Meet the miracle makers Meet the miracle makers

By Siobhán Holliman [gallery]MOST mums-to-be get the first glimpse of their growing baby at around 18 to 20 weeks into their pregnancy. That seems to be the average time when the first ultrasound scan is carried out at the hospital's antenatal unit. All going well, the woman has about another 19 or 20 weeks to wait until baby's arrival. All births are seen as little miracles in their own right but when baby comes a lot, lot earlier than anticipated - they need more than luck on their side to survive, especially those fragile, tiny little boys and girls that come into the world three or even four months ahead of schedule. The neonatal unit at University Hospital Galway admits between 370 and 380 babies each year and about 45 of these would be extremely premature - weighing between 500 grams and 1.5 kilos and some being born at just 24 weeks old. This is in stark contrast to full term babies born at 39 or 40 weeks who weigh at least double that, an average of about 3.4 kg (7Ibs 7 ozs) and upwards. These babies who often arrive with extremely short notice require very special care and in Galway there is a wonderfully dedicated and caring team which is committed to ensuring these babies are given the very best chance at life. A new neonatal intensive care unit at UHG has just been officially opened by President Michael D Higgins and came into operation at the beginning of December. The original neonatal unit had been in place at the hospital for the past 25 years and a major upgrade was planned for the past five years. With a staff of 40, from cleaners to consultants, the critical care facility provides intensive care for critically ill premature and full term newborn infants. It has a capacity of 17 cots and can safely accommodate 20 babies with the daily average being between 16 and 18 babies. The average length of stay for a baby in the unit also varies from a few days for full term babies who might have had an infection risk up to three months for premature babies. It has become a familiar place for parents Helen and Declan Duffy from Oranmore - all of their children spent their first weeks of life here. During our visit they were watching over their latest family member, one-week-old Donnacha who was born six weeks early. Arriving early seems to be a family trait as his two-year-old sister Molly was born five weeks premature as was Cathal, now aged 12, who was born seven weeks ahead of time. 'It's amazing to see some of the same faces here now that we first met 12 years ago,' says a delighted Helen, who was full of praise for the unit and its many staff. Little Donnacha has been coping very well with his early arrival and his parents were optimistic that he will go on to face life's challenges like his other siblings. 'Everyone is so wonderful here,' the couple remarked. The unit thrives on the success of its amazing team work, much of which is co-ordinated and managed by clinical nurse manager Ann McDonnell. Every day is different and she can deal with a variety of tasks from preparing for an arrival from the delivery suite to booking an ambulance to transport a baby to another hospital. Ann is often the first point of contact that a parent has with the unit and she regularly meets parents who have been told their unborn baby is likely to be admitted to the unit. 'Being shown around the unit does make it easier for parents who have been told their baby will need special care. It helps to allay some of their fears,' explains Ann. The major rennovation project included the provision of a parents' room which allows parents to stay overnight in the unit. Many parents have fundraised over the years for the unit and the parents' room was furnished thanks to the UHG Child Remembrance Committee. Ann is keenly aware of the physical and emotional strain having a baby in the unit can put on parents and the entire family. 'It can be very difficult. Some parents have to travel huge distances and they're wonderful to come and visit their babies every day,' adds Ann who says they have babies from Sligo, Mayo, parts of Limerick and even as far away as Birr and beyond. What everyone wants the babies here to do is grow, especially Ana O'Reilly Marshall who is one of only three neonatal dieticians in the country. 'My main role is to make them (babies) grow,' she explains. 'A premature baby can't feed like a full term newborn and so the challenge is to mimic the nutrition it would get from the placenta as if it were still in the womb.' You might not think a baby weighing the same as a bag of sugar requires a lot of calories but it needs about 150 calories per kilo, compared to the average adult who needs 35 calories per kilo. Ten years ago there were only three consultants in paediatrics at UHG, now there are seven and two of these are specialised consultant neonatologists. Dr Ethel Ryan joined the team two years ago and works alongside the other consultant neonatologist, Dr Donough O'Donovan. Between them they share daily ward rounds and manage patients' care. There are three main categories of babies who come to the neonatal unit - premature babies, those to rule out infection and others who are experiencing respiratory distress. 'The youngest baby who survived was born here at 24 weeks. The biggest issue for very premature babies is breathing. They can't breath independently and require incubation and a ventilator. We also administer a surfactant to the lungs to stop them collapsing,' remarks Dr Ryan. The Galway unit would see on average about 14 babies each year who are born at 28 weeks or less. They are at an extremely high risk of dying and require exceptional care. In 2010 two babies born in Galway weighed between 500 and 600 g, one weighed between 600 and 700 g and two weighed between 700 and 800 g. 'You do get used to working with such small babies. We forget that babies are very strong and resilient. They're tougher than we think. We aim to handle the babies as little as possible and of course you learn to be a lot more gentle,' explains Dr Ryan. While she is delighted with the new unit she says the real winners are the babies. The old unit served its purpose but birth rates in the West have escalated since it was first built. The consultant points out that one problem for babies in special care at UHG is that the hospital doesn't have paediatric surgery facilities so they have to be go elsewhere for any operations required. There is also just one specialised neonatal transport service team that operates from 9 am to 5 pm all around the country. She would like to see it operate seven days a week, around the clock and for more teams to be provided. The consultant points out that having a baby in hospital places a huge stress on families. 'It's easy to forget the impact that it can have. Explaining to parents what is happening can often help to calm and reassure them,' she adds. Another team member who is very familiar with helping families to cope with this pressure is senior social worker Mary McMahon. From helping with benefits and entitlements to offering emotional support when a baby is a diagnosed with a long term illness, Mary's job reaches from the hospital and into the community. 'It can be a difficult time for families. Very often my relationship with families can continue for some time,' she explains. Interestingly the babies are also seen by clinical specialist physiotherapist Breda Cunningham whose job is not to get them moving but is focused on observing their movement, position and sensory environment. She follows up with all premature babies until they are two years old to ensure their functions are within the predicted norms and also follows up babies with other abnormalities when they are in their own homes. Of course the moratorium on hiring staff has impacted the unit also but clinical nurse manager Anne Matthews makes every effort to ensure that services are provided from within existing resources. She is seen by many staff as the 'go to' woman and is very involved in strategic planning and making sure there are adequate staff numbers with the proper skill mix to ensure the unit can operate safely. 'It is intensive work and I try and ensure that the unit is a nice place to work in,' she explains. The unit is a very busy but surprisingly exceptionally quiet place. At first glance many of the incubators appear to be empty but a second look focuses your gaze towards a tiny hand or a jerk of a little foot. Most of the babies here don't cry - but fortunately most of them eventually get the chance to.