Top Care for the Tiniest Patients

With her March delivery date quickly approaching, Kendra Floyd was looking forward to delivering healthy twin girls. In mid-February, she visited her obstetrician, Dr. Daniel McDonald, for her regular check-up and received unexpected news.

"During the ultrasound both babies' heart rates looked normal, but Baby B wasn't moving enough," Kendra said.

Because Baby B's heart rate was slowing down, or decelerating, during a nonstress test, Dr. McDonald admitted Kendra to Missouri Baptist Childbirth Center and scheduled a cesarean section (C-section) to safely deliver the babies.

"I met my husband, Kennus, at the hospital," Kendra recalled. "I was nervous because this was my first C-section, and we were worried about the babies."

Dr. McDonald told the Floyds that the babies would be going to the NICU after delivery because they were just under 34 weeks gestation, and a team of NICU specialists would be in the operating room during delivery to immediately care for each baby.

When babies are admitted to Missouri Baptist NICU, families benefit from a special collaboration between the leading experts in premature and high-risk birth. As part of BJC HealthCare, the neonatologists and pediatricians in the NICU are from Washington University and St. Louis Children's Hospital, one of the top pediatric hospitals in the country. These doctors and the NICU staff work together, providing patients and families with an unmatched quality of care right at Missouri Baptist.

"When patients and families come to Missouri Baptist, they have all the advantages of a large academic medical center, but in a hospital setting with a family atmosphere," said MoBap Director of Women and Infants, Pam Brouder RN, MSN, NE-BC.

Before surgery, a NICU neonatologist visited with Kendra and Kennus to discuss what would happen after delivery. "The close communication between obstetricians and neonatologists about high-risk deliveries helps us prepare the NICU team, as well as parents," neonatologist Dr. Jeffrey Dawson explained.

"Neonatologist Dr. Brittany Blue met with us and explained what the NICU specialists would do in the operating room," Kendra said. "She also described how the babies' heart rates, breathing and feedings would be monitored in the NICU."

ADVANCED MEDICAL CARE

Comparing the C-section to her previous deliveries, Kendra said, "the C-section was fast. Khori delivered first at 2:16 p.m., weighing 4 pounds, 15 ounces. Kaila was born at 2:18 p.m., weighing 5 pounds, 9 ounces."

Three hours after her surgery, Kendra and Kennus visited the NICU to see their daughters, meet the NICU team and ask questions.

"One of our first jobs is to help parents understand their newborn's condition and reassure them that our medical team is going to help and support them every step of the way," Dr. Dawson said.

"When I first saw Khori and Kaila they were in isolettes, or beds covered by plastic hoods," Kendra recalled. "They needed help breathing, had tubes in their noses for feedings and cables hooked to them to monitor vitals. The nurses and doctors told us how our daughters were doing and explained the purpose of the equipment and monitors," she continued. "I was able to reach my hands through the holes on the side of the beds and touch our babies for the first time."

While she was in the hospital, Kendra was just down the hall from the twins and the NICU specialists, which made bonding and visiting easy. "Once I was settled in my private room, I could visit Khori and Kaila whenever I wanted," Kendra said. "I was able to hold, feed and help care for them."

"It's our goal to keep moms and babies together as much as possible for bonding," said NICU nurse manager Cindy Weishaar, RN, BSN, referring to the proximity of the postpartum and NICU rooms and parental visiting hours.

Even though they visited frequently, the Floyds found it difficult to see their children hooked to monitors and hear alarm bells go off.

"Whenever the monitors would alarm, I always wondered what I was doing wrong," Kendra said. "But the NICU team was there to reassure us that everything was okay."

GROWING & DEVELOPING

Khori and Kaila gained strength as they developed and graduated from the isolettes to infant warming beds, and their oxygen was removed when they could breathe without support.

Feeding and eating were obstacles that both Khori and Kaila faced. To address the twins' eating challenges, the NICU introduced the Floyds to a team of occupational therapists who specialize in newborn development.

"The therapists helped Khori and Kaila develop feeding skills," Kendra said. "Because she was smaller, Khori took longer learning how to eat, but the therapists monitored her to make sure she was getting mouthfuls of nourishment, was breathing properly and wasn't pausing when eating."

Kendra turned to the lactation consultants for breastfeeding support. Even though this was not her first time breastfeeding an infant, Kendra acknowledged that with twins in the NICU "it's different. There are two mouths to feed, and I didn't know the best way to feed premature babies or how to build my milk supply."

The lactation consultants offered advice on pumping, breastfeeding and nipple care that Kendra found helpful. "Not only was I able to breastfeed both girls in the NICU, I also pumped breast milk to feed them by bottle or for the nurses to give them through the tube," Kendra said. "How much they ate was closely monitored. If they weren't getting enough by mouth, their intake was supplemented with my breast milk or donor breast milk through the tubes in their noses."

BRINGING BABIES HOME

The length of time infants stay in the NICU varies. Usually premature infants stay until the time of their full-term due date. Khori and Kaila stayed in the NICU for a month, one week shy of Kendra's original March delivery date.

To help prepare the Floyds for bringing the twins home, the NICU team provided teaching sessions, handouts and videos. "We felt ready to bring the girls home," Kendra said. "All of our questions were answered, and we watched videos on how to perform CPR and putting infants in car seats. We also talked about feeding, as well as growth and development milestones."

Kendra and Kennus are happy to have Khori and Kaila home, and their two older sons, Kiyan (seven) and Kyren (three), are adjusting quickly. "They are already protective big brothers," Kendra said with a proud smile. "Having everyone home is a blessing, and we thank MoBap and the entire NICU team."

CONTINUED SUPPORT

After NICU patients and families leave the hospital, Missouri Baptist provides continued support. "Now that we're home," Kendra said, "a feeding consultant is coming to our house to discuss feeding schedules and make sure that the girls are doing well with breastfeeding."

With their NICU experience behind them, Kendra advises other families going through a similar experience to "be patient, stay calm and don't rush the process. Even though you want your child at home, a premature baby has special needs, and the staff at MoBap NICU is going to give them the best care to help them grow and develop."

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