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Neonatal Intermediate Care Unit and the Road Home: Read Emily's Story
Date: 10/24/2012


When she woke up on Friday, May 18, Emily Kucker was not feeling well. As she had for the previous couple of days, the 32-weeks pregnant Hamilton resident was experiencing pain in her upper abdomen. Thinking it was heartburn, she went to work, but her body had other plans.


Emily was feeling worse as the day wore on and left early. She called her doctor’s office, RWJ OB/GYN Hamilton, to explain her symptoms.


“When I spoke with Dr. Flores, he said it was best to go to the hospital’s labor and delivery unit to see a doctor immediately,” explains Emily.


At the hospital, Emily’s worsening symptoms and lab work indicated she had preeclampsia, a pregnancy-induced condition which causes the mother’s blood pressure to rise, in some cases, very quickly to dangerous levels.


If left untreated, preeclampsia can advance to eclampsia, and in some cases the patient develops HELLP syndrome — a potentially fatal condition that can cause clotting problems and liver rupture. The only cure is delivery. “I was in a lot of pain. The doctor asked me to focus on him and said, ‘We have to deliver immediately. Your baby will be okay,’” Emily explains.


Marilyn Giorgi, MD, board certified neonatologist was on duty that day.

“When Emily’s husband, Mike, arrived just minutes before she delivered, I let him know we were fully prepared for the delivery. Although 32 weeks is certainly pre-term, I was confident the baby would be okay,” she recalls.


Emily, whose condition had advanced to HELLP syndrome, was brought into the operating room for an emergency caesarean section.


Dr. Giorgi and her team stood by as the on-call obstetrician delivered a 3 lb. 2 oz Jackson Kucker. At once, Jackson was placed on a CPAP machine to help him breathe and his condition was evaluated in RWJ Hamilton’s neonatal intermediate care unit.


Emily was placed in recovery and her condition began to improve.


Arriving eight weeks early, Jackson had his fair share of challenges coming into the world — most of which are shared by many newborns in the neonatal intermediate care unit.

Immature Lungs
– CPAP machine helped him breathe for the first six days

Temperature – a temperature-controlled baby bed regulates his body temperature

Nutrition – feeding support and assistance from the nursing staff to help mom transition Jackson to breastfeeding

Jaundice – photo therapy for six days to help his liver do its job

Low Platelets – Jackson’s low blood platelets were monitored

Apnea of Prematurity – caffeine therapy and an apnea monitor to indicate Jackson would stop breathing for 15 to 20 seconds during sleep, causing his oxygen levels and heart rate to drop


“This is not what you’re expecting when having a baby,” says Dr. Giorgi. “The care and attention these babies need is atypical and parents can be overwhelmed. We are here to get them through it so they can take their healthy babies home.”


To go home, Jackson needed to meet certain criteria in each of his areas of challenge. With the exception of the apnea, which is being treated on an outpatient basis, Jackson passed with flying colors.


“We took him home after 33 days. He was a healthy 5 lbs. 2 oz. when we left the hospital. The nurses gave us a lot of guidance to prepare us and now he’s doing really well,” Emily says.

At Home with Infant Apnea

To keep an eye on Jackson’s apnea after they were sent home, the Kuckers were set up with a portable apnea monitor.


A representative came to their home to train them on the monitor. Connected to Jackson with wires affixed to the child’s skin with a safe adhesive, the monitor tracks Jackson’s breathing activity and heart rate, and then keeps a report of the data.


At a follow-up consultation at the infant apnea program at Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital in New Brunswick, Emily and Mike meet with a physician to review reports generated by the apnea monitor. These will indicate to the physician whether Jackson’s apnea has resolved.


Typically apnea goes away in time with no residual effect, but it can be both exhausting and intimidating for new parents. The infant apnea program at RWJ’s Children’s Hospital offers new parents a way to understand what is going on and know what to look for.



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