How Do You Spell S*T*R*E*S*S? The Preemie Experience…

Posted by candy on Jan 15, 2013 in NICU, Preemie

How Do You Cope With the STRESS of  Having a Baby in the NICU? Part 1

Buzzers and bells and loudspeakers, oh my!” and “How can anyone get any sleep in here?

Do you remember your first peek in the NICU? A recent ad hoc survey of family, friends and healthcare workers turned up some rather frightening adjectives when asked: In a word, what was your first impression of the NICU ? Responses included : scary, surreal, torture chamber, bizarro, Orwellian, hell, warzone, and heaven.
(I understand most of the sentiment. But, heaven? That mom added,“’cause that’s where my baby is.”)

Heavenly sentiments aside,  how do you cope when life deals you the NICU card? How do you manage the STRESS? Can’t eat, can’t sleep, can’t see the sun, the trees, the flowers in bloom. Having a child in the hospital rips through emotional defenses. Many call it the roller coaster. Quipped one father of a preemie, “Can you say, trainwreck?”

According to this week’s podcast guest, Danea Gemmel, mother of 24 week twin girls, the secret is to “manage the minutes.”  Wise advice from a mom who had cause to wonder if either or both of the twins would survive what we in the NICU refer to as a patient’s  medical course. (Sometimes it seems more like an obstacle course.)

“First you manage the minutes, then you manage the hours, then the days, then you get to when they’re 11 years old!” beams Danea.

Adequate rest and good nutrition is the key to mending. Moms need to recover from the birth and build back the blood lost in delivery. Estimated blood loss for a normal  delivery is 250 cc, or about 3 cups; double that for a cesarean. (When you donate blood to the Red Cross, they take less!) Dads need to provide a calm atmosphere for mom, who is physically spent and now must also pump her breasts, ad nauseum, often while recovering from major surgery.

Of course, dads don’t get off so easy, either. Many parent partners won’t readily admit it, but they also have to cope with the emotion-commotion that accompanies the whole premature baby package. There’s the financial stress on top of the concern for mother and child, and despite The Family and Medical Leave Act, (which provides certain employees with up to 12 weeks of unpaid, job-protected leave per year) many breadwinners opt to keep working, to keep the tummies full. That daily service, in the best of work environments, requires a certain amount of sleep. Ha! Sleep takes on an ethereal quality during this time of worry and every four-hour breast pumping. Add  other children to the household…well, I don’t have to tell you.

Click here for Danea’s  interview about handling STRESS in the NICU:Danea-G-podcast2

Julia and Meredith today24 week micropreemies, 8 years later :)

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Home At Last With Your Preemie

Posted by candy on Jan 15, 2013 in Infertility, NICU, Preemie

Home With Your Preemie:

5 Things Parents Should Know and Do

by Candy Campbell, DNPc, MSN-HCSM, RN, CNL

[Reprinted with permission from Health4Mom.org]

Annie Tao photography

(Courtesy:Annie Tao photography)

The first few weeks at home with a preemie can be especially trying. No matter if your preemie was born at 26 or 36 weeks, here are a few things to keep in mind

1. I Got The Thermoregulation Blues

Your preemie lacks the subcutaneous fat necessary to keep herself warm unless she is sufficiently wrapped. You don’t have to crank up the thermostat to 80F (after all, Eskimos have babies, too), but a wise parent wraps the baby in more than one layer.

For the first day or so, take baby’s temp before feeding or bathing, just as you did in the hospital. Then you will know how she reacts to what is normal environmental temperature for your household. Add or subtract layers accordingly.

Place the thermometer under the arm.

Remember: Normal = 98F-99F

Over 100F = could be a sign of illness; remove one layer and                                     check again in 30 minutes

Over 101 F= call your healthcare provider

Another hint: do NOT use a heating pad to warm the crib. Better to warm blankets by tossing in the dryer on ‘delicate’ for 5 minutes.

Recognize cold stress: cool hands/feet, sleepy, poor feeding.

Recognize heat stress: warm to touch, red, crying, may have ‘prickly heat’ rash.

