Inside the Neonatal Intensive Care Unit at the University of Maryland Medical Center you’ll find a very advanced level of neonatal care. With state-of-the-art equipment, advanced monitoring techniques and sophisticated medication, Neonatal Intensive Care Unit (NICU) specialists help vulnerable babies grow into healthy children. That journey is not purely a physical one. Many premature babies also struggle with developmental delays that must be identified and treated as early as possible. Early interventions are extremely powerful, and luckily for people in the Baltimore area, Professor Brenda Gardner is on the front lines identifying babies who may need treatment, working with families and making referrals to infant and toddler programs.
Evaluations start immediately in the NICU. As Doctor Gardner explains “high probability babies are any baby with a medical condition that puts them at super high risk for having difficulties with their development. The list includes conditions such as Down syndrome, experiencing a grade four hemorrhage, and chronic lung disease, but by far the most common way babies are identified as high probability is if they are born weighing less than 1200 grams (2.65 pounds).
The stress, shock and trauma of those initial days are intense. Doctor Gardner takes comfort in connecting parents with the programs, therapists and doctors that will be their lifeline for the coming years. “To meet someone who is going to come out to your home and help is so reassuring for families.” Parents who a few weeks earlier might have only been making decisions on what color to paint their nursery and which car seat to buy are suddenly faced with an overwhelming amount of information and choices that might be among some of the most difficult in their lives. Doctor Gardner is passionate about getting families all the information they need. “Many times I talk with parents who are trying to decide to continue care or withdraw support.”
Another way Doctor Gardner helps parents is to teach them the unique signals that premature babies use and the best way to respond to them. “Premature babies use three basic types of signals, approach signals, coping signals and avoidance signals.” Over stimulation is an issue with premature babies, so it is crucial that a parent or caregiver’s response is appropriate to the need and the amount of stimulation. As Gardner explains, “with each interaction we want to be sure that we are fostering growth.”
While these first days, weeks and months are critical, Dr. Gardner believes in taking the long view. “We tell parents that the ultimate goal is we want kids to reach their maximum potential and be ready for first day of kindergarten. It is a long road with many steps along the way and it begins to make more sense as parents begin to understand the difference between chronological age and adjusted age.
“Chronological age is the age of a child according to their date of birth, adjusted age is an official calculation that measures number of days a child was born prematurely. To calculate it, subtract the number of weeks they were born early from their chronological age. For example, a 10-week-old who was born 8 weeks early has a corrected age of 2 weeks old.” For those who need help figuring out the difference there is an App available on the Apple store called pediatricagecalc, which she proudly points out, was developed by her son. “I don’t get any royalties,” she admits.
Adjusted age helps parents understand where their children are developmentally and makes the milestones for success much clearer. Adjusted age is only used for 12 months. At that point, Gardner talks to the parents about transitioning to using chronological age. While the transition can be rough for parents, she tries to stresses the reasoning, “the ultimate goal is to get them to the place where they are doing the same things other children their age are doing. But in order to understand and appreciate all the success we need to see where we they are and how far they must go.”
Gardner tries to keep parents focused on their children’s success. “I tell them to push forward and assume their child can do everything.” The results are often remarkable and reassuring to other parents raising children with disabilities. “There have been many times where you meet these children and they are struggling as premature babies but you see them in middle school and they are developmentally fine.”
Adjusting to life with a premature baby can be overwhelming for many parents. Most commonly, a preemie might need to go back to the NICU for follow up visits, see a Pulmonologist, a Neurologist, a Gastroenterologist for their G-tube, and a Geneticist if they have a genetic condition such as Downs Syndrome. They might also be attending growth and nutrition programs among other therapies.
Scheduling the sudden explosion of medical and therapeutic visits takes a toll on new parents who are still often struggling with feelings of guilt or post-traumatic stress. Gardner makes it a priority to help these new parents understand these feelings and coaches them on the nuts and bolts of scheduling.
The massive amounts of appointments can be intimidating and affect the overall well being of families. “I walk them through it. We go over various scenarios and make choices. Ultimately I advise them to try and get all their services from one provider.” Some of her advice is a little more “hands on,” especially the tips on using baby massage to combat a typical preemie problem known as hyper elasticity.
“See the strength” is Doctor Gardner’s driving principle. It is a message she tries to impart to Doctors as well as parents. This year, she’ll being taking her message global when she goes to Saudi Arabia to attend a Neo-Natal Medicine conference. “I really enjoy and look forward to helping people think differently about things.”