All was quiet and the lights were dim in one of the now-occupied nurseries in the new neonatal intensive care unit (NICU) at Sacred Heart Medical Center one recent afternoon.


The nurses just cant get used to it, Jean Kelleher, nurse manager of the NICU, says of the lack of noise.


The nurses are used to bright fluorescent lights overhead and continuous noise from beeping heart monitors, noisy ventilators, and other whirring medical equipment, all of which is used to help high-risk and premature babies, weighing as little as 15 ounces, survive life outside of their mothers wombs.


The nurses also are used to hot, cramped quartersbut not anymore.


The new NICU, which opened late last month, is located on the third floor of Sacred Hearts new $100 million west tower addition and occupies 27,000 square feet of floor space, up from the roughly 5,000 square feet of space it had occupied in the hospitals main building. The new unit is part of the Sacred Heart Childrens Hospital, which occupies space on the third floor of the hospitals main building, east tower, and now the west tower. The various areas of the Childrens Hospital are connected via sky bridges.


The new NICU contains three separate nurserieseach with a different wall color that parents can remember to find their infant. The blue and pink nurseries each house eight semiprivate rooms that encircle a central nurses station, while the purple nursery houses six semiprivate, similarly configured rooms. All but one of those 22 rooms has two patient bedsthe other, located in the purple nursery, has three bedsgiving the unit 45 semiprivate beds.


In addition, two rooming-in rooms, which are located near the pink nursery and are used by families who have babies that are nearly ready to go home, can house one infant bed each, giving the NICU a total capacity of 47 beds. The rooming-in rooms resemble a master bedroom, including a bed for a babys parents, and are designed to give parents some practice in caring for their child on their ownwhile still just a call button away from a nursebefore heading home.


Monitors located near each of the units infant beds display a babys heartbeat, blood pressure, and respirationall without making a sound. The new silent monitors sound only if a babys vital statistics drop below certain levels. Then a soft dinging sounds to notify a nurse.


New ventilators, which breathe for babies electronically, also are silent, except for a four-toned tune that tells nurses perhaps a baby has begun breathing on his or her own or the ventilator has become disconnected.


The new nurseries also have a variety of lighting options, such as central overhead lights that are controlled by a dimmer, under-counter lights in the semiprivate rooms that allow nurses to do their charting, and recessed-can lighting at each patients bedside that can be dimmed.


Weve really focused on minimizing stimulation, Kelleher says. Were learning that by decreasing noise, light, and touch were really doing these babies a big favorand our nurses benefit, too. She says that the decreased stimulation helps reduce pain for the babies, encourages their development, and helps reduce the nurses stress levels.


From four beds to 47


Sacred Heart developed its first NICU in 1972. It consisted of four beds tucked into the back corner of the well-baby nursery on the main hospital buildings ninth floor. By 1976, the number of neonatal intensive care beds had increased to 12, which were located in three separate rooms, and the unit was given its own nursing staff.


In 1980, the NICU that had been used up until recently was built. The space contained three long banks of electrical outlets into which personnel could plug pieces of medical equipment to support babies. A total of 18 cribsarranged side by side in three rowscould be placed in that one nursery.


It was state of the art at that time, Kelleher says. She adds that most NICUs across the country still are arranged that waywith all of the beds in one large, open area.


During the following 24 years, as demand for neonatal intensive care grew, small spaces throughout the hospitals ninth floor were converted to help support additional infants.


It was piecemeal at best, Kelleher says.


She says that cramped NICU cared for as many as 42 infants at one time on three separate occasions in the last three years. The NICU typically cares for between 20 and 30 babies on any given day. Those babies weigh an average of about 2 1/2 pounds each. Kelleher says that she expects the new NICU to reach full capacity in the future, although she says she cant predict how long that will take.


Peggy Mangiaracina, assistant vice president and director of Childrens Services at Sacred Hearts Childrens Hospital, recalls how in the old unit electrical cords from medical equipment lay all over the floor, and at times, nurses had to bend down under an infants crib and crawl on the ground to plug in an additional piece of medical equipment.


