of monitoring equipment, IV pumps, isolettes, open warmers, and other critical equipment all around. Amelia’s ward probably had about eight other babies there, and oh my goodness, were they tiny. Some nurses were doing little body massages for the preemies through gloves built into the warmers; others were feeding their patients; and still others were just taking care of different record-keeping and monitoring duties. Into this scene of incredibly dedicated people doing what has to be some of the hardest work in the hospital our baby girl was admitted.

It was kind of tough to keep my mind on everything that I was being told at this point – hours the unit was open, the fact that they may need to put Amelia on oxygen and/or antibiotics depending on what the doctor wants to do, and the invitation to come back down to visit her pretty much whenever we wanted. It was even tougher to have to turn around and leave my new baby girl behind and go back upstairs to make sure Geitra was doing OK, and was informed about what was going on – I mean, we’d been parents for all of about two hours now, and here we had our first medical emergency and had been separated from our daughter. We just had to trust that the hospital staff knew what was best.

Neil and Amelia in the NICU.I went back upstairs to Geitra’s room, where we spent an hour or so together before they were able to move her to a private post-partum room for the two nights we’d be staying at the hospital for her recovery. I let her know what the situation was downstairs in the NICU for Amelia, and after a little bit the NICU night doctor came upstairs to let us know that they had gone ahead and ordered a CAT scan for Amelia to take a close look at the contusion on her skull and make sure it wasn’t anything dangerous. As far as they could tell, it wasn’t – but they also found a small subarachnoid hemorrhage (bleeding between the inside of her skull and her brain) with the scan. The doctor noted that this would need to be confirmed later in the day by the pediatric radiologist, but that this was probably also a fairly common occurrence – just not often recognized since newborns aren’t routinely CAT scanned – that should resolve itself normally.

After the discussion with the doctor and getting Geitra settled in to her new room, I went back down to the NICU to see Amelia again. By this time, they had gotten her hooked up to an EKG, a temperature sensor for the warmer, an IV for nutrients, and an oxygen cannula to help ease the effort to breathe. It was nerve-wracking to see her little body hooked up to so much equipment, but she seemed pretty calm over all. I spent some time talking to her nurse and the doctor to understand exactly what her situation was, and then was able to sit down in a rocking chair and hold her for about half an hour. Wires, tubes, and all – it was amazing to really hold my baby girl for the first time.

Geitra holiding Amelia in the NICU.I finally got back upstairs to Geitra at about 4:30AM or so, and we talked just a little bit about how Amelia was doing before we collapsed to get a couple hours’ worth of sleep. Her nurse woke us up around 7AM to get her vital signs and everything, and we prepared to head down to the NICU together. We got there around 8:30AM, and were pleased to discover that Amelia had already made some improvement – they had dialed back on the oxygen they were giving her to be the same as normal room air, so all they were really doing was giving her a little extra pressure. The contusion on the back of her head was also starting to shrink. We spoke with the nurses a bit, and took turns holding her for an hour, snapping pictures as we went. After that, we needed to let her get some rest—but started our pattern of visiting Amelia every three hours or so in order for her to start nursing and get weaned off of the nutritional IV.

Things progressed quickly over the next couple of days. A pediatric neurologist did an assessment of Amelia on Wednesday, looking at the CAT scans and doing a physical exam, and assured us that she will probably have no long-term impacts from any of the symptoms she exhibited after her birth. He ordered a follow-up CAT scan for Friday morning to make sure that the intracranial bleed wasn’t getting any larger—this meant that Geitra would be going home one day earlier than Amelia was likely to be released from the NICU, but having the assurance of the follow-up scan was a good thing.

Amelia in her NICU isolette.Amelia’s oxygen cannula had been removed late in the day on Tuesday, and the NICU staff moved her to a closed isolette (think “incubator” and you’ll have the right image) to give her some additional privacy. This also allowed the nurses to make sure Amelia was controlling her own body temperature. Amelia was introduced to her Nana and Papa Snider (Geitra’s parents) on Wednesday as well when they came to visit the hospital, and she was successfully taken off of her IV and moved to a “step down” ward late that evening. In this ward, normally used for patients that would be leaving NICU soon, Amelia was just resting in an open-air bassinette like she would have been using in a normal hospital nursery. The Sniders visited her again on Thursday before they headed back home to Ohio, and Geitra was discharged Thursday evening with a promise that Amelia should be able to come home on Friday assuming her CAT scan results were good.

Friday went quickly and slowly, all at the same time. We got to the NICU around 8AM, but had to wait until 8:30AM to get in and see Amelia. The nurse who was taking care of her that day was hyper-efficient, and was already calling Radiology in order to get the CAT scan taken care of as soon as possible. She was quite successful, since Amelia was being wheeled down to radiology before 10AM. The scans were done, and the neurologist came down to look at the results around 11AM – and happily, he declared that the internal bleed was already starting to dissipate and that Amelia could go home as soon as the NICU doctor did a final exam. That took a little bit, since the doctor was busy with more-urgent cases, and then got called away to an emergency delivery while she was writing up the final notes in Amelia’s chart. By about 3PM, we started changing Amelia into her “going home” clothes and putting her into her car seat for the very first time.

Amelia in her car seat, ready to go home for the first time.The drive home went well, with Amelia sleeping quietly in her car seat for most of the trip. It was wonderful to finally introduce her to her new home, her nursery, and her dog – yes, Maggie was quite gentle when we introduced them to each other! We treasure the “first of the firsts” we had together that day – and we look forward to all the “firsts” to come.

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