2. Feeding Frenzy?

Preemies may need to eat every 2-4 hours to consistently gain weight. Do NOT let the baby sleep more than 5 hours the first few weeks, or until your healthcare provider tells you to do so.

Breastfeeding? Avoid fasting during the night to keep your blood sugar from dropping too low. Think about it: the baby is taking nourishment from you; you need replentishment!  Those decreased hormones of pregnancy can cause postpartum depression…and hypoglycemia makes it worse.

Set up a Breast Feeding Station for nights. Before turning in, arrange a plate of wholesome snacks, and a pitcher of juice and/or water at your station. (You don’t need to drink milk to make milk.)The idea is to achieve economy of movement, establish a routine and avoid the kitchen at night.

Here‘s how: go potty, wash hands; change diaper, cleanse hands; feed baby and yourself simultaneously! The whole session should take about 30 minutes.

3. Don’t Be The Rabbit

Preemies are by definition immunosuppressed. It may take up to two years to fully gain immunity to the big, wide, world we live in. Meanwhile, what ‘s a preemie parent to do? Go ahead…be the Nazi. You have our permission to blame the NICU Docs and Nurses, who implore you to guard the health of your preemie.

Here’s how:

  • wash hands after every diaper change;
  • limit visitors, (keep sickies away!)
  • play the ‘NICU card’ for Doctor’s appointment times (early or latest in the day),
  • keep up with routine vaccinations (talk to your healthcare provider about seasonal RSV and flu innoculations)
  • DO NOT ALLOW SMOKING anywhere around the baby (Research shows second-hand smoke can be deadly to infants!)

4. When to call your Healthcare Provider:

  • fever > 100F(axillary)
  • Listless/floppy
  • Excessive crying with no known cause
  • Vomiting and/or Diarrhea
  • Poor feeding
  • Redness, swelling or foul smelling drainage from any body part
  • Yellowing skin or eyes
  • No stool for 48 hrs
  • < 6 wets a day
  • White patches in mouth

5. When to call 911 :

Baby turns blue or pale

Extreme difficulty breathing

When all else fails, do what parents have been doing for centuries: trust your gut. YOU are the best advocate for your child because YOU know her better than anyone. If something seems wrong, it probably is. Better to seek help than regret you didn’t.

Candace Campbell, MSNc, RN, has practiced as a NICU nurse, and educator for 20 years. Her documentary film, Micropremature Babies: How Low Can You Go? plus her delightful children’s books, My Mom Is A Nurse, and Good Things Come In Small Packages (I Was A Preemie),are available on Amazon.com or at:   www.CandyCampbell.com

A part of the profit from each book and film goes to The March of Dimes.

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More Preemies in the News

Posted by candy on Jan 15, 2013 in Uncategorized

A new study from Canada shows that preemies who are now in their 20’s  fare well in the long run. Most have jobs, and are living independently. This study included 130 families of babies with birth weight less than 900 grams, but none less than 700 grams, born between ‘77-’82. Many had at least one neurological problem, including cerebral palsy. A major limitation is that most families in the study were white, relatively well-educated and higher-income, and covered by Canada’s universal healthcare system, so the results are not necessarily the same as the general population. Families with lower incomes, less education or less access to healthcare may  face greater challenges, including (not easily quantified) more stress and strain on the family unit. (Source: Pediatrics June 7, 2010)

We need more studies to continue to follow families of extremely preterm children born in more recent years,like the a certain docu featured on this website!

And here’s news,from the June issue of Health Watch, of a study that parallels some ad hoc research I’ve conducted informally for many years as a NICU nurse, singing softly to preemies:Kangaroo care

“We took healthy premature infants, the ones that are in incubators… and let them hear music by Mozart and compare their energy expenditure, how much energy they spent just lying there while listening to music compared to a period without music at all,” said Dr. Ronit Lubetzky of the Tel Aviv Medical Centre.

The effect was not surprising. The babies’ vital signs reflected a more restful state within 10 minutes of listening. In general, more rest = more weight gain = less time in hospital. That’s another win-win !

Stay tuned to more news on the preemie baby front.

