Integrated Neonatal Intensive Care (INIC)

Thanks to a pioneering Covenant Medical Center program, preemie Hannah Jackson wasn’t separated at birth from her parents.
Rather than residing in an intensive care nursery, Hannah, who arrived three weeks early, benefitted from being beside her parents, Stephanie and Joshua Jackson of Waterloo, in a labor and delivery suite as part of Covenant’s innovative Integrated Neonatal Intensive Care (INIC) program. This program allows for intensive care staff, doctors, and equipment to be available in the mother’s room, keeping her and her baby together in one place.
The family-centered model began in February — the first of its kind in Iowa and among a very few nationwide. Preemies and their parents bond earlier, reducing stress and potentially improving the health of the child, whose well-being is monitored in a GE Giraffe OmniBed, an incubator with radiant-warmer technologies.
Of the 1,500 babies delivered annually at Covenant Medical Center, about 150 to 200 are admitted to the NICU, according to Teresa Horak, RNC-OB, director of Women’s and Children’s Services. Preemies delivered before 30 weeks are transferred to the University of Iowa Hospitals and Clinics with its more extensive resources.
Previously, Horak said, “The mom would be in bed worrying about her baby. The dad or support person would try to figure out whether to be with the mom or the baby.
“Now they’re all in the birthing room and don’t have to go back and forth to the nursery every time they want to see the baby. It’s a very good thing for the parents and the baby.”
The birthing suite boasts a full-featured, all-in-one natal care station for the baby, as well as a foldable couch/bed, TV, wireless Internet, nearby washer and dryer and dining for the parents and supporters.
“If you’re a parent,” Horak said, “you could live here until you’re ready to go home.”
Studies of family-centered programs abroad have found that preemies placed with their parents increased their weight by 25 percent, were more likely to be breastfeeding when going home, and were discharged earlier.
Horak cited another health benefit.
“Babies that are skin to skin with their parents pick up their anti-bacterial protection, which is extremely beneficial,” she said. “We’re working on getting our regular newborns skin to skin in that first hour after delivery and as much as we can with the preemie babies. Our program is called ‘heart to heart’ — baby’s heart to mom’s heart.”
To implement this program, having the proper technology was imperative.
“Preemies don’t always maintain their own temperature,” Horak said. “They should be in the womb where mom does that for them. When they’re out here, they can get cold. The great thing is to keep them with their moms. When that’s not feasible, they will be in the Giraffe Omnibed incubator.”
“Covenant approached GE Healthcare about a new care model,” said Rita Barksdale, general manager of Maternal Infant Care with GE Healthcare. “We identified the right monitoring technology and worked with them to implement the solution.”

“We developed the Giraffe OmniBed to support parental bonding and contact,” said Barksdale. “We believe features like a rotating mattress and internal bed tilt can help lead to a positive experience for babies, their parents and the caregiver.”

Stephanie Jackson, a stay-at-home mom with toddler Elizabeth, and Joshua, associate pastor at Grace Baptist Church, were surprised June 8 when Stephanie started having painful contractions during the 37th week of her pregnancy.
Hannah debuted 50 minutes after they arrived at Covenant.
“Our daughter was purple and they were pumping oxygen into her mouth,” Joshua recalled. “I had never been as stressed in my life as when she started receiving treatment right after birth.
“The doctors and nurses’ faces and the words expressed were more positive as the hours moved on,” he added. “They moved Hannah out of the incubator into a sleeping station in the birthing room, and I was able to be present 24/7 to see the special treatment she was receiving and monitor my wife’s progress and health. Had they been separated, I’d be pulling my hair out.”
Stephanie said having Hannah in the same room improved her “peace of mind.”
“There was a brief time when I was in another room. I couldn’t see what was going on or have a constant update. Once we were together again, I could see that she was still breathing and her heart was still going strong,” she said.
“For my health, it made a huge difference, and it seemed to stabilize her a lot. It’s not comfortable walking, and she wanted to nurse every hour. The first night I wouldn’t have slept at all being in a different room and trying to walk down to her. Even with diaper changes, she likes hearing our voices. She would calm down. Her heart rate would change.”
INIC, Horak said, promotes a “collaborative” approach using the expertise of nurses and hands-on experience of parents.
“The moms are there all the time, and they get to know the baby really well,” she said. “They’re in partnership with the nurses. They’re more attuned to that baby, and the nurses respect that. The nurses are teaching the parents, and the parents pick up on many things that they tell the nurses.
“We’re worried about brain development, about their breathing and eating — a lot of different things,” she added. “The parents get consulted right along with us. We do have a feeding protocol incorporated with our moms on how they eat. The moms breastfeed the babies early, as long as the doctors decide they can get at it, and they actually help us decide how much to feed the baby and how much they ate.”
The parents also were advised on more technical issues.
“We received a lot of information about all the machines and to keep lights and stimulation down,” Stephanie said. “We had to learn how to change a diaper differently with all the cords attached to Hannah.”
“She had some respiratory issues,” Joshua said, “so we were given audio clues about how she was breathing — ‘grunting’ was how they described it. They explained if this is the sound, that’s telling us that this is the problem.”
The parents also became educated about the GE Giraffe Omnibed.
“The monitoring is key,” Horak said. “We always have to know what the baby is doing. They also have bili lights if the baby is jaundiced.”
The nurses, Joshua said, “did a good job of explaining to us — both in technical and layman’s terms — the monitoring. When she was nursing I would have a good idea how she was doing by looking at the numbers going up or down. I could almost clock it, and it would be 20 seconds and a nurse would be walking through that door.”
Nurses in the INIC program have been “tremendous advocates and problem solvers,” according to Horak.
“The nurses have really embraced it,” she said. “They’ve done a lot of the good thinking about how we make this work. Most of them are moms and intuitively get it that most people want to keep that baby with them.”
Year to date, Covenant has had over 45 babies graduate from the INIC program. “All are at home and doing great,” Horak said.
To be discharged, doctors must determine the babies are healthy, maintain their temperature, and breathe and eat well. Horak said the average length of stay is 11 days, “but it could be two days or a month. Usually the baby will go home on their due dates, but there are babies that do well and go home earlier and those that don’t and are here longer.”
Hannah, who was 19 ¼ inches and 6 lbs., 6.8 oz. at birth, exceeded “back to birth weight” at 7 lbs., 7 oz. at her two-week appointment and had no complications.
Her parents praised Covenant’s pioneering approach.
“It seems strange that you would have the child separated from the parents; that you would have that isolation,” Joshua said. “It’s the logical thing to do to have the family together.”