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- Subscribe - Contact Us - Rate Card - Place an Ad Valley&State Backpage O&E Sports Archives Classifieds Faith&Beliefs Obituaries Revels February 27, 2004 Neonatal nurses deliver on their promises By Steve Zimmerman Ashland Daily Tidings With the number of premature births rising both nationally and statewide, what medical personnel do in the first hours of birth can be the difference between life and death. The statistics are staggering. According to the March of Dimes, premature birth affects one in 10 babies in Oregon and cost $13.6 million nationally in 2002. Nurse Debi Evans laughs as she meets "graduate" William Harold Maddox VII and his mother Tonya Maddox of Medford. William, now six months old, was under the care of Evans in the Rogue Valley Medical Center neonatal intensive care unit after he was born seven weeks early. When you think of the medical staff, you mostly think of the doctors making the hard medical decisions. But it is the nurses on the frontline in a hospital's neonatal intensive care unit that have the most impact. In this area, Rogue Valley Medical Center has the only neonatal intensive care unit, serving a six-county area. Arlene Borella, the clinical manager for the neonatal intensive care unit and for pediatrics, said the number of premature babies seen at RVMC has risen. "From the six counties we capture and a part of northern Oregon, we have seen an increase in premature babies with lower birth weights," she said. "It is not only the number of premature births but also the fact they are being born earlier. We see a lot more of the 24-, 25- and 26-weekers." Experts in the field cannot seem to put any specific reason behind the increase in premature births. "We have parents and moms who have excellent prenatal care all the way through their pregnancies," Borella said. "There is no reason to expect there is going to be any problem and they are delivering at 33-35 weeks for no reason we can pinpoint." But the opposite is also true, where a mother with little or no prenatal care can walk in and deliver a normal healthy baby. So it is really a crapshoot for the experts. Borella said the unit uses a team concept when a preemie is brought into the unit. "We have respiratory therapy, nursing care and lab," she said. "They are not people who are used to working with adults. They are more used to working with the neonates and they pick up on things very quickly." The unit has three levels of nurses caring for the newborns. Level three nurses work with the sickest kids who are very premature or on ventilators. A team is assembled whenever an Ashland woman goes into premature labor and is being transported by one of the many emergency transport services in the area to RVMC. "We get a level three nurse and a respiratory therapist to be on standby," Borella explained. "The physicians are there all during the day hours but if we need to get a physician there, he is called immediately." A warming table is one of the most important pieces of equipment in the unit in those first minutes. "The warming table is set up at all times," Borella said. "We flip the light on and get the heat going. One of the best instruments we have is the newer model of the isolettes, which are the closed plastic lidded machines, which provide heat, oxygen and moisture. Once we have assessed the baby, which can happen within the first four or five minutes, we get them in the isolette." When family members arrive, they are told of the situation and told what safety precautions they must take when seeing the baby for the first time. Once things settle down, the physician will take then into their office and tell them specifics of the situation. The average stay for a premature baby and its mother varies with each situation. "One of our favorite babies we have had here was here for 72 days," Borella noted. "I would say on the small babies, 24-26 weekers, they can be here for as long as three months. The average length of stay is around two weeks." Premature babies are more likely to be born with or develop physical and mental health problems. That assessment begins almost immediately. "We never make any guarantees one way or the other," Borella said. "The occupational therapist can do a preliminary study and even at three or four days can begin to identify if there might be developmental problems." Surprisingly, with the stress on neonatal nurses, most at RVMC have stayed in the unit for most of their career. One of them is Deborah Evans, who has worked in NICU since 1971. "Besides the fact I am local and at the top of the pay scale here, I like babies," she said. "I really like babies so those are three good reasons." In her 30-plus years in the NICU, Evans has seen many changes, all for the better. The best is the drop in mortality rates. "We used to see babies born five or six weeks early die," she said. "And now we are pretty much 100 percent on being able to keep them alive." Evans compared working in the NICU to riding a roller coaster. "There are days when we are way up high and others when we are way down low as far as workload," she explained. "One of the nice things about working here is the fact the days are never the same. The babies change, the families change and the sicknesses change so it is a challenge from a nursing perspective to be able to work in this non-static environment and use the knowledge I have gotten." So with spending so much time with the preemies, do nurses get attached to them and is it hard to see them go? "We get attached to the babies," she said. "We make lasting friendships with the families. I am getting pictures of babies I took care of who are now having babies of their own. Our miracle baby reunion that happens once a year in the summer is another opportunity to reestablish those friendships. We are absolutely thrilled when these guys go home." Michelle Ruthstrom is a first-time mom. Her son, Joshua, was born three weeks early and weighed 6 pounds, 11 ounces. He was in the neonatal intensive care to dry out his lungs. Ruthstrom said she has learned a few things from working with the nurses in the NICU. "I have learned that they require a lot of care," she said. "They are very demanding as far as their oxygen. I had no idea that you would have to pay attention to those things." She knew she was going to deliver early due to an illness during pregnancy and her labor was induced. Ruthstrom wanted to deliver naturally but Joshua was brought into the world through a Caesarean section. "When I could not deliver naturally, they did the C-section," she said. "Natural birth might have prevented his lungs from being so wet. But the C-section left him kind of wet. I was scared but it was the best thing for Joshua." About the time it was noted that little Joshua had a temper, he began to cry for his mother. Joshua went home after about one week in the unit. His is just one of the many success stories for the dedicated staff at the Rogue Valley Neonatal Intensive Care Unit. DailyTidings.com Home Page Valley&State | Backpage | O&E | Sports | Archives | Weather | Classifieds Columnists | Faith&Beliefs | Obituaries | Revels | Subscribe | Contact Us Copyright 2004 Ashland Daily Tidings and Ottaway Newspapers All Rights Reserved Site Search: .:Advertisements:. RESOURCES - Mail Tribune News - ODOT Road Cams