Scott Webb (Host): Being a first time parent can be a little scary, especially if the baby is born prematurely or has to spend time in the neonatal intensive care unit, the NICU. But most of the stays are fairly routine and a majority of newborns graduate with flying colors from the NICU and head home with their eager and soon-to-be exhausted parents. And I'm joined today by Dr. Destiny Harrell-Washington. She's a board-certified physician in pediatric medicine, practicing in the Franciscan Physician Network.

Host: This is the Franciscan Health Doc Pod. I'm Scott Webb. Dr. Washington, thanks so much for your time today. We're going to talk about newborn care, NICU, baby graduates, all that good stuff. So as we get rolling here, let's talk about newborn care, especially with first time parents. What are the most common discussions you're having with parents regarding, you know, caring for their newborn and then specifically the NICU graduates?

Dr. Destiny Harrell-Washington: Yeah. So, I see a lot of newborns every Day. the most common thing I get from parents is just sounds that newborns make and things that they do that can be scary. So, to name a few, one is called periodic breathing of the newborn. Sometimes infants will breathe really, really fast, and then they'll breathe really shallow, and then sometimes they have a brief pause in their breathing for like 10 seconds, so that can be super scary to newborn parents. And I usually reassure them that this is very common in newborns and it typically resolves by like six months of age. They also have questions about all the sounds that newborns are making such as grunting, hiccuping, sneezing, snorting. Newborns tend to do a lot of sneezing from all the amniotic fluid that they have still inside their system. And so, sometimes parents will think that the baby is sick, but they're really just kind of sneezing out all the amniotic fluid.

We also talk about gas. Newborns are very gassy little babies.

Host: Yeah, they are.

Dr. Destiny Harrell-Washington: Yeah, I typically discuss how to kind of get rid of the gas, like massaging their stomachs or moving their legs in a bicycle motion or using like over-the-counter gas drops or probiotics or changing formulas if necessary. So, that's what we typically talk about, just kind of common things that they're seeing and hearing.

Specifically for the NICU graduates, I usually go through their whole NICU course and entirety with the parents. Typically, they have some leftover questions from the NICU that they didn't get a chance to ask the neonatologist. So, I just ask them about any concerns they have about their infants, whether it's like their breathing or the nutrition. And then, I discuss, you know, any extra vitamins the infants may need. We usually recommend like a pediatric multivitamin with iron. Because in the third trimester of pregnancy, actually the mom built up a lot of iron stores for the baby, so these babies actually are deficient in iron and they have to take the multivitamin with iron usually for the first year of their life.

Host: Yeah. And as a parent myself, of course, I experience those things, those noises. You know, "Are those noises normal? We should probably ask." And by the time you get to the second child, everything seems normal. You know, you're not quite as alarmed by every little thing, right? So, what medical conditions cause a newborn to stay in the NICU?

Dr. Destiny Harrell-Washington: So, there could be several conditions that cause a newborn to stay in the NICU. One is just prematurity. So at St. Anthony's in particular, any baby that's born 35 weeks or less stays in the NICU. Sometimes it can be 36 weeks or less. Another thing, it's really just like feeding issues. A lot of babies that are born premature are not able to suck by themselves yet, so they'll need like a n NG tube or like an orogastric tube. Sometimes breathing issues, their lungs are pretty immature, so they may need like a ventilator or they may need oxygen therapy, like CPAP or BiPAP for support. And then, sometimes we have newborns that are even born not premature, but the mom has a fever during delivery or she has an infection. So when the baby comes out, that baby ends up getting the infection from the mom. So, they might have to go to the NICU because they have sepsis, and they'll need antibiotics. So, there can be lots of things, but it's mostly either feeding, breathing or infection.

Host: Yeah, the big three, their feeding, breathing, infection. And I'm sure unexpected stays in the NICU have an effect on the entire family, physically, emotionally. Maybe you can talk about that a little bit, just what families go through when they have those unexpected stays in the NICU.

Dr. Destiny Harrell-Washington: Yeah. So, it can be very emotionally taxing because you think, you know, you've grown this baby inside of you for so long and you're just kind of really excited to bring the baby home. And when that doesn't happen, that can just be kind of very sad for everyone. And then, you know, you see the baby kind of get whisked off to the NICU and they have all these lines and tubes and everything. So, it's really good to have, you know, an emotional support system, friends and family NICU nurses in particular, they're just amazing people as well. They usually provide really good bedside support. And then, just the NICU nurses really help coordinate questions that the parents may have with the neonatologist. Physically too, it can be hard for mothers too, because typically the baby's mouth can be pretty tiny, so they can't latch onto the breast. So, sometimes moms will be what we call exclusive pumpers, where they're kind of just like pumping breast milk two to three hours around the clock. So, that's pretty physically demanding. But I know a lot of the mothers, they do find joy in pumping for their babies. Since they can't care for them 24/7, they feel like they are doing the best they can for them by pumping.

