DATE: Wednesday, March 26, 1997             TAG: 9703260034

SECTION: DAILY BREAK             PAGE: E1   EDITION: FINAL 

SOURCE: BY DEBRA GORDON, STAFF WRITER 

                                            LENGTH:  149 lines

PREEMIE FOR A DAY NURSES AT CHLDREN'S HOSPITAL OF THE KING'S DAUGHTERS LEARN HOW TERRIFYING IT IS TO BE A PREMATURE BABY, AND HOW TO HELP THEIR TINY CHARGES.

For 27 weeks, she'd floated in a sea of warmth, ensconced in a cloak of safety and protection. It was dark in her small space, the constant ``whoosh, whoosh'' of her world a soothing lullaby.

Then everything changed.

There was shouting - ``We've got an emergency!'' Brightness. Cold.

People stood over her, putting freezing instruments on her naked chest, under her arm. They strapped her legs and arms away from her body, stuck tubing down her throat, put tape on her face and then ripped it off, sprayed her with icy liquid. And all the while they yelled, and shined beams of light into her eyes, and touched her and let go and touched her again, until she lost control. Her blood pressure plummeted, she stopped even trying to breathe, and her heart rate slowed.

It sounds like torture. But it's actually the way premature infants are treated seconds after delivery as they're admitted to a hospital's neonatal intensive care unit, or NICU.

And once there, it gets worse. Preemies are often subjected to sound and light levels that damage their immature eyes and ears, positioned in ways that cause their muscles to shorten and their joints to dislocate. They can be exposed to physical stresses - even from such simple things as changing a diaper - that could cause their brains to bleed and interfere with their breathing.

It needn't be this way.

Dozens of clinical studies in recent years show that introducing relatively simple, low-tech changes into the high-tech world of the NICU - like lowering the lights and swaddling babies - can dramatically improve a premature infant's quality of life. It can also accelerate weight gain and reduce hospital stays.

At the region's largest NICU, the 56-bed unit at Children's Hospital of The King's Daughters, officials decided the best way to teach staff about the importance of these changes - called developmental care - was to have the nurses feel what the babies felt.

To make them ``preemies for a day.''

The first thing the 10 nurses notice when they enter the large, sixth-floor conference room at Children's Hospital is the temperature. It's freezing.

``It's supposed to be that way,'' says NICU educator Michelle Lindsay unsympathetically.

Then they see the white sheets spread out on the floor. The ice-filled basins in which large syringes, stethoscopes and thermometers rest, the adult-sized diapers, and the piles of multicolored nipples and tiny bottles.

And their smiles freeze on their faces.

Since December, Children's Hospital has put 50 of its 200 nurses through this four-day training, modeled after a session developed by Massachusetts-based Children's Medical Ventures. The company designs special ``developmental care'' products for NICU babies, including a padded, bendable tube which can be wrapped around an infant to imitate the security of the womb, crib covers to filter noise and light, and special bunting that helps babies learn to calm themselves.

The training focuses on four areas - feeding, positioning and development, admission and parent interaction. Three teachers use role playing to expose the nurses - most of whom have worked in the unit for more than a year - to the NICU world the preemie sees.

``Lay down, flat on your back, hands over your head, chin up,'' directs developmental educator Donna Englestad.

The nurses, three of whom are from Sentara Norfolk General's nurseries, gingerly sink to the ground, stretching out their middle-aged bodies, groaning about stiff limbs and sore backs. Then Englestad tells them to pull their knees up and let their legs fall open in a froglike position.

``How's that feel?'' she asks.

``It hurts,'' comes one answer. ``It doesn't feel good.''

Now you know how the babies feel, Englestad says.

Flip onto your stomach, she directs. Pull up your butt like a baby, lay your head flat, your arms to the side. Now try and turn your head.

``Is that natural?'' she asks.

Putting babies into these positions - common in the NICU - is not only uncomfortable, she explains, but often causes later problems.

