Wednesday, April 30, 2008

Welcome to the NICU, let me show you around

Only occasionally do families of NICU babies have enough advance warning to get a tour of the unit where their precious child will spend the next few days, weeks, or months. The baby is often whisked out of the OR or birthing room before the parents get more than a glimpse and it may be up to 2 hours before the baby is stable enough for them to be permitted to visit.

Sometimes the mother is so sick that it is days before she can leave the birthing center or ICU herself. These can be some of the longest moments of a parent's life.

Babies generally start their stay in some kind of radiant warmer bed. If the NICU is well funded, it may be something like this one:

The bed pictured above has many features which make life easier for the NICU staff, for parents, but most importantly for the tiny infants who need those features to make their lives safer and more comfortable.

Starting at the top:

The bed has a radiant warmer component hidden in the clear shield at the top. It opens when the top is lifted and closes when it is closed. In the open position, the radiant warmer unit can provide enough heat to keep a tiny baby warm in an average-temperature room. The tiniest won't stay warm for long, even in this environment, because they lose heat as body fluids evaporate directly through the skin.

Fortunately, the top can be closed at the touch of a button to make a closed, humidified environment for the baby. Closing the hood shifts the bed to heating by gentle currents of warmed and (optionally) humidified air which are designed to form a barrier between the baby and the exterior.

A sensor probe is attached to the baby's abdomen, armpit, or occasionally side or back to let the bed know exactly how much heat to provide to maintain the baby's temperature.

Not all units have the option of a monitor attached to the ICU bed as this one does, but all babies requiring this type of bed will be monitored (to be discussed later).

Because NICU babies are weighed frequently, a scale has been built into the bed. This allows the baby to stay in his/her warm environment while being weighed. The bed can keep a log of weights and graph them.

The sides have portholes for use when the bed is in its closed position and the sides fold down to permit more access for delicate procedures when the bed is open-- or once the baby is more stable, to allow him/her to be removed without opening the top.

The unit can be lowered so that family members can sit beside the bed to visit or raised enough for the tallest staff member to work comfortably.

More on NICU equipment and admission procedures to come

Friday, April 25, 2008

Captain Barbecue hangs a chicken

Neumed left a comment on a previous post in which he mentions cooking a chicken on a string. That sounded like too much fun, so I had to go looking and found Captain Barbecue. What a hoot!

I also found William Rubel who has written an entire book about hearth and campfire cooking. Now I know what to ask my kids to buy for Mother's Day.

It does look fun -- and quite tasty. Most Boy Scout camping areas don't permit open fire cooking any more, but there are a few places left -- including a local park with fire rings. I'll be passing this along to our troop Quartermaster and cooking instructor.

As a side note, parts of the Captain Barbecue web site might be considered naughty. Not quite R naughty, but definitely PG-13+ naughty.

Saturday, April 12, 2008


My 12 year old is officially a Star scout. He completed the requirements a couple of months ago, but the Court of Honor was this week. He's worked hard to get here and is raring to go on with the requirements for his next advancement. He "only" needs 2 more merit badges from the required for Eagle list - and 2 months more in his leadership position - before he is eligible for the Scoutmaster conference and board of review which will determine when he has earned the Life rank. I believe the merit badges may take longer than he thinks. Some of them can be quite challenging.

We have other scouts advancing and our newest recruit will bridge as soon as he completes his Arrow of Light in the Cub Pack. He's been visiting troop meetings and seems to fit in well with the troop. He's looking forward to camping with the boys - and they've been working with him on his Arrow of Light requirements.

Baby gets a pacemaker

Little Liam King was only 5 days old when he became the youngest patient ever to receive a pacemaker to regulate his heart rate. Depending on which version of the story you read, his parents were told he'd only live 15 minutes, 15 days, or 15 months without the surgery. I'll be looking for the story to be published in one of the medical journals to find out which.

Liam was born with a heart defect which affected the electrical system in his heart. This is called heart block. The heart's electrical system is supposed to coordinate the contractions which pump blood through the heart. In heart block, the blood vessels are often normal, but the electrical signals don't get to the right place to cause the ventricles (lower chambers) of the heart to contract. There are 3 types of heart block.

First Degree -- the signal gets through, but not as fast as is typical. This type of heart block usually does not require any treatment.

Second Degree -- Most of the signals get through, but there is an occasional missed beat. Depending on the frequency, this type may cause enough symptoms to require a pacemaker.

Third Degree -- also known as complete AV block. This is the type baby Liam has. No signals get through to the ventricles. The ventricles have their own electrical signal which will cause them to beat at a slow rhythm, but which may not provide enough blood flow - especially for a baby. Individuals with third degree block are at risk of sudden cardiac death and will need an implanted pacemaker.

The images of baby Liam on the icWales site show just how large the pacemaker is in comparison to this fairly small infant. It covers about half of his abdomen. As he grows, the pacemaker will have to be periodically replaced and repositioned. He seems to have done very well in his hospital stay. He was delivered 6 weeks before his due date and released from the hospital only a little over 4 weeks after his birth. There are more than a few 34 week preemies who would still be hospitalized even without the cardiac complications and surgery.

Update: See the comments - Liam's dad dropped by to let me know they were actually told he might only survive 15 minutes. Amazing how differently the various news sites reported this.

Wednesday, April 09, 2008

The Pope is Coming!

I have tickets to stand on the lawn and watch him drive by. Probably the closest I'll ever get to the Vatican, though.

It's been crazy busy here. Work is busy, homeschool co-op is busy, the Scout troop is going to make me totally crazy. Being secretary and treasurer when you're married to the Scoutmaster is probably not the best idea. Refusing to have check writing privileges -- definitely a smart move. Sorry, honey. You'll have to go to the committee for the money. When I get caught up, I'll write a review of Troopledger. It has some very useful features and some which could be improved. Overall, it's a positive, though.