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The best chance of life: stories of hope in the neonatal unit The best chance of life: stories of hope in the neonatal unit
(7 months later)
Inside one of Britain’s busiest specialist neonatal units, Michelle Waters is bending over an open cot, her hand gently resting on her sleeping baby, Myia, who was born after 25 weeks – 15 weeks early – weighing a pound and a half (700g).Inside one of Britain’s busiest specialist neonatal units, Michelle Waters is bending over an open cot, her hand gently resting on her sleeping baby, Myia, who was born after 25 weeks – 15 weeks early – weighing a pound and a half (700g).
Waters, who has three boys at home in Southend, Essex, was transferred to Homerton University hospital in Hackney, London, for delivery, as the hospital specialises in extremely premature babies, accepting newborns from 23 weeks into pregnancy. Southend University hospital has a neonatal unit, but takes only babies older than 27 weeks.Waters, who has three boys at home in Southend, Essex, was transferred to Homerton University hospital in Hackney, London, for delivery, as the hospital specialises in extremely premature babies, accepting newborns from 23 weeks into pregnancy. Southend University hospital has a neonatal unit, but takes only babies older than 27 weeks.
“In the beginning, we were very worried,” says Waters, 31. “She was in intensive care for weeks and our main concern was whether her little lungs would cope. She’s still on 30% oxygen and they said we might need to take oxygen home with her, but she’s good. Now it’s all about getting her into a feeding routine. The staff here have been brilliant.”“In the beginning, we were very worried,” says Waters, 31. “She was in intensive care for weeks and our main concern was whether her little lungs would cope. She’s still on 30% oxygen and they said we might need to take oxygen home with her, but she’s good. Now it’s all about getting her into a feeding routine. The staff here have been brilliant.”
Every six minutes, a baby in the UK is born too early, too small or too sick to enjoy the immediate comfort of its mother’s arms. Instead, these vulnerable infants are whisked away to spend their formative hours, weeks or even months in plastic incubators, their tiny bodies hooked up to monitors in special units where, in some cases, their treatment can determine their very survival.Every six minutes, a baby in the UK is born too early, too small or too sick to enjoy the immediate comfort of its mother’s arms. Instead, these vulnerable infants are whisked away to spend their formative hours, weeks or even months in plastic incubators, their tiny bodies hooked up to monitors in special units where, in some cases, their treatment can determine their very survival.
Seven years ago, my twins arrived six-and-a-half weeks prematurely, an event that plunged our brand new family into a bewildering world of ventilators, nasal feeds and “kangaroo care”, where, it turns out, tucking your tiny naked scraps of humanity under your shirt for hours each day helps them grow and bond, a process that can suffer in a hospital environment.Seven years ago, my twins arrived six-and-a-half weeks prematurely, an event that plunged our brand new family into a bewildering world of ventilators, nasal feeds and “kangaroo care”, where, it turns out, tucking your tiny naked scraps of humanity under your shirt for hours each day helps them grow and bond, a process that can suffer in a hospital environment.
Compared with many very sick babies around us, ours were lucky. My daughter, the smallest, at a little under four pounds, spent less than a day in intensive care. The twins were in the unit for less than three weeks, mainly for the sucking reflex to kick in and for weight gain.Compared with many very sick babies around us, ours were lucky. My daughter, the smallest, at a little under four pounds, spent less than a day in intensive care. The twins were in the unit for less than three weeks, mainly for the sucking reflex to kick in and for weight gain.
They were also fortunate to be born at Homerton, a hospital with a busy, highly regarded neonatal unit, where the chances of survival, especially for extremely premature babies, are higher than the UK average. The care reflects pioneering advances in this specialised field.They were also fortunate to be born at Homerton, a hospital with a busy, highly regarded neonatal unit, where the chances of survival, especially for extremely premature babies, are higher than the UK average. The care reflects pioneering advances in this specialised field.
I can still recall my rising panic, just over halfway through my pregnancy at 23 weeks, when my obstetrician warned me to rest, as “twins are likely to be born early”. She ticked off on her fingers the pitiful statistics: “If born today, they’d have an 11% survival, 26% if born next week, or 44% if born at 26 weeks.” Each was accompanied by an equally frightening statistic for likelihood of disability.I can still recall my rising panic, just over halfway through my pregnancy at 23 weeks, when my obstetrician warned me to rest, as “twins are likely to be born early”. She ticked off on her fingers the pitiful statistics: “If born today, they’d have an 11% survival, 26% if born next week, or 44% if born at 26 weeks.” Each was accompanied by an equally frightening statistic for likelihood of disability.
