Tiny triplets get special care at hospital's neonatal center
URBANA – Curled up inside his nice warm incubator, Jacob Pickett opens his eyes wide and squirms – all 2 pounds, 15 ounces of him – as his dad reaches in to change his tiny diaper.
Mom is busy at another incubator, changing the diaper of Jacob's brother, Zachary, and in a third incubator draped with a pink blanket, the boys' sister, Katelyn, is sleeping soundly.
Anne Pickett finishes the diapering first.
"You done already?" her husband, Tom, asks, looking up with a smile. "Come take a look at his."
These are precious hours of the day for the Picketts, of Heyworth, who drive to Carle Foundation Hospital in Urbana to be with their triplets every afternoon after Tom gets off work.
The babies were born Nov. 19 – three months early and less than 3 pounds apiece – and are still too small to leave the hospital.
The Picketts say they don't know how soon they'll be able to take their babies home, but they accept they need to be in the hospital right now, given their fragile condition.
"To be honest with you, we just take it milestone by milestone," Tom Pickett says.
He and Anne remember the day they learned they were having triplets, and how they kept looking at each other in amazement and saying, "Triplets!"
"It was a bit of a shock," Anne recalls.
Having the babies at Carle, though, was planned.
Anne's was a high-risk pregnancy, and there are only two hospitals in this part of the state that carry "Level 3" designations, meaning they can care for the highest-risk expectant mothers and newborn infants. One is Carle, and the other is St. John's Hospital in Springfield.
With a due date of Feb. 11, Anne Pickett was on bed rest for a good portion of her pregnancy and spent about five weeks in a Bloomington hospital before she was transferred to Carle in the 24th week.
"They were expecting that the triplets would come early," she says.
They did, at 28 weeks.
Katelyn was born first, weighing 2 pounds, 10 ounces. Jacob followed a minute later at 2 pounds, 6.5 ounces. And Zachary came along another minute later, the smallest of the three at 2 pounds, 5 ounces.
Posing for a News-Gazette photographer on a recent December afternoon, Anne cuddles both her sons against her chest, one in each arm. The boys' sister is still sleeping peacefully, but neonatal intensive care nurse Sara Dalbey says she just can't bear to see Katelyn left out of the pictures.
The Picketts readily agree, and Dalbey gently lifts their daughter out of the incubator and places her in between her brothers.
The Picketts say they're grateful their triplets weren't born with the severe breathing problems that cause so many preemies to wind up on ventilators. But even without more severe problems, Katelyn, Jacob and Zachary have had breathing lapses since their birth.
"That's another reason we don't get hung up on when they're coming home," Tom says. "These babies can take a turn at any point. Although they're doing great, they're doing wonderful, we try to be realistic about it."
The Pickett triplets arrived in the neonatal intensive care unit at Carle just the way medical experts want them to in a high-risk birth: Anne was already in the hospital where the babies would receive their care, so they weren't subjected to a move.
"Our goal is to transfer the (expectant) moms, not the babies," says Donna Belcher, manager of Carle's neonatal intensive care unit, commonly referred to as the NICU (pronounced "nick-you.")
That's because in a premature birth, the baby's lungs and other major organs are still underdeveloped, and the baby's immature nervous system can't adapt to normal levels of noise, light and movement.
Typically, a baby born around its due date and without complications fully adjusts to breathing and regulating body temperature out in the world within six hours after birth, says Carol Beyer, director of nursing for Carle's women and childrens' department.
Premature infants, however, "just can't make that transition on their own," she says. They need to be enclosed in a warm environment and might need mechanical help breathing for extended periods.
It's so important to keep disruption to a minimum, the Carle nurses say, that the hospital has included a dedicated elevator in a recent expansion project that will whisk high-risk newborns directly from labor and delivery on one floor to a new neonatal intensive care unit on another.
Belcher is looking forward to the NICU's move to new quarters. The current one is crowded, and the families of the babies are sorely lacking the privacy they need for such an emotional time of their lives, she says. The 28-bed NICU, set to open early next year, was designed with more room for the families, who will each have their own semiprivate spaces in one large unit.
