Could anyone doubt the health benefits of a camera that links newborn children in a neonatal intensive care unit (NICU) with their mothers?
Kim Ryan, a midwife at the National Maternity Hospital in Dublin, and her colleague Denise McGuinness first proposed the idea of introducing such a camera into the NICU at Holles Street a few years ago.
"The two of us were throwing out ideas and wondering whether there was anything that could be done to minimise the separation between mothers and their infants in the NICU," says Ryan. "We had heard of this web-camera thing that existed in other countries, but not in Ireland – a system whereby if a mother was physically unable to visit her baby postdelivery she could see the baby live on camera."
Ryan researched what camera technology options were available and in use in hospitals around the world, and which might be best suited to Holles Street. Based on that work, the hospital signed a contract for a NICU web camera with US-based Angle Ear Camera Systems to install the camera and supporting technology.
A single camera began operating in May 2016. At that stage, says Kim, it was used only for communication between mother and child within the Holles Street setting. For example, when a mother was in recovery in another part of the hospital, perhaps after having an emergency Caesarean section, while her newborn baby was in the NICU.
Between 70 and 80 families have now used the camera service, and from July 2017, a web link was established between Holles Street and St Vincent’s University Hospital, which is a few miles away. This was important in cases where the mother was transferred to St Vincent’s, for whatever reason, while her baby remained in the NICU, says Ryan.
Funding
There is a camera over the baby in the neonatal unit, and there is a web-based log-in process where the mother is the administrator and can add friends and family. The camera, along with lighting, the encrypted software and a 24-hour helpline, costs €2,900.
The issues of security, confidentiality and data protection had to be addressed to the satisfaction of everyone involved, says Ryan. There was a lot more to do than just setting up a Skype link. Parents could Skype from the NICU, she says, but they are not meant to use their phones there because they can interfere with the equipment.
The funding for the first camera was provided by the nursing and midwifery planning and development unit of the HSE. In 2017, a second camera was funded by Marie and Shane Fitzsimons, who lost their son Aidan after making use of the camera for his very short life. "They were willing to come in and talk to me the day after his funeral – to speak to the hospital, to tell the management how important this camera was to their son, who only lived for eight days," says Ryan.
A third camera was installed at the NICU following a corporate donation by Amgen, a biopharmaceutical company with an office in Dún Laoghaire. All three cameras are based at the Holles Street unit and have web links to St Vincent’s.
Impact
The rules governing visits to the unit are strict, and even siblings are not permitted to visit the baby for infection-control reasons. For grandparents, who are permitted to visit the baby, the visiting hours are limited to two hours a day.
“An easy way for them to see the baby is to log into the website where they can see the baby live,” says Ryan. “As well as that, there are aunties and uncles and family and friends around the world; this breaks a physical boundary.”
The cameras in the NICU have improved the bonding between mothers and their newborn babies and reduced the physically-separated mother’s anxiety, she says.
And she says the clinicians have reported that if a woman is able to watch her baby on the web, it can have a positive impact on her pressure readings and need for pain relief after an emergency section.
Expressing breast milk
The camera has also had a positive impact on the ability of mothers to express breast milk, as watching their babies helps trigger the release of oxytocin, which is the breast-feeding hormone, says Ryan. The ability to express breast milk has been shown to reduce susceptibility to post-natal depression. “Some women report a huge difference in what they are able to express by simply watching their baby. It’s all biology.”
Ryan would like to add the functionality that would enable the newborn to hear the mother's voice
And, of course, the availability of the mother’s breast milk can be vital for the infant in the unit because it can help the baby’s immature gut to develop.
In the near future, Ryan would like to add the functionality that would enable the newborn to hear the mother’s voice. “There is a microphone placed inside the incubator, which could enable the mother to speak, or sing, or whisper to the baby.”
Home
Ireland is coming late to the camera-in-NICU party. There are already multiple facilities providing camera links across the US. The UK has the technology too, as does Australia and the Netherlands.
“The next phase is home use,” says Ryan. “That’s what the ultimate value of the project is going to be. It’s going to be connecting parents and families with their baby in Dublin because – potentially – these families can be separated for three months if it is a very premature baby born at 28 weeks.
“Not everyone can visit the hospital. If you were in Mayo, the mother might be able to, but the father might have to go back to work. So, financially, geographically – everything – it might just not be feasible for a parent to be here always, and that can go on for weeks, if not months.”
