Anna Zimmermann, MD, MPH

The Lessons I Have Learned from NICU Families

Disclosures

• I have nothing to disclose

• I have no financial incentives related to this talk

• All pictures included in this presentation are from NICU families who have

given written permission to Mighty Littles and Dr. Anna Zimmermann for use in media content and presentations.

Learning Objectives

• Describe two or more changes that can be made in your NICU routine to minimize miscommunication and improve consistency between care providers and families.

• List at least two key factors causing families anxiety at the time of discharge, particularly for the most medically fragile infants.

About me

MD, MPH

• Full-time clinical neonatologist in an 80-bed Level IV NICU

• In private practice for over 10 years

• International NICU experience

• Director of quality and education

for the NICU where I work

Anna ZimmermannMama

• Struggled with recurrent miscarriages and infertility.

• Mom of 3

• My babies were not in the NICU

• Preterm labor with both pregnancies

• Postpartum hemorrhage with both

pregnancies

• Complete failure with breastfeeding

• Children hospitalized 3 times

Anna Zimmermann

Mighty Littles

• Started in 2020

• Initial idea was for the Mighty Littles

Book, currently in production stage

• Added a Podcast - now weekly

• Collaborations with parents,

physicians and organizations in the US, Canada, NZ, UK

• Commitment to share all NICU stories and up to date practical NICU education

Anna ZimmermannWhat you can expect from this talk

• Chronological order - before, during, and after NICU

• Personal stories from NICU families I have interviewed

• General themes of inclusion and communication run through nearly every interview

• What is next?

Outline

Prenatal Consults

• Facts…just the facts.

• Statistics only get you so far

• Universally, families want to be given

hope. And they will hold onto that hope no matter how small.

• Focusing on negative outcomes often does not change parental decision making, but can put huge barriers in place for forming trust and strong relationships

• “Won’t know til baby is born”

• Uncertainty and lack of control can feel

paralyzing for some families

Honesty is Key

It Won’t Be Us…Denial is a coping mechanism which allows families time to process what is coming at them.

The initial coping mechanism

• Keep taking bump pictures believing you will get to term

• Hearing outcomes about Congenital Diaphragmatic Hernia but believing it won’t be you

• Having your baby go for Body Cooling, but talking about the weather and what is on TV.

Denial

Inclusion

Family description at admission

• Foreign and technical

• Intimidating

• Overwhelming sadness

• Total disconnect from reality

• Isolating and lonely

• Loud

The NICU is…

Don’t Touch!It is all in the messaging.

For Moms and Babies

• Connection and belonging

• Improved milk production

• Improved HR stability

• Improved temperature stability

• Improved CR stability

• Improved weight gain

Importance of Touch

Encourage

Hand Hugs

and

Head Hugs

Early

Canada & Uganda

Family Integrated Care in the NICU

Shoulda, Coulda, Woulda

If Only….

Consensus / Communication

Home? Say What?

Family description at discharge

• Safe and secure

• Comfortable

• Supportive

• Family

The NICU is…

Don’t Get Addicted to My Monitors!

Who You Gonna Call?

• Start early

• Define follow up

• Care coordinators - one call

point person after discharge

• Use personal equipment at hospital prior to discharge

• Opportunity to room in overnight

Discharge Planning

Community and Connection