Belcher, who has been a neonatal intensive care nurse for more than three decades, remembers in the mid-1970s when it was rare for a baby born as early as 28 weeks to survive. The 1990s brought new technology that can help today's babies survive a birth as early as 23 and 24 weeks, though they're still considered high-risk – and even that extra week between 23 and 24 makes a big difference in lung development, she says.
Beyer says she has seen too many complications arise during a birth to ever consider having a baby outside a hospital.
"I had a friend ask me if I'd ever consider a home delivery," she recalls. "I said, 'No, not on your life. I could not live with myself if something went wrong.' "
Most of the babies in Carle's NICU were born prematurely, but a handful end up there for other reasons – infections, a difficult labor and delivery, birth defects and genetic abnormalities, Beyer and Belcher say.
No matter how sick their babies are, the parents are encouraged to spend as much time as they can with them in the hospital, and to hold their infants against their chests in skin-to-skin contact known as kangaroo care.
"It's beneficial to the baby and the parent. It helps with that bonding process," Belcher says. "Plus, they stay very warm next to the parent's chest. It's like a natural incubator."
One of the most telling signs of just how much equipment is used to help these babies through their first few months of life is the wall full of electrical outlets at each incubator.
Display screens over each incubator show each baby's vital signs, such as blood-oxygen level, respiration rate and heart rate.
Monitors connected to the babies go off periodically because preemies simply forget to breathe at times, Belcher and Beyer say.
This can be terrifying to the parents, but usually it just takes a little stimulation – rubbing the baby's back – to restart breathing, the nurses say. All the parents are offered a chance to learn this technique, along with CPR, during their babies' stay in the hospital.
There was a time when a premature infant had to reach 5 pounds to be taken home, but not anymore, Beyer says.
These days, there is no minimum weight – though the babies must be able to eat normally, maintain their temperature, be gaining weight and able to get home in a car seat or car bed. And the parents must be capable of providing support at home.
Beyond the babies' medical needs, the hospital offers services for the families, among them a pastoral care nurse who provides moral support to the parents, and a social worker to help the parents cope with daily commutes, care for their other children at home, a place to stay in town, meals at the hospital and helping make arrangements for help upon the baby's discharge.
A baby's stay in the NICU is tough enough for two-parent families in which husband and wife have each other to lean on, Belcher says. The stress kicks up to a whole other level for single teen mothers giving birth to a baby with severe medical complications.
"We don't have the Brady Bunch families," she says. "You have a 15-year-old mom with a 17-year-old sister for her support person. That's reality."
Party of Five
The Picketts, both analysts for State Farm Insurance, met in Georgia in 1997 at a super-visory development school. They married two years later.
"We didn't talk about starting a family until a couple of years after we were married," Tom recalls.
It took three years and the help of in vitro fertilization, the Picketts said, but they got the good news in June that Anne was pregnant. And about a week after that, they learned they were expecting triplets.
Because Anne was on bed rest and in the hospital for so much of the pregnancy, she and Tom say they haven't gotten the nursery ready or the baby supply shopping done yet.
But they've had loads of support from friends, neighbors and coworkers who have brought a steady supply of home-cooked meals, gift certificates and offers to help, Tom says.
"It's just been one of those things that you wonder how you're going to be able to pay those people back in some way," he says.
When they're at the hospital, the Picketts take over much of their babies' care. They give sponge baths inside the incubators, change diapers and hold their children while they are fed breast milk through tubes in their noses. Diaper changes and feedings are coordinated, so the babies burn off as few calories as possible in the process, Tom says.
"They burn a lot of energy even changing their diapers," he says.
Plans for after the babies come home are still being worked out, the Picketts say, but they're hoping their parents will be able to come help on rotating weeks.
Meanwhile, the babies gradually are putting on weight and each taking in about 8 ounces of breast milk a day – an ounce at a time.
And, tiny as they are, boys will be boys: Already, Jacob and Zachary seem to move around a lot more than their sister does.
"They were kicking each other last night," Tom says.