But, even over the past few years, advances in neonatal care means more early babies – a population that is rising – are surviving. A baby born today after 23 weeks, has a 29% chance of making it, a week later, the survival rate rises to 47% and at 25 weeks, it has a 69% chance. The latest figures, from the 2012 Homerton-run EPICure study, also show a rise in the number of premature infants who make it to age three without a disability.But, even over the past few years, advances in neonatal care means more early babies – a population that is rising – are surviving. A baby born today after 23 weeks, has a 29% chance of making it, a week later, the survival rate rises to 47% and at 25 weeks, it has a 69% chance. The latest figures, from the 2012 Homerton-run EPICure study, also show a rise in the number of premature infants who make it to age three without a disability.
Last week, I returned to the unit where my twins spent the first three weeks of their lives, to find out why premature babies’ chances of survival have improved and how staff are coping with the rise in numbers.Last week, I returned to the unit where my twins spent the first three weeks of their lives, to find out why premature babies’ chances of survival have improved and how staff are coping with the rise in numbers.
A decade ago, for instance, Myia’s chance of survival would have been less than 50%. Today, it is 69%. Now at 36 weeks, she is 4lbs and thriving, having had her first bottle feed that morning.A decade ago, for instance, Myia’s chance of survival would have been less than 50%. Today, it is 69%. Now at 36 weeks, she is 4lbs and thriving, having had her first bottle feed that morning.
Related: Mothers of premature babies also need care – as I know too well | Joanna Moorhead
“Hers is an amazing story,” Zoe Smith, lead consultant neonatologist at Homerton’s NICU (neonatal intensive care unit), says, talking about Waters, 31. “Her waters broke at 19 weeks. Normally, if a baby doesn’t have the fluid around it, it is more physically squashed and the lungs don’t mature, they can be stunted, so when they are born they can’t supply the oxygen they need. That baby has done remarkably well.”“Hers is an amazing story,” Zoe Smith, lead consultant neonatologist at Homerton’s NICU (neonatal intensive care unit), says, talking about Waters, 31. “Her waters broke at 19 weeks. Normally, if a baby doesn’t have the fluid around it, it is more physically squashed and the lungs don’t mature, they can be stunted, so when they are born they can’t supply the oxygen they need. That baby has done remarkably well.”
With such fragile patients, Smith says, there is a trade-off between the treatment they need to survive and what their tiny bodies can withstand. Neonatologists have come up with a method of ventilating babies such as Myia with underdeveloped lungs, called high-frequency oscillation.With such fragile patients, Smith says, there is a trade-off between the treatment they need to survive and what their tiny bodies can withstand. Neonatologists have come up with a method of ventilating babies such as Myia with underdeveloped lungs, called high-frequency oscillation.
Using pistons to deliver shorter bursts of oxygen, it is less damaging to her tiny lungs than other methods of ventilation such as continuous positive airways pressure – given to less premature babies, including my daughter. Premature babies treated with high-frequency oscillation, nicknamed “the wobble” because it makes babies shake, have been shown to have better lung function as adolescents.Using pistons to deliver shorter bursts of oxygen, it is less damaging to her tiny lungs than other methods of ventilation such as continuous positive airways pressure – given to less premature babies, including my daughter. Premature babies treated with high-frequency oscillation, nicknamed “the wobble” because it makes babies shake, have been shown to have better lung function as adolescents.
Admissions to the unit have risen by 50% over the past seven years, from 620 in 2008 to 924 in 2015, and the cot capacity has gone up from 31 to 46 in the same period. About 10-12% of admissions are between 23 and 25 weeks.Admissions to the unit have risen by 50% over the past seven years, from 620 in 2008 to 924 in 2015, and the cot capacity has gone up from 31 to 46 in the same period. About 10-12% of admissions are between 23 and 25 weeks.
Critical neonatal advances in recent decades include giving steroids to mothers-to-be in order to boost a premature infant’s lungs before birth. Another development, used at Homerton, is the use of a “cooling suit”, which improves brain function and reduces the chance of oxygen-deprived infants having cerebral palsy and other disabilities.Critical neonatal advances in recent decades include giving steroids to mothers-to-be in order to boost a premature infant’s lungs before birth. Another development, used at Homerton, is the use of a “cooling suit”, which improves brain function and reduces the chance of oxygen-deprived infants having cerebral palsy and other disabilities.
