The Lessons I Have Learned from NICU Families · 2020. 12. 4. · Anna Zimmermann, MD, MPH The...
Transcript of The Lessons I Have Learned from NICU Families · 2020. 12. 4. · Anna Zimmermann, MD, MPH The...
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Anna Zimmermann, MD, MPH
The Lessons I Have Learned from NICU Families
Disclosures
• I have nothing to disclose
• I have no financial incentives related to this talk
• All pictures included in this presentation are from NICU families who have
given written permission to Mighty Littles and Dr. Anna Zimmermann for use in media content and presentations.
Learning Objectives
• Describe two or more changes that can be made in your NICU routine to minimize miscommunication and improve consistency between care providers and families.
• List at least two key factors causing families anxiety at the time of discharge, particularly for the most medically fragile infants.
About me
MD, MPH
• Full-time clinical neonatologist in an 80-bed Level IV NICU
• In private practice for over 10 years
• International NICU experience
• Director of quality and education
for the NICU where I work
Anna ZimmermannMama
• Struggled with recurrent miscarriages and infertility.
• Mom of 3
• My babies were not in the NICU
• Preterm labor with both pregnancies
• Postpartum hemorrhage with both
pregnancies
• Complete failure with breastfeeding
• Children hospitalized 3 times
Anna Zimmermann
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Mighty Littles
• Started in 2020
• Initial idea was for the Mighty Littles
Book, currently in production stage
• Added a Podcast - now weekly
• Collaborations with parents,
physicians and organizations in the US, Canada, NZ, UK
• Commitment to share all NICU stories and up to date practical NICU education
Anna ZimmermannWhat you can expect from this talk
• Chronological order - before, during, and after NICU
• Personal stories from NICU families I have interviewed
• General themes of inclusion and communication run through nearly every interview
• What is next?
Outline
Prenatal Consults
• Facts…just the facts.
• Statistics only get you so far
• Universally, families want to be given
hope. And they will hold onto that hope no matter how small.
• Focusing on negative outcomes often does not change parental decision making, but can put huge barriers in place for forming trust and strong relationships
• “Won’t know til baby is born”
• Uncertainty and lack of control can feel
paralyzing for some families
Honesty is Key
It Won’t Be Us…Denial is a coping mechanism which allows families time to process what is coming at them.
The initial coping mechanism
• Keep taking bump pictures believing you will get to term
• Hearing outcomes about Congenital Diaphragmatic Hernia but believing it won’t be you
• Having your baby go for Body Cooling, but talking about the weather and what is on TV.
Denial
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Inclusion
Family description at admission
• Foreign and technical
• Intimidating
• Overwhelming sadness
• Total disconnect from reality
• Isolating and lonely
• Loud
The NICU is…
Don’t Touch!It is all in the messaging.
For Moms and Babies
• Connection and belonging
• Improved milk production
• Improved HR stability
• Improved temperature stability
• Improved CR stability
• Improved weight gain
Importance of Touch
Encourage
Hand Hugs
and
Head Hugs
Early
Canada & Uganda
Family Integrated Care in the NICU
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Shoulda, Coulda, Woulda
If Only….
Consensus / Communication
Home? Say What?
Family description at discharge
• Safe and secure
• Comfortable
• Supportive
• Family
The NICU is…
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Don’t Get Addicted to My Monitors!
Who You Gonna Call?
• Start early
• Define follow up
• Care coordinators - one call
point person after discharge
• Use personal equipment at hospital prior to discharge
• Opportunity to room in overnight
Discharge Planning
Community and Connection