Author: Caitlin Hartman
Published: Wednesday, November 16, 2011
"Sometimes", said Pooh, "the smallest things take up the most room in your heart."
A.A. Milne, Winnie-the-Pooh
November is “Prematurity Awareness Month,” a month dedicated to the awareness of a health crisis impacting millions of families worldwide. In the United States, 1 in 8 babies are born prematurely, before 37 weeks gestation. Worldwide, this number expands to include 13 million babies. This means too many babies are born before they are ready to make their entrance into this world, often without fully developed lungs or other life-threatening complications. While we still do not completely understand why premature births occur, some modifiable lifestyle factors have been identified which increase a woman’s risk. These include, but are not limited to, late or no prenatal care, drinking alcohol, smoking, illicit drug use, lack of social support, very high levels of stress, and long working hours with long periods of standing. In addition, a number of medical conditions, with important nutritional influences, have been identified to increase risk, including, diabetes, obesity, being underweight before pregnancy, high blood pressure and preeclampsia, short time between pregnancies, and clotting disorders (March of Dimes, 2011)
Earlier this week, I had the exceptional experience of visiting the neonatal intensive care unit (NICU) at a local hospital, which cares for many of these premature babies. From the second I walked through the doors I knew I had found my calling. It was evident the level of dedication, devotion, and love that was present. Every day, the physicians, nurses, and dietitians collaborate to develop or revise individualized plans for each small baby, whose needs are unique and ever-changing. Each room housed a tiny baby fighting for life. Many of the rooms were filled with parents and loved ones. Several of the mothers were cuddling their babies, providing physical touch and affection. Some of the parents were simply present. Others living hours away, count on the kindness of nurses and volunteers to hold and comfort their little ones. The parents of these infants face the road less traveled, with demanding emotional costs. They spend hours in the NICU away from their family and other children, struggling with the incredible expenses of NICU care, often feeling isolation, loneliness, and despair. One day the baby may be thriving and growing rapidly, while the next all hope seems lost. It was a moving experience to observe the miracles that occur in the unit daily. Specifically, to witness the survivability of babies less than 400 grams because of the quick decisions, experience, and skill of the medical staff. To provide a point of reference, 400 grams is equivalent to 2 medium-large apples, 1 ½ large baked potatoes, or a men’s size 9 running shoe. As these babies grow very quickly, optimal nutrition is remarkably important.
During my visit, there was one little baby born at 26 weeks gestation, just over 400 grams. It was incredible to see, such a tiny life. Ten tiny fingers and ten tiny toes. He was in a little incubator to help him regulate his body temperature with little goggles over his eyes. Because his lungs weren’t fully developed, he was on a ventilator to help him breathe. He was someone’s perfect miracle.
The NICU was a beautiful, cutting-edge facility. There was a small room overflowing with all of the stored mother and donor milk. Many of the mothers had accumulated an amazing supply of milk for their babies. Human milk is the optimal nutrition for both term and pre-term infants. However, sometimes mom’s milk may not be enough. Dietitians play a critical role in the NICU in helping to determine and meet the large nutritional needs of these tiny babies.
This experience was emotionally moving, motivating, and inspiring. As a pediatric intern, I look forward to learning how to assess a neonate’s nutritional status and needs, provide accurate and optimal nutrition intervention, and monitor and evaluate the tolerance of feedings, the adequacy of nutrition support, and proper growth and development to ensure the best chance at survival and the best life possible.