Taking ‘Baby Steps’

NICU nurses make virtual house calls with new grant

Like every expectant parent, Yui Matsuda hoped for an uneventful delivery and a healthy baby. But moments after giving birth, the first-time mom learned her newborn would have to be admitted to the neonatal intensive care unit (NICU). “Our son was only in the NICU for four days, but it felt like forever,” says Matsuda, an assistant professor at the School of Nursing and Health Studies. “Some babies stay for months.”

However long they stay, babies receive round-the-clock specialized care in the NICU, and their families come to rely on the expertise of highly skilled NICU nurses. But what happens when it’s time to graduate from that protective environment, where lifesaving bonds have been formed? Even Matsuda, a nurse educator with access to an array of peers in her profession, found that prospect unsettling. “The anxiety and stress I felt as I went home with my son was very difficult,” she admits.

For advice and reassurance, Matsuda turned to friend and colleague Danielle Altares Sarik, Ph.D., APRN, CPNP-PC, a pediatric nurse practitioner and research nurse scientist at Miami’s Nicklaus Children’s Hospital. From their conversations grew a plan to help other parents of NICU grads better navigate the critical transition from hospital to home.

Thanks to a three-year grant from the Florida Blue Foundation, Sarik and Matsuda’s proposal, “Baby Steps:  A Telehealth Nursing Intervention to Improve the Transition to Home for Pediatric Patients,” is now a reality for parents at Nicklaus Children’s, where each year, more than 800 critically ill newborns from Florida, Latin America, and the Caribbean receive complex care. Most infants admitted to the NICU weigh under three pounds and stay over a month. Some return home with assistive medical devices, such as tracheostomies, G-tubes (a tube inserted through the belly that brings nutrition directly to the stomach), and ventilators.

“Caring for an infant is one thing, but caring for infants with multiple special needs makes it much more complex, so having the support of a NICU nurse after discharge is very important for families,” says Matsuda, the project’s co-principal investigator with Sarik. Baby Steps makes culturally tailored telehealth nursing services provided by a Nicklaus NICU nurse available to parents for free, five days a week through a simple Facetime-like app called Pediatric Virtual Care.

Nicklaus nurse interventionist Maria Miranda, R.N., RNC-NIC, CLC, was among the first bedside NICU nurses trained for this new telehealth position. When the service launched in April, Miranda explains, she fielded a number of COVID-19-related calls, like “who was able to visit, what they should do to keep the baby from getting sick, etc.” Otherwise, her advice runs the gamut, from which diaper rash cream to use to identifying signs and symptoms of seizures. “The parents say they really like having someone they can talk to about their child’s care,” says Miranda. “And if they need to show me something on the baby, they can show me through the app.”

Students in Matsuda’s Public Health Nursing course complete a clinical rotation by observing and simulating this telehealth nursing intervention, exposing them to what may be a growing trend in nursing. In this pilot year, Matsuda and Sarik hope to serve 125 families. They believe access to a novel telehealth service like theirs, where caregivers initially connect with their NICU telehealth nurse in person at the hospital, will have measurably positive effects on both caregiver confidence and patient outcomes, such as significant reductions in hospital readmission rates and unplanned emergency care use.

The investigators credit Florida Blue Foundation, Nicklaus Children’s Hospital Foundation, and the Nicklaus NICU and telehealth teams for significant collaborative contributions. “This is something I would have loved to have had when I gave birth to my son,” says Matsuda, “so I’m very excited that we have been able to realize ‘Baby Steps’ in a tangible way and offer it to families.”

This article originally appeared in the Fall 2020 issue of Heartbeat.