Englestad sees babies in the NICU follow-up clinic who can't bring their hands together because their shoulder muscles have shortened from lying on their back so much. Or whose hips are out of alignment because they lay with their legs splayed apart.

The solution is simple.

Englestad pulls over an adult-sized Bendy Bumper, a pastel-colored, padded tube about 7 feet long that she wraps around her guinea pig, NICU nurse Denise Fleming. The tube, manufactured in much smaller sizes by Children's Medical Ventures, provides boundaries for a baby, much like the womb does. Soft cotton straps wrap around the baby's shoulders and legs, keeping them in comfortable positions. Englestad curls Fleming into a fetal position, the nurse's hands near her face so she can suck them for comfort.

``Doesn't that feel better?'' she asks.

``Ummm hmmm,'' murmers a secure Fleming, nearly asleep.

Babies who are ``contained'' like Fleming, studies show, tend to be calmer, require less medication and gain weight more rapidly.

But it isn't until the admission simulation, reminiscent of what the babies experience soon after birth, that the nurses begin to understand the terrifying experience of being a preemie.

The four nurses lie on the sheet-covered floor, arms by their sides, eyes wide open. They are preemies, born 13 weeks too early, taken from their mother's womb during an emergency Caesarean.

``Oh, my God, here they come,'' Lindsay yells. ``Get 'em intubated.'' She works over Cheryl Masters, a Sentara nurse here for the training, while Englestad and perinatal coordinator Jennifer McMurray, ``admit'' the other three ``babies.''

Lindsay rips masking tape off a large roll and uses it to strap down Masters' hips, ankles and wrists. ``Where's the electrodes? Can anyone get a length? I can't put a line in without a length!'' she yells.

She sticks a piece of tape over Masters' lip, simulating the tape that would be used to hold a ventilator in place. Then, deciding it isn't working, roughly pulls it off. She shines a flashlight in Masters' eyes and thrusts an ice-cold ``stethoscope'' onto her bare skin.

Masters jumps with the shocking cold.

``We need an IV here,'' Lindsay yells. She grabs a bottle from the tub and sprays ice-cold water - representing the sterilizing solution, Betadine - over Masters' skin.

``We're losing them, we've got to suction them,'' Lindsay yells, sliding a thin rubber tubing into Masters' mouth.

``Whoops, just had some meconium (a newborn's first bowel movement), got to get a diaper on her,'' she calls, lifting Masters' legs high above the nurse's head and slipping a diaper under.

There is much laughter as the exercise unfolds, but it is laughter with an edge.

Is this what it feels like? the nurses ask. Is it really this bad?

No, say their teachers. It's worse.

``We're not sticking you with needles and stuffing a ventilator down your throat,'' Lindsay says.

And then they show their students how it could be.

It was bright, but the nurse had placed a gauze bandage over her eyes and ears so the lights and noises were muffled. She could hear whispering, but it was so faint it barely registered. Within minutes of her exit from her mother's womb, a foam-filled cushion had been placed around her, which made her feel safe and secure. A firm pressure on her back from the nurse's hand comforted her, and she got extra relief by sucking the rubber nipple someone had put in her mouth.

The bell-shaped cone the nurse used to listen to her heart had been warmed under the lights. And when the nurse needed to slip a needle into her arm for an IV, she first held a warm compress against the skin to raise the vein, making the insertion easier and less painful.

The baby sighed and closed her eyes tightly. In the quiet dimness she could focus on the most important thing. Breathing.

``Did you see that?'' whispered the nurse. ``Her oxygen levels and blood pressure are holding nice and steady. She's doing good.'' ILLUSTRATION: Color photos by Beth Bergman/The Virginian-Pilot

Above: During training, Donna Stanford, a neonatal intensive care

unit nurse, is swaddled as a preemie shoud be. Below: A nurse with a

baby in the unit.

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