A Small Baby Unit in our Neonatal Intensive Care Ward
A preterm baby is prematurely “extracted” from its mother's protective and enveloping womb. While inside the womb, the baby is surrounded by darkness and the sound of the mother's heartbeat and is shielded from the pull of gravity. At premature childbirth, the baby suddenly emerges into a bright and noisy environment with unfamiliar smells and tastes, is separated from the mother and subjected to the overwhelming touch of many hands, and suffers continuous pain from dozens of life-saving medical procedures, all of which create a chaotic and stressful experience unsuitable for the newborn’s level of development – and which may have permanent impact on its development. Studies show that after leaving the neonatal unit, which may take many weeks from childbirth, the traumatic experiences the baby had experienced in the unit leave their mark on its developing brain and have a decisive effect on the child’s development for the rest of its life.
Shamir Medical Center’s Neonatal Intensive Care Ward cares for some 850 newborns every year, 120 of who are born preterm with very low birth weights (the tiniest of them weighed just 330 grams at birth). In cases of extreme prematurity, a baby may be hospitalized for many months, a period during which the premature babies struggle to survive – and parents struggle to cope.
Based on data from developed nations, including Canada, Sweden, and Japan, the survival rates of premature babies in Israel are among the lowest, while the risk of sustaining serious brain injury – one that is associated with mental retardation, cerebral palsy, severe learning disabilities, and a general impairment in the quality of life – is among the highest.
Improving premature babies’ chances
The Shamir Medical Center’s Neonatal Intensive Care Ward, headed by Prof. Iris Morag, applies a unique, groundbreaking approach, which recognizes the importance of the very early life experiences and their effect on the development and future of each baby. We advocate a “minimum invasiveness, maximum sensitivity and gentleness” approach towards the baby and parents. According to this approach, every event is registered in the young brain, and has potential future significance. The provided care is thus calculated and precise, not just at the medical level, but also emotionally – aiming to minimize adverse experiences (pain, noise, light, disconnection) and, as much as possible, simulating the conditions of the womb. According to the developmental approach, adjustments should be made to the premature baby’s changing needs and different stages of development.
Providing parents with constant support is an integral part of care at the ward. In the face of their great emotional hardship, we strive to empower parents, by encouraging them to take an informed an active part in their child’s care, from the very first and frightening moment. We see parents as important and equal partners in all treatment and decision-making. This is a complex, sensitive, and unconventional issue in intensive care, and our teams regularly undergo unique training to be able to best address it. Our groundbreaking efforts in the area of humane and inclusive neonatal care have led, for the example, the Shamir Medical Center to be one of the world’s first to allow and encourage parents’ physical presence during the initial Covid wave. Unlike other hospitals, we refused to close the Neonatal Unit to parents as most – eventually, the pivotal importance of this matter was widely understood, leading all neonatal units to do the same.
Efforts to reduce the risks of premature birth include advanced medical instrumentation, highly skilled professional teams, and organizational processes – but must also encompass a therapeutic environment tailored to the special needs of the neonatal unit. Thanks to this unique approach, we have reduced brain damage rates from 25% to 8% in 2021; however, to significantly increase preemies’ chances of survival and improve their quality of life, an upgrade of the care environment is urgently needed.
The main obstacle: An unadjusted therapeutic environment
The existing therapeutic environment is a significant obstacle. The Neonatal Intensive Care Ward was established 25 years ago, and our tiny patients are hospitalized in large and crowded halls (12-18 babies per hall). The halls afford no privacy and the individual baby’s environment cannot be adjusted (in terms of noise and light levels, as well as movement and activity around the child). Parents witness overwhelm sights that may cause them to disconnect, and as a result, often suffer from anxiety, depression, and even post-traumatic stress – all, at a time when their children most need them to be healthy, strong, and optimistic.
Our vision: A “small baby unit” – a calm and supportive environment for babies and their parents
Our solution to these challenges is to establish a special unit dedicated to babies born in the earliest weeks and whose hospitalization conditions are critical for their future development. Similar units, in which premature babies are hospitalized together with their parents in rooms that provide privacy and are adjusted to individual needs, have emerged elsewhere in the world.
Establishing the advanced unit will position the Shamir Medical Center at the forefront of global neonatal care and will facilitate healthier and happier lives for both babies and families, for years to come.
Simulations in medicine have been proven to improve key skills and communication abilities among medical staff, and lead to better care. Therefore, within the Small Baby Unit, we plan to designate a special area for simulations. Our Neonatal Intensive Care Ward has a state-of-the-art simulator, where medical teams undergo simulations on a weekly basis. The simulation room will enable watching the teams in training, filming the process, and will include a study and discussion area.
Photo credit: Doron Horowitz