Play in NICU (click here to read more)

The play is defined as any kind of freely chosen activity, intrinsically motivated, and personally directed. It is vital for physical and motor development, but also social, emotional and intellectual development.

Play in NICU might be challenging due to baby`s clinical state, which might not be suitable for doing some activities; due to distracting noises, the equipment connected to the baby, the regular procedures that the baby is undergoing or lack of space for keeping the toys. In our case, the play was an issue because Aurora and Victoria had chronic lung disease and they used most of their energy on breathing. However, we tried to stimulate them in a way that wasn’t too demanding and stressful for them.

Apart from talking and singing to them whenever it was possible, we made sure they also had the toys that were suitable for their age and also, recommended by the play therapist and occupational therapist — for example, sensory lights or musical instruments. We even used an application on the telephone for visual stimulation.

Aurora playing with the sensory lights provided by the hospital.

Our play sessions in Nicu represented a great time to bond with the girls, to see their psychological progress and to share smiles, which we enjoyed a lot. If the girls were awake at the same time and in a good mood, we use to put them together on a play mat and observe them, making sure the water from the tubing that belonged to the breathing machine, was not going into their nose.

Aurora and Victoria playing together

Sometimes, we use to put them next to each other in their bouncing chairs and entertain them by playing peek-a-boo, reading a story or show them different toys. We used to facilitate play by putting the girls in a comfortable position, for example making rolls for their head, so they felt their head safe, which also helped with the correction of their head shape. As you know, babies are at risk of plagiocephaly, because of their relatively soft skull.

Play session in NICU

When on the play mat, we use to roll a towel and put it around them to encourage movement, bringing hands together or touching their feet. In term and healthy baby, these things happen naturally, and the parent notices his baby already rolling over and putting his feet in the mouth. A premature infant instead, needs help with the smallest things to build up his mobility, strength and confidence, and play represents the best way to achieve these things.

Once Maria was allowed to visit her sisters, she used to bring her toys so they could play with them and to pretend to be a doctor and treating them. It was fascinating to see how play connects the children and helps them communicate. When she was around, Aurora and Victoria kept watching her and smile, showing they loved her presence.

Maria playing with Victoria

It is important to know that a premature or sick baby has his rhythm to play and parents should respect that and follow it, to make sure the baby is not overstimulated and distressed. Whenever the baby looks overtired, or I pain, he should receive the opportunity to rest and recover, until he shows he is ready to play again. Aurora and Victoria as well, had days when they just wanted to sleep, to be held, and not being interested in any toy or activity and we just listened to them.

Aurora had a period when she was continuously fed via an NJ tube because she got stuck from the breading point of view and doctors considered it would help her lungs if her tummy was empty and the possibility of vomits was reduced, which prevented the aspirations to her lung. The insertion of the NJ tube required a lot of attention, ability, and an X-ray to make sure it is in the right place. During that period, we have been extremely cautious with the way we moved or let Aurora play because nobody wanted her NJ tube to come out, and restricted at the same time by the feeding pump that was pushing the milk.

Aurora having Nj tube.

In conclusion, play in NICU is crucial, although sometimes it is so difficult to achieve. I found it upsetting and stressful to take care of so many tubes and wires; to make sure I do not pull something or harm the girls. I dreamt to the day when I could run in the park with them, let them roll over and lift them to the sky, without any restraint, without any impediment. I desperately wished that freedom, and when it came, it was such a relief.

Thank you for reading!

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Breastfeeding in NICU

Mother`s milk is like a “magic potion” that has a significant effect on baby’s immune system and development. It also represents the best way for a mother to transmit her love to the baby, to bond and to soothe him.

When a baby is born prematurely, a lot of these things change. The mother does not have the opportunity to put her baby to the breast, but instead, the baby is fed through a tube with a syringe. In my case, soon after Aurora and Victoria were born, I was given a syringe and asked to express by hand. I did not understand why it was like that, so I asked, and the midwife told me that in the first days after delivery, the quantity of milk is minimal. Therefore, expressing with a pump might make the precious drops colostrum, rich in vitamins and minerals, to get lost in the tubing of the expressing kit. I followed the instructions, and I regularly expressed to stimulate the lactation. Some moms with premature births might struggle because their body is still not ready for this step.

Expressing by the pump was such hard work. It was sorrowful not to have the girls at my chest. So what I did, was to take something that belonged to them, a muslin for example, and had it close during the expressing sessions. That was helping to stimulate the milk production. Some moms might try to look at the pictures with their babies. I was not able. Whenever I tried, I ended up crying seeing them so little and sick.

Victoria fed by her dad with the syringe

To be able to feed himself, a baby needs to synchronise the sucking, swallowing and breathing. This happens after week 32 of gestation and even later if the infant is facing breathing issues. Aurora and Victoria were fed by UVC and IV in the first days, and OG and NG tubes, once they were able to receive the milk I was expressing for them. It took a long time for them to have the tube out due to the respiratory support they needed.

Victoria being fed by UVC and IV in the first days.

Aurora fed by UVC in the first days

At UCLH, I use to express in the expressing room. There was space for four moms at a time, and usually, we use to share our stories and struggles and encourage each other. More common questions were: ”At how many weeks was your baby born?”, ”Do you have other kids?”, ”What do you do to produce milk?”, ”For how long are you in NICU?”. All the expressing kits were for one use only. That was to reduce the spread of possible infections. The pump was cleaned before and after use by the moms, and every day by the staff of the hospital. Nonrecyclable bottles were provided, and the milk was kept in the hospital’s fridge, labelled with the name and the expressing date and hour. The nurses use to keep the amount of fluid necessary to feed the babies in the refrigerator that was in the nursery, and the rest of the amount was stocked in the freezer.

Once transferred to Whittington Hospital,  Aurora and Victoria were put in the isolation room because of the virus they had, CMV. I use to express in the same place. There was a pump only for me and bottles at discretion. Also, I had the opportunity to sterilise the kits.

At home, I expressed with a manual pump, filling the bottles from the hospital. Because I had much milk, I use to put it in the freezer. The bottles were taking much space, and I also used the milk bags, easy to find in any pharmacy. The milk can stay frozen for six months at home, and three months at the hospital. I manage to produce it for almost, four months, for both Aurora and Victoria. Maybe I could do more, but travelling to the hospital, being under pressure and stressed all the time, waking up during the night, use to make me lose weight, energy and I became exhausted.

After the girls had all my milk, they had the formula. From the very beginning, they did not tolerate it well, so the team that took care of them changed many types of milk, until the dietitian decided they should have the amino acid formula. It is a kind of milk with very broken proteins, usually given in cases of allergy to cow’s milk. It has a horrible taste and smell. After they were one year old, we gradually changed the PURAMINO with a goats milk formula, called NANNYCARE. Initially to number 1, and after, number 2 and they still consuming it.

The amino-acid formula

The formula that Aurora and Victoria had been on after they turned 1 year old

I can not stress enough the importance of mother’s milk for a baby, moreover, for a premature infant. Preemies do not have a strong enough digestive system to tolerate the formula. Mom’s milk is easy to digest, protects the baby against bacterias and infections and makes him thrive better than any other food or supplement in the world.

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