NICU and Numbers

If you visit any neonatal unit in the country, by the side of each incubator or cot there will be an electronic monitor. The first thing you’d probably notice is that the monitors are almost constantly alarming; emitting electronic blips and beeps of varying volume and urgency.

These monitors show all sorts of different numbers, constantly displaying data that, when interpreted correctly can give us all kinds of information relating to the baby’s condition. They can show us that the  babies are comfortable and settled, that they’re uncomfortable or in pain, that something just isn’t quite right or that they’ve suddenly become critically ill.

Whenever a new baby is admitted and the parents have had some time to process the fact that their tiny, fragile newborn is sick I make sure that they have a basic understanding of what each colour number relates to, what the numbers actually mean and the limits we want the values to remain in and why.

Green is for heart rate.

Blue is for oxygen saturation.

White is for respiratory rate.

Yellow is for carbon dioxide output

Red is for blood pressure.

The majority of the parents don’t have any medical training or indeed any experience of hospitals but that doesn’t mean that they don’t have the right to try and understand what it happening to their baby. I try to keep my explanations basic but let them know that if they want more in-depth information I’m more than happy to help them.

I also tell them that, while the data the monitors give us is highly useful we don’t rely solely on the monitors to give us information and that sometimes the monitors alarm for completely benign reasons. These monitors are sensitive enough to pick up the baby’s heart rate and breathing, which means that they also pick up hiccups, sneezes, wind and all manner of other movements which the monitor can misinterpret. A baby creating the mother of all dirty nappies may well strain or hold their breath for a few seconds which is more than sufficient to set the monitor alarms off.

Therefore, I always tell parents that the most important indicator we have to assess the baby’s conditions is their appearance and how they’re behaving.

At least once per shift a monitor will alarm because it thinks the baby has stopped breathing. If you look the baby and they are pink and settled and obviously still breathing it is likely that they’ve just been taking quite shallow breaths and the monitor hasn’t picked them up. On the other hand if the baby is very still and grey or blue then clearly they are not breathing and the reason the monitor hasn’t picked up any breaths is because there aren’t any.

I try to remind parents of this when they become a bit fixated on the monitors and I appreciate that it’s a really easy thing to do. The different patterns and coloured lines are quite hypnotic and it can be really frightening when the monitor alarms and you don’t really understand why, especially when on some occasions staff check the baby and then silence the alarm and then on other occasions they start calling for help and the entire medical team come pouring into the room.

The parents of babies who stay on NICU for a long time often become quite adept and working out what the monitors are telling them and will often let us know if the alarm that has just gone off is alerting us to a genuine problem of whether the baby has just had a bit of a strop. These parents have learned to cope with life on NICU, taking all but the worst news in their stride and are managing to actually to set aside the noise, monitors, blood tests and medications and be parents instead of terrified onlookers.

At the other end of the spectrum are the parents who spend more time looking at the monitors than they do their baby. These are parents who have also been on NICU several weeks or even months but struggle to accept that, although their baby was critically ill, they are now on the road to recovery. When their baby was first born it is probable that they were prepared for the worst and even though the worst is no longer likely to happen they seem to struggle to move past that.

They visibly jump every time the monitor alarms and will often call two or three different nurses (and sometimes the doctors) over to the incubator because they don’t think we’re responding to the monitor appropriately. On more than one occasion I’ve had a parent refuse to hold their baby or have skin to skin time because they don’t believe us when we tell them that, even though the monitor has alarmed a few times their baby is honestly stable enough for cuddles.

I remember caring for a baby whose mother had an entirely unhealthy fixation with the monitor and would refuse to even look at her daughter if the numbers were ‘wrong.’ We’d tried again and again to explain to her that individual numbers don’t really tell us everything; that her daughter looked settled and comfortable and that the monitor can alarm from all sorts of things including hiccups to the fact that she just fancied a bit of a kick and wriggle.

I can still see the mum staring at the monitor, wringing her hands while her baby slept peacefully and her partner begged at her to ‘stop looking at the numbers and look at our daughter.’

The poor woman just couldn’t help herself, so frightened was she that her baby would die even though the baby was actually growing stronger every day. She tried to use the monitors as reassurance that everything was fine but more often than not would jump to the opposite (and incorrect) conclusion.

I have occasionally come across colleagues who try and prevent parents becoming fixated with the monitors by refusing to explain what the numbers mean, instead telling the parents that they will alert them if something happens to their baby. As far as I can tell the only purpose this witholding of information serves is to make the parents nervous and mistrustful of that particular nurse and that they will approach other nurses until they get the information that they need.

I try to put myself in the parents shoes and I know that I would be furious if Squidge was in hospital and the staff kept things from me, ostensibly for my own good. It’s hard enough being the parent of a sick child without feeling as though the staff who are supposed to help you are actually conspiring against you.

However, from a professional point of view I also have to make sure that I don’t give the parents too much information. NICU is a bewildering place to find yourself, with information pouring in from every angle and not enough time to process it and make sense of it all. The last thing I want is for something I’ve said to be misunderstood and cause to cause more distress.

It’s all about finding a balance…and learning not to jump out of your skin when the loudest and most obnoxious monitor screams ‘BEEP!!’ There’s nothing more unsettling to a parent than thinking you can see one of the nurses panicking.

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