Host: Yeah, definitely. And just wondering, when we think about the NICU grads, are there some special needs, special physical needs that they'll often have?

Dr. Destiny Harrell-Washington: Yeah. So, the range for NICU grads, it's such a huge spectrum of like what they could need, you know, depending on how premature they are born from like 24 weeks all the way up to like 35 weeks. So, sometimes they're born very premature. They could need like a G-tube to go home with because they're still working on their feedings. Sometimes they can develop chronic lung disease. So, sometimes they can need like a trach tube to go home with. These are typically co-managed by like the general pediatrician and the specialist. And then, sometimes when they do have the chronic lung disease, they have a pretty increased risk of developing asthma or what we call reactive airway disease. So typically, we'll have these babies taking some type of inhaled steroid every day, or they'll just take albuterol if needed.

Host: Sure. And I'm sure you've had many rewarding experiences working with NICU families, but maybe you can just recount one of them for us. Like tell us some of the most rewarding times or one of the most rewarding times or experiences you've had.

Dr. Destiny Harrell-Washington: Yeah, I would say the most rewarding times are when they can finally get their G-tube out. That's really exciting for parents. They no longer have to deal with the machines of putting all the liquid through the G-tube and all the pumps and everything like that, so that's really exciting for them. And then, really just seeing all the milestones. They start out so tiny and so small. So, it's nice to watch them grow and get bigger and complete their milestones like smiling, laughing, you know, rolling over, crawling, just all the things they are just excited to see.

Host: Yeah. Those are some of my favorite moments. I was the only one home the first time my daughter walked.

Dr. Destiny Harrell-Washington: Oh, wow.

Host: And, you know, then my wife and my son walked in, I'm like, "I swear, she just walked to me" and they're like, "Sure. She did," because when they walked in, she was sitting on the floor. So, I love those milestones. It brings a big smile to my face. And I'm wondering what can parents do in general just to prepare to care for their newborns?

Dr. Destiny Harrell-Washington: I would say a couple of things. I would say make sure they have like a proper car seat, especially for the NICU graduates. sometimes they come out a little bit smaller, so you just want to make sure like the minimum weight requirement on the car seat is small enough for the baby. I've seen that in a couple instances where the parents bring the car seat to the NICU and their baby's only four pounds, but that car seat fits a six-pound and up baby. So, definitely just making sure they have the weight limit correct. And then, also just like a safe sleep environment. So, making sure they have like a bedside bassinet set up. A lot of the hospitals will offer infant CPR classes and breastfeeding, birthing classes. So, those can be super helpful for first time parents too.

Host: Yeah, definitely. And this has been really helpful educational today, doctor. As we wrap up, what do we do-- I know what we did with our son. He was about four-and-a-half when his sister was born, so we worked on preparing him for having a sibling, having a little sister in the house. But generally speaking, for siblings, pets, as we prepare for the arrival of a newborn, what do you recommend?

Dr. Destiny Harrell-Washington: Yeah. So, definitely with four-year-olds or even, you know, ages like one to four toddlers, they love to be helpful. So if you can just involve them in the care of the baby as much as possible, like if they could just hand you a diaper or hand you wipes, or hold the bottle, anything that involves them in the care makes them feel like they're not, you know, being ignored or anything like that and you're still giving them attention, you're still spending time with them. And then, sometimes we always tell parents too to go to the store with the sibling and have them pick out like a little gift for the baby, so that when the baby gets home, they can be like, "Okay, it's like a little gift for you" and they can play together and try to help them bond. So, that's really helpful. For pets, I usually tell parents to try to get them like acquainted to like the sounds and smells of a baby. So, sometimes I'll tell them to play like recordings of babies, like on YouTube or have them smell maybe like the detergents you're going to wash the baby with or lotions or powders, just to help them get more acquainted to like having a baby around.

Host: Yeah. Well, this has been really fun today. Nice to meet you and great to have your time. Thanks so much. You stay well.

Dr. Destiny Harrell-Washington: Of course. Thank you.

Host: Learn more about newborn care and NICU graduates at franciscanhealth.org and search pediatric medicine. And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.