Your comments and questions welcomed.




Preemies in the News- Documenting Common Sense

Posted by candy on Jan 15, 2013 in NICU, Preemie

(This article by Candy the Nurse first appeared in Dec. 2010)

Two news items about preemies were reported in the past two weeks which were indirectly linked. Holding preemie hand

First, a study published by the Journal of Developmental & Behavioral Pediatrics
discussed qualitative research with 59 parents who participated in a read-aloud-to-your-preemie-in-the-NICU program. The follow-up telephone survey showed that this activity resulted in parental feelings of increased closeness to their infants.

Nothing new there.

The second item, from the journal, Cerebral Cortex, states preemies who hear their mother’s voice are able to distinguish mom’s voice from other voices, plus stimulate an emotional response. Furthermore, when preemies hear a nurse or other voice, researchers saw an entirely different ECG response, i.e., no stimulation to the emotional brain centers.

Again, this is intuitive.

Any parent, and those of us who have worked in the field of neonatology, could attest to the validity of this research… for free. Nevertheless, research is important to build an evidence-base with which to more closely plan our interventions.

Since the economy is tight, I’m glad at least some folks found work as researchers!

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Concerned About Infertility?

Posted by candy on Jan 15, 2013 in Infertility, NICU, Preemie

Are you one of several million couples over the age of 30 concerned about infertility ? Do your eggs have stress fatigue from standing too long at the ’start’ line ? Is your sperm count waning because you are overweight? What’s the difference bewteen IVF and IUI? What’s the latest in genetic infertility research?

These and other HOT  topics were covered in the sweltering heat at the SMART ART conference in Las Vegas on Artificial Reproductive Technology (ART). Candy the Nurse was pleased to be one of the breakout session presenters, hosting the topic (what else?) “Psychosocial aspects of parenting a very low birth weight baby.”


Merck Pharmaceuticals sponsored this three day assembly where some of the best and brightest researchers and clinicians from the US and Canada shared updates on the state of the ART of the science of infertility.

Some nurses were invited to attend thanks to a grant from Merck. We thank you!

Participants agreed  that an ethical continuum exists  on one side, helping families longing for a child, to the other, which   stretches waaaay over to where Eugenics lurks in the midst of murky decisions. Surely, the next ten years of medical technological breakthroughs promise many changes in this young science.

The Renaissance Hotel proved a lovely and quiet refuge to study and discuss. The hotel and SMART ART staff went above and beyond to make attenders feel welcome.

Keep an eye out for interviews with several of the speakers, to be posted soon as your nurse here can eke out a few minutes to edit the audio files.


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Pump for Your Preemie

Posted by candy on Jan 15, 2013 in NICU, Preemie
(Reprinted with permission from Healthy Mom & Baby  magazine and Health4Mom.org)
Expert advice on pumping for your preemie
By Candy Campbell, DNPc, MSN-HCSM, RN, CNL
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Are you the mom of a preemie who dreads pumping milk at night while the baby is in the NICU? You’re not alone. Who can blame you? It’s inconvenient. It interrupts your sleep. And perhaps you’re discouraged that even though you are pumping every 2-3 hours during the day, your milk supply is also dwindling.While there is no solution to the fact that your milk supply follows the simple principle of supply and demand (i.e., if the demand exists, the supply will follow), there are a few simple strategies you can use to help support your milk supply.

Set up a pumping station

This would be ideally placed in a comfortable, well-lit area away from your partner (no need for you both to lose sleep). Before you retire for the evening, cover a plate of healthy snacks (e.g., celery and peanut butter, apples and cheese, or any protein/fruit/veggie combo that doesn’t require refrigeration) and place it at your cozy spot. Add a pitcher of iced water (or water plus juice), a photo of your newborn, headphone access to soothing music, and you’ll be good to go when the alarm clock buzzes.

Pump efficiently

Try to limit the whole pumping routine to less than 30 minutes. Sit comfortably upright at your prepared place (good lung expansion increases milk flow), attach the pump on both sides simultaneously (you can rent or buy a dual electronic breast pump), and start snacking. Then rise, empty your bladder and wash your hands. You may be tempted to skip this step, but omit it at your peril—breast infection, or mastitis—may be the painful result. Pump for 20 minutes, refrigerate or freeze your milk, rinse your equipment and head back to bed.

