Live from the NICU: University of Iowa hospital explores new way for parents to keep tabs on ill newborns

IOWA CITY — Every tiny fist, every open eye, every infant smirk — whether gas-induced or not — is a big deal to new moms and dads getting the first glimpse of their newest family member.

So missing those milestones and moments of connection can further aggravate the anxious experience of seeing a newborn whisked away to the neonatal intensive care unit — or NICU.

“When we were checking out, it was like we were leaving with a little stranger because — at that point — I had held him for maybe 10 minutes,” said Blake Rupe, 35, of Iowa City, who on Feb. 24, 2020, gave birth to a son with low blood sugar and a fever. “They decided they would have to take him down to give him a treatment course for what they were presuming was sepsis, which was terrifying.”

Raven Rupe, now about to celebrate his third birthday, stayed in the University of Iowa Hospitals and Clinics NICU for only three days before being discharged. But during his stay, Rupe — recovering herself — saw him just two to three times, each visit brief.

“By the time I would get there, I would have to turn around and go back to get my own vitals,” she said. “It would have been really nice to be able to check in and see how he was doing.”

The UI Stead Family Children’s Hospital is considering installing a NICU camera system that would allow families of intensive care infants to do just that — watch a livestream of their baby stretching and arching and blinking or just sleeping.

“I didn't know that such a service like this could be an option — it didn't occur to me that this could be a thing. But now that I know about it, I really would like it to happen,” Rupe said. “That would be such a great service for parents, even family members that aren’t able to be in the hospital.”

'Best practice in many NICUs’

The university in November began looking for an “established and proven” comprehensive “web video streaming solution” to provide video access to family members of babies in its NICU — which includes 88 beds in private and semiprivate rooms spread over two units.

The university’s NICU annually admits about 1,000 babies from Iowa and neighboring states — reporting a 95-percent survival rate among all its infant patients. For premature babies born 27 weeks of pregnancy or after, UIHC’s survival rate is 96 percent or higher.

Among babies born at 22 weeks, UIHC’s survival rate is 57 percent — higher than the 30 percent reported last year nationally and 7 percent reported nationally between 2008 and 2012.

UIHC hasn’t used a NICU bed camera system before — positioning the prospect of one as a potential new service to families, according to Emily Spellman, associate director of neonatal services at the UI Stead Family Children’s Hospital. Web camera systems are, she said, used in other NICUs nationally “to support family-centered care.”

“These systems allow families to have a safe, secure connection to view their baby while they are not able to be present,” she said. “This helps to build trust with families and increases satisfaction and family participation when they are not at the bedside.”

Although Rupe’s Raven was in the NICU just a few days, many babies stay for weeks or months.

“Parents have to return to work before the baby is discharged or care for other children at home so cannot be present at all times,” Spellman said. “This allows for parents to see their baby through a safe, secure connection when they are unable to be here in the NICU.”

The university’s request for system proposals closed in December, although officials haven’t chosen a vendor or signed a contract. UIHC hasn’t publicly projected what a camera system would cost, should it choose to install one. But, according to Spellman, a “generous donor has provided funds to support this project, which will impact many families in our NICU.”

“Camera systems are becoming a best practice in many NICUs and fits with our core tenet of patient and family-centered care,” she said. “It is something we have wanted to provide for families for many years and, thanks to the donor, now have the opportunity to do so.”

Hope to install some this spring

Vendors interested in the UIHC project were asked to describe their web video streaming systems — including hardware capabilities and limitations, mounting possibilities, camera adjustment options, video resolution and other features.

“We anticipate that if we are to implement a camera system, we would implement it for all of the beds in the units,” according to UIHC’s request for proposals, but saying full installation might not happen all at once.

To choose a camera system, UIHC said it will consider how patient families can access the video; the livestream, photo, audio and replay options; the language possibilities; and whether the family can send and receive messages, comments and alerts.

UIHC also requested specifics about access, like whether a camera system limits livestream logins per patient; can be transferred if a baby switches units; and how families are disconnected or decommissioned once a baby is discharged.

“Please explain the security of the proposed solution,” UIHC’s request says.

System suppliers had to propose an implementation timeline — describing how long it would take to get a system up and running, including employee training and patient family support.

“We hope to install the camera system and pilot in some NICU beds this spring,” Spellman told The Gazette.

The idea, she said, is to allow parents and family to livestream a NICU bed “with only the baby on camera.”

“Parents will sign an agreement for use,” she said. “Families will use their own device or may have the ability to check out a VPN encrypted device to take home with them to view their child. Only the parents will have access to the secure link and those they choose to share it with.”

'Super amazing’

Given the stress separation can cause families, Spellman said, NICU cameras could help health care workers by increasing parent satisfaction and “putting them at ease that they can see their baby when not able to be present.”

Rupe said her own mom experienced that frustration 35 years ago on Oct. 13, 1987, when she gave birth to Rupe and her twin sister, Blaire. At 28 weeks along, the twins were 2 pounds when delivered via emergency C-section and rushed to UIHC’s NICU.

“She says she didn't get to see us until we were three days old, and that entire time she was convinced we were dead and they just wouldn't tell her,” Rupe said of her mom’s experience. “We stayed in the NICU for three months, and a lot of that were in little incubators.

“She would have loved to see a monitor or video feed of us in NICU.”

Jill Pick’s daughter, Lincoln, spent 44 days in the UIHC NICU — having been born in 2014 at 29 weeks in Waterloo and brought by ambulance to UIHC. In utero, she wasn’t getting enough of her mother’s blood supply, hindering her growth and movement.

Lincoln’s lengthy NICU stay divided her family, as Pick’s husband returned home with their oldest daughter; their middle child stayed with grandparents; and Pick stayed with Lincoln — albeit apart from her in the hospital.

And even though Pick stayed, she didn’t get as much time with her baby as she wanted.

“There were times I remember coming to check on her in the middle of the night and her being surrounded by a team because something had happened,” Pick said. "There was that moment of, ‘I'm your mom, and I don't even know what's going on.’ So you do feel that disconnect.”

The nurses were incredible, she said, leaving morning notes with hand prints and updates on Lincoln’s condition. But a live video feed would have been “super amazing.”

“My husband had to go back to work, so he just got a phone call update from me or whatever pictures I would send — his connection with her was in my control,” Pick said. “So for him to be able to peak in on her or check on how she's doing … It would be so neat to give that to whoever you feel like you want to be a part of it.”

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