Dale Wolford

Nicu clinical experience

11/17/2020

For this week’s clinical I had the chance to observe at the Nicu floor at Akron Children’s

hospital. Nicu stands for Neonatal Intensive Care Unit and in Akron Children Hospital’s case

they have the floor split up into 2 different types of areas. The rooms consisting of 702-724 are

designated for more acute care that are typically related to low birth weight babies. The other

side of the unit consisting of rooms 725-747 are designated for more long-term care babies such

as trach patients. They also have another floor designated for overflow if the unit becomes too

packed due to incoming patients. This clinical was very interesting for me as it showed what

primarily goes wrong with the birth process and causes defects in these children for them to end

up on the Nicu floor. It was also very cool in the way the observation worked in how I could just

walk around the unit and ask questions to different nurses taking care of different patients.

When first arriving on the unit I got a tour of both sides of it and shown the central white

board that showed each of the patients room occupancy and which nurse was taking care of

them. This was very different from other units as most of the rooms were either a 2:1 or 1:1 ratio

for each of the patients to nurses. I had never seen a more individualized set up for each of the

specific patients but that soon made sense why it was so personal. The first patient’s I got to see

were a pair of twins who were preemie babies that were both born at about 28 weeks into the

pregnancy. They initially had both been intubated because of their lungs not being developed

enough yet, but since that time of birth a month and a half has passed and their status has gotten

much better. One of the twins had progressed so much that she was only on a nasal cannula and

could breath efficiently and consistently. For the other twin however they have not progressed as

quickly and because of that is currently on a NAVA machine or Neurally adjusted ventilatory

assist machine. This device is controlled by electrodes embedded within a nasogastric catheter

that detect the electrical diaphragmatic activity and transmit that info to the ventilator to match
Dale Wolford
Nicu clinical experience
11/17/2020

up (synchronize) with the user’s own respiratory efforts. This provides the patient to have a lot

more control over their breathing and provide support to it when they are not having adequate

gas exchange whether it be inspiratory or expiratory.

Another patient that I got to see was an oddball out of the group as she was one of the

few babies who was very active and playful. This patient was currently being taken care of for

her Tracheostomy which I did not realize is a VERY attentive task for an individual and can

practically not be done by the parents of the child until they are thoroughly educated about how

it works. This patient also has VATER syndrome which is a group of birth defects that often

happen together in Utero. This is due to her trachea and esophagus issues including some slight

spinal cord abnormalities but they are not severe. The main issue arises with the patients Trachea

as it is not strong enough to support the baby’s breathing and will collapse without the Trach.

When the Trach is in however she is easily capable of breathing on her own and even gets 2 hour

period where she does not have to be on the ventilator for assistance. This is different from the

other patients on the unit as usually the reason for getting a tracheostomy in Nicu is because of

BPD (Bronchopulmonary dysplasia) or premature birthweights causing undeveloped lungs.

The last patient that I thought was also very intriguing was a patient with Omphalocele.

This is a birth defect in the abdominal wall that causes the infants intestines, liver, stomach and

other organs to stick out through the stomach into a ball like sac with a very thin and transparent

barrier. I found this very interesting as my neighbor had this issue occur to him when he was just

a baby and I had forgotten what the name of it was. Luckily the look of this defect is worse than

it seems as the survival rate is much higher than I would have expected with 90% of patients

pulling through and living healthy and happy lives. In the case of my neighbor his surgery helped
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Nicu clinical experience
11/17/2020

him out tremendously but with any case of Omphalocele there will be other abnormalities that

arise. This caused my neighbor to experience growth defects well behind his normal age group

and out of the trend from the genetics of his family. However he is still able to live a very

healthy and happy life with both his family and friends. This clinical experience was both

educational and fun as you get to see a lot more depth and detail with the subjects we talk about

in class are explained a lot more.