The whole world was upended by the Covid 19 pandemic early in 2020. While hospitals have dealt with previous infectious disease outbreaks such as SARS bird flu and Ebola, nobody could have predicted the havoc that the Covid 19 pandemic brought to healthcare and its practitioners. Truly it has made an indelible mark in nursing practice, even in the provision of care to the littlest patients in the Neonatal Intensive Care Unit (NICU). How did covid affect our Level 3 NICU you ask? Read on…

The Early Days

Prior to the declaration of the World Health Organization (WHO) that Covid was already a global concern, our organization has already started with the inventories of our personal protective equipment (PPEs).

Infection Control has always been a foremost consideration in our hospital. We remain proud of how we have kept our numbers low in terms of ventilator-associated pneumonia or central line-associated bloodstream infection, for example.

For this reason, part of our preparation was to stockpile our PPEs, review our donning and doffing procedures, ensure that we had a good number of negative pressure rooms with Hepa filters, and have a feasible plan of contact tracing and symptoms monitoring among team members in case of exposure.

Despite our consistently high compliance with handwashing, more stringent guidelines were still enforced. More alcohol-based hand gels were made available within 3-6 feet of each bottle or wall pump. Surgical masks were provided for consistent use. We thought that it was to be another version of the bird flu – a quick peak then it will all be over. That was our collective hope!

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Mandatory Testing for Patients

Nevertheless, they had to conduct mandatory testing for all patients coming in to the hospital. Regardless of whether they are staying as inpatient or just being seen as outpatient, all of them got tested.

The same was true amongst the mothers who were coming to our Labor and Delivery (L&D) Department. Those who were ready to pop or those who were just visiting the Obstetric (OB) Triage for any reason (non-stress testing, minor bleeding, etc.) were all tested. In a nutshell, the expectant mothers were tested every single time they come to the hospital.

The question that didn’t have a clear-cut answer was: are we testing all the infants born in the hospital then? 

Since there was no precedence to this pandemic, no one in authority was able to certainly state yes or no. Furthermore, there were no scientific studies that can back up either of those answers. Just like most of the healthcare decisions made during the pandemic, especially during Spring to Summer of 2020, we played it by ear.

The Ever-Changing Protocols

As referenced in the previous paragraph, our organization, just like all the other healthcare systems had to rely on expert opinions from the governmental authorities. The leaders were closely paying attention to the recommendations from the Centers for Disease Control and Prevention (CDC) and the WHO. We also remained very mindful of our PPE supplies.

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PPE Use

At first, it was okay to wear cloth masks if we were not actively taking care of patients. That was to help conserve our dwindling supplies of the surgical and the N-95 masks.

Prior to the pandemic, we had ample supplies of the PPEs. We used the masks, gowns, and gloves appropriately. What I meant by that is, single-use meant we never recycled our PPEs. With the uncertainty of the growing need, however, we had to reweigh and reconsider our options.

Thankfully, we were able to cut corners without putting the patients at risk. In the NICU, particularly, we wore the N-95 masks when we were providing direct care to babies born of Covid positive mothers or those who exhibited respiratory symptoms.

To limit our exposure and also conserve the use of PPE, those babies were placed inside the isolette. We wore full PPE: hat, eye shield, N-95 mask covered by a surgical mask, disposable isolation gown, shoe covers, and gloves when we were handling (assessing, bathing, feeding, etc.) the patients. That way, we didn’t have to change our gowns every single time.

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Covid Testing for Babies Born of Covid Positive Mothers

Initially, after babies were born, we immediately bathed the babies and took them to our NICU extension. We were fortunate that we had a dedicated unit wherein we took care only of babies born of Covid positive mothers or those who were considered patients under investigation (PUIs). The downside to that was no one was allowed to visit the babies since it was a closed unit with alarms and monitored doors.

We tested those babies right upon arrival in the unit, and then again at 72hours of age. Most of them, thankfully, were asymptomatic. We, the NICU nurses, would panic whenever one of them sneezed or desaturated. After a couple of negative results, those babies were discharged to the dad or other family members if they were able to present a negative Covid result.

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The Support Person Situation

At first, the babies’ fathers or support persons were not allowed to accompany the mothers in the L&D room. It was universal as there was a system-wide visitor restriction initiated. Because of that, we had that collective gnawing feeling every time a baby is born. Another joyous and momentous occasion unwitnessed by a family member!

I distinctly remembered this one birth I attended. The mother had a Cesarean section to deliver her twin boys. The dad was not present during the birth so he didn’t see them at all since we had to whisk them away to our unit. The obstetrician and the neonatologist had a spirited discussion regarding that situation. However, we had to follow the current policy, our empathies set aside.

A few months into the pandemic, we slowly allowed the dads to visit provided they had negative Covid test results. Everyone was respectful of the protocols, but we all could tell that the care we provided at that time was lacking of tender loving care (TLC). We had limited interactions. Our conversations were short. They were not even allowed to do skin-to-skin care, knowing fully well that it is important in parent-child bonding.

The Opposite of Rooming In

Rooming-in was and continues to be ideal for mothers and their newborn infants. However, because of the strict isolation protocols, we had to separate them. Sometimes to the point that we didn’t even feed those babies with their respective mothers’ pumped breastmilk. We discarded colostrum, considered as liquid gold, instead of feeding it to the babies. There was uncertainty if the coronavirus was transmissible through breastmilk, thus, that decision to throw the precious first few drops of mothers’ milk.

Eventually, they allowed the well babies to room in with their mothers, albeit from a safe 6-feet distance. The father or the support person became the primary caregiver. Since moms cannot breastfeed, dads provided the kangaroo care the babies desperately needed. Parents visited the babies in the NICU extension unit, one at a time.

All through those changes, the parents were very flexible and accommodating. If babies had an extended NICU stay, the staff allowed them to have limited visitation. If they cannot physically come, it was Zoom to the rescue. We usually would set aside 15-30 minutes for each baby to have a Zoom session with their respective families at home.

Personally witnessing those moments, my heart broke. Since I worked the night shift, parents would usually sing a lullaby to a dozing baby over Zoom. Imagine how much sweeter it would have been if they were doing that cuddling with their babies…

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Nursing Personified

Through it all, the nurses became “proxy parents.” A nurse may be taking care of three babies in two adjacent rooms since we also enforced physical distancing between cribs. Technology was utilized to help monitor multiple babies despite not being physically near them at all times.

We gave our patients extra cuddle time, despite the PPE barriers between us. We reasoned that even if we literally cannot touch them with our bare hands, we can still somehow provide them with the emotional bond they may have been missing from not having their parents around.

At the end of the day, pandemic or not, our goal remained the same. We wanted to provide the best TLC to each of our patients every single day!

What about you? What were your pandemic experiences in your work? How did that change you as a person? As a nurse? Please feel free to share your experience in the Comment section below.

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