Making milk

Research shows there are 5 simple prerequisites for making milk:

  • Increase nutrition: 500 calories a day is recommended
  • Increase fluid intake: 10-12 glasses of water or other non‑caffeinated and non-sugary drinks are best
  • Decrease stress: this is hard; your baby is in the NICU!
  • Get lots of sleep: another hard one!
  • Stay on schedule: pump milk every 2-4 hours round the clock

Tempted to skip the snack?

Don’t—it will help keep your blood sugar level in a more even state, which in turn serves to increase estrogen and prolactin levels that help elevate both your mood and your lactation supply. You should see improved milk results in a day or two.


Hello world!

Posted by admin on Nov 30, 2009 in Greetings all, NICU, Preemie

baby ultrasound Preemie Parents, everywhere!

Here in this blog, you will find  info that I hope you will find helpful to ease your journey along the bumpy road of the NICU and beyond…

Scroll down for previously published articles and thoughts. Please feel free to leave  a comment. I’d love to hear more from those of you who are enjoying the preemie book.

Meanwhile, reflect that this is a very good time to have had a preemie. The medical community has come a long way, baby, in so far as knowing how to best care for your precious bundles.

Wishing you many parental blessings,

Candy the Nurse


Sing to Your Baby!

Posted by admin on Nov 23, 2009 in NICU, Preemie
(Reprinted with permission from Health4Mom.org)
by Candy Campbell, DNPc, MSN-HCSM, RN, CNL
AWHONN’s Neonatal Nurse Expert
Premature infants thrive when parents spend lots of time interacting with them.
NICU parents: Do you feel anxious, frustrated, aching to do more for your premature baby’s growth and development besides pump that milk, and sit and stare?

You are not alone.


There is still much to learn, but every year researchers add to the evidence that premature infants thrive when parents interact with them. Each minute your preemie’s brain is making 200,000+ neural connections; early recognition of you as parent is key. Now we know that singing or humming to your baby elicits different but equally positive results that sounds from a non-parent or instrumental music alone cannot do.


If your baby is in the NICU, you’re likely to be asked to provide skin-to-skin holding, massage, and to read to your baby. Now, research is adding the benefits of adding humming or singing to your nurturing activities. And you’re in luck—you don’t need any special equipment, yet maybe you think, “I can’t sing!” Interestingly, babies don’t seem to mind the quality of the voice, as long as it is familiar and not too loud. So go ahead, hum a few bars…


As you belt one out, you may worry about “over-stressing” your preemie. Understanding her “stress cues” is the first step to knowing how to interact and improvise musically with your child. You don’t have to rhyme, and you needn’t make sense. Just go with the flow and see what happens. For instance, if baby is sleepy, hum a lullaby. If she’s awake, sing about what you feel, or see. Then pause. Wait for her response, and take it from there.


Psychologists tell us that quantity plus quality time are important prerequisites for establishing emotional bonds. Plan to spend as much time with your baby as possible. That’s a tall order if you have other children, or if you live far from the NICU, but well worth calling in the troops of willing friends and relations for help. Your presence is ultimately therapeutic for both you and your child. So hum or sing to your baby, and she may come home sooner than you think!


  • Shorter hospital stay
  • Increased weight gain
  • Increased oxygen saturation
  • Increased sucking
  • Decreased stress cues


  • Their mother’s voice over any other
  • Sung versus spoken words
  • Music; it encourages sucking behaviors
  • Singing; it strengthens their brain’s language paths
  • Humming; it strengthens music and rhythm paths

Candace Campbell, MSN-HCSM, RN, has practiced as a NICU nurse, and educator for 20 years and is an expert advisor to Healthy Mom&Baby magazine and Health4Mom.org.
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Hello world!

Posted by admin on Nov 23, 2009 in Uncategorized

© 2003 to 2017 Candy Campbell,MSN,RN - All Rights Reserved.