As we tour the unit, it is clear fine-tuning goes on all the time.As we tour the unit, it is clear fine-tuning goes on all the time.
Inside their incubators, the infants look cosier than I recall, enclosed in little “nests”, which aid development. A few have hand-knitted or brightly coloured blankets on top, to keep light out. There is less noise too, after studies revealed the harmful effect of sounds such as an incubator door shutting. The unit is very quiet, save for the hum and bleeps of monitors.Inside their incubators, the infants look cosier than I recall, enclosed in little “nests”, which aid development. A few have hand-knitted or brightly coloured blankets on top, to keep light out. There is less noise too, after studies revealed the harmful effect of sounds such as an incubator door shutting. The unit is very quiet, save for the hum and bleeps of monitors.
However, like elsewhere in the NHS, the unit has its challenges, of nurse shortages and more demand than it can safely supply. A 2015 report by Bliss, the premature and sick baby charity, found 64% of neonatal units did not have enough nurses to meet British Association of Perinatal Medicine standards, for instance a ratio of one nurse for every baby in intensive care. It also found 65% did not have sufficient nurses with a specialist qualification in neonatal care and that 70% treated more babies than was recommended.However, like elsewhere in the NHS, the unit has its challenges, of nurse shortages and more demand than it can safely supply. A 2015 report by Bliss, the premature and sick baby charity, found 64% of neonatal units did not have enough nurses to meet British Association of Perinatal Medicine standards, for instance a ratio of one nurse for every baby in intensive care. It also found 65% did not have sufficient nurses with a specialist qualification in neonatal care and that 70% treated more babies than was recommended.
Homerton’s nurse to baby ratios vary: commonly 1:2 in intensive care, but with “1:1 for a very sick baby”, according toSmith. The unit has some vacancies, but is trying to make up the shortfall with agency and other nurses. It trains about 10 new neonatal nurses a year.Homerton’s nurse to baby ratios vary: commonly 1:2 in intensive care, but with “1:1 for a very sick baby”, according toSmith. The unit has some vacancies, but is trying to make up the shortfall with agency and other nurses. It trains about 10 new neonatal nurses a year.
Related: NHS neonatal intensive care units 'stretched to breaking point'
In a staff room, we meet Dr Narendra Aladangady, a consultant neonatologist and researcher whose quick smile and easy manner I remember from 2008. Told of a parent who is keen to speak to him, he exchanges glances with Smith and I guess a difficult conversation lies ahead. Not all babies do well and it is part of a consultant’s job to deliver bad news.In a staff room, we meet Dr Narendra Aladangady, a consultant neonatologist and researcher whose quick smile and easy manner I remember from 2008. Told of a parent who is keen to speak to him, he exchanges glances with Smith and I guess a difficult conversation lies ahead. Not all babies do well and it is part of a consultant’s job to deliver bad news.
Aladangady, who is near the end of his shift, looks at his colleague with a rueful grin: “Zoe, you know I really thought I would leave on time tonight.”Aladangady, who is near the end of his shift, looks at his colleague with a rueful grin: “Zoe, you know I really thought I would leave on time tonight.”
Before heading back into the unit, Aladangady looks reflective for a moment, no doubt preparing for the task ahead. “You know if I were in their shoes …” he says, placing his hand on his heart in a poignant gesture that completes his unfinished sentence. “How difficult is it when your baby is not doing as well as expected? It’s hard.”Before heading back into the unit, Aladangady looks reflective for a moment, no doubt preparing for the task ahead. “You know if I were in their shoes …” he says, placing his hand on his heart in a poignant gesture that completes his unfinished sentence. “How difficult is it when your baby is not doing as well as expected? It’s hard.”
Two noticeboards full of images of beaming, healthy children and messages to staff on the unit’s wall, serve to give voice to those whose babies have thrived and hope to those who are still struggling with an anxious and uncertain future. One message reads: “Austin and Freddie will never forget you as mummy and daddy won’t let them! Homerton NICU we love you, Bradley, Charlotte, Austin and Freddie.”Two noticeboards full of images of beaming, healthy children and messages to staff on the unit’s wall, serve to give voice to those whose babies have thrived and hope to those who are still struggling with an anxious and uncertain future. One message reads: “Austin and Freddie will never forget you as mummy and daddy won’t let them! Homerton NICU we love you, Bradley, Charlotte, Austin and Freddie.”