The Nest

Our specialized trained team cares for our smallest preemies in a dedicated space within our Level IV Neonatal Intensive Care Unit, also known as the Nest. Babies born before 29 weeks’ gestation need a different kind of protective care than babies who are even just a few weeks older. We have adapted our protocols to account for these fragile babies’ unique medical and developmental needs. Our Nest team consists of specially trained nurses, therapists, and physicians caring for our tiniest patients.

Neuroprotection

Our Nest and NeuroNICU teams collaborate to deliver advanced neuroprotective care to our tiniest patients, with the goal of minimizing any potential negative impacts of premature birth on their developing brains. The protective measures we take include:

• Continuous noninvasive monitoring of brain oxygenation in the first week of life, and beyond when needed.
• Use of careful positioning to minimize intraventricular hemorrhage, a type of bleeding in the brain that is unique to extremely preterm infants.
• Creating a healing environment that reduces babies’ pain and stress through:
  • Light exposure tailored to the baby’s stage of maturity.
  • Minimizing noise levels.
  • Coordinated “touch times” to reduce noxious stimuli.
  • Reducing invasive procedures and testing when possible.
• Promoting parent-infant bonding through:
  • Early and frequent holding, with specialized chairs for kangaroo care at each bedside.
  • Social work support for all families.
  • Specialized psychological support to alleviate the stress and anxiety that can be associated with a prolonged NICU hospitalization.
• Encouraging parents’ daily involvement in routine care as well as developmental care activities, which promote growth and development.

Lung support

To support a preterm infant’s breathing while protecting the lungs, we use an array of specialty equipment, including:

• Specialized ventilator protocols: We use two lung-protective modes in order to gently assist babies’ breathing. This gentle approach can minimize later breathing complications.
• Continuous positive airway pressure (CPAP): If a baby isn’t on a ventilator but needs oxygen support, we use bubble CPAP, which provides humidified air through small tubes that fit into the baby’s nostrils from a machine delivering a continuous flow of air to improve a baby’s gas exchange and promote lung growth in the gentlest manner.

Feeding and nutrition

We use special feeding and nutrition approaches to help small babies grow. This includes gradual increases in nutrition tailored to an infant’s size and caloric needs.

• Our registered dietitians participate in daily rounding, and they monitor babies’ nutritional needs closely.
• The care team makes frequent adjustments to babies’ intravenous therapy (IV) and milk nutrition.
• Our milk technicians mix extra nutrients with breast milk to achieve optimum growth in the smallest and most premature babies.
• For mothers with inadequate breast milk supply, we provide pasteurized donor breast milk.

Follow-up care

When preterm babies leave the hospital, they may be referred to the Infant Development Specialty Program, which focuses on all aspects of a baby’s development. The clinicians include developmental-behavioral pediatricians, nurse practitioners, nurses, and social workers who work closely with psychologists and rehabilitation therapists, as needed, to conduct individualized developmental assessments. The team tracks babies’ progress over the first three years of life and gives parents guidance to support their baby’s development. The clinicians coordinate referrals to community services and early-intervention programs.