In the new unit, each semiprivate room is equipped with two movable booms in opposite corners of the room. The booms are vertical columns that hang from the ceiling on an articulating arm and contain electrical outlets, suction capabilities, and gas lines that provide oxygen and compressed air. A device can be attached to the boom to allow the oxygen and compressed air to be blended at a specific ratio and administered to a particular baby. The vertical booms replaced the long rows of electrical outlets along the wall and allow nurses to connect medical equipment more easily. The new booms also negate the need for many of the electrical cords that had littered the floor of the old unit.


Another concern with the old unit was that there wasnt much room for parents, Kelleher says, adding that parents often felt as though they were in a nurses way.


Parents, obviously, were upset over what they were going through and mothers were trying to pump breast milk and there just wasnt any privacy, Kelleher says.


The only private room was an isolation room, which was small and had a see-through sliding glass door that allowed the space to be closed off from the rest of the nursery. That room was reserved for babies who were having trouble breathing or who had cardiac anomalies.


Now, parents have a dedicated sitting area near their infant in each semiprivate room. Theres also a comfortable couch on which parents can sit and view informational videos or DVDs on a large-screen TV at the far end of each of the three nurseries.


Outside of the nurserieselsewhere within the NICUare two rooms where mothers can go to pump breast milk for their babies privately, if theyd rather not do that by the babys bedside.


We want families to know that their babies and they come first, and next come the needs of the nurses, Kelleher says.


Parents even were asked to participate in the design of the new unit. As a result, a resource room filled with educational materials and computers was developed. The room is attached to a large family waiting room, which is located across the hall from the units secured entrance. The resource room contains three laptop computers, a desktop computer, and a printer, all of which were donated by Bank of America. All of the computers offer Internet access, although the laptops allow visitors to access only certain Internet sites, such as informational sites about various syndromes that affect premature infants and on how to care for premature or high-risk infants, as well as parent support group chat rooms.


Next door to the family waiting room is a room furnished by the Sacred Heart School of Nursing Alumni, with a sofa bed, bedside table, and phone. Its called the quiet room and is for parents who arrive with their baby via MedStar in the middle of the night. It gives them a place to settle for the night so that they dont have to worry about making sleeping arrangements while trying to admit their baby into the NICU. Its also available for parents who have a child in NICU that isnt doing well or didnt survive. They are able to use the room to make phone calls and grieve in private, Kelleher says.


The nurses and NICU staff members gained a large classroom; a nurses lounge; a quiet room in which physicians can dictate medical chart notes; an auxiliary secretary station that can be used by physicians, insurance auditors, and caseworkers; and a dedicated elevator that allows NICU nurses to descend quickly to the Birthing Place operating rooms one floor below, where Cesarean sections are performed.


Up until now weve had people working in spaces the size of closets, Kelleher says. But with this new addition, everyone has been given the gift of space.


The unit also has a nutrition center in which breast milk is cataloged by name and date, and bottles are prepared for each baby in a clean, controlled environment. Before, nurses used to prepare bottles for each baby at the babys bedside, Kelleher says.


This is a huge advancement for preventing contamination, Kelleher says.


Butterflies and window boxes


The new NICU has a whimsical, almost magical feel.


From the third floor of the main hospital, a person walks through a skywalk to the west tower. The floor and ceiling of the skywalk is bright blue and soon will have imitation butterflies dangling from the ceiling. Just beyond the skywalk is an imitation tree, the trunk of which has been hollowed out so that children can walk through and hide inside.


A few more steps and one approaches the entrance to the new NICU. Parents are told to follow a cobblestone path, which consists of cobblestone-colored tiles inset into the hospitals floor. The path leads to an oversized door, flanked by bright yellow trimmed stained-glass windows complete with window boxes that soon will hold silk flowers.


Once at the door, parents must ring a doorbell, which buzzes the nurses station inside. Parents are asked to identify themselves and show their arm bracelet to a device at the door.


If their bracelet matches that of their baby inside, theyre allowed to enter, wash their hands, and proceed to the nurses station.


We wanted to have some whimsical touches to help parents and family members take their mind off of what theyre going through, Mangiaracina says.