Ten-month-old John Brignone is a record holder. He has spent more time in Utah Valley Regional Medical Center's newborn intensive care unit than any other baby in its history: his entire life.
John was born prematurely at 26 weeks, and his parents, Michael and Kerstin Brignone, literally watched their son complete his growth outside the womb. They watched one of his eyes, still fused shut when he was born, open; they saw his ears take shape as cartilage formed; and they watched as his skin, only one layer thick and translucent when he was born, thickened to form his body's protective cover.The Brignones accompanied their son to death's door and back again more than once, watching and participating in a miracle of human growth and medical science.
And they learned this: The bonds between parent and child can be formed despite a multitude of impediments. While the process for forming those bonds (gazing at, touching, talking to and caring for a baby) may be altered by an early birth, the end result is not. Parent and child develop a unique relationship that is the foundation of their life together.
In a year, approximately 4,500 premature babies are born at Utah Valley. Few will require as lengthy a stay in the ICU as John Brignone. But their parents will share similar feelings.
"We as a society have nine months to prepare for the birth of a baby, and we go through that preparation in stages," said Jim Boles, a medical social worker at Utah Valley Regional Medical Center. "If that process is interrupted, a parent's first thought is that they weren't ready for this. And then, when the child is placed in the ICU, families have ambivalent feelings. They've just had a baby, but is this a happy occasion or a sad one?"
They will wonder whether their baby will survive and whether it is in pain. And they will wonder about cementing their relationship with their baby in spite of physical separation, the circumstances surrounding the baby's treatment and the fact that they have been replaced as the baby's primary care givers.
"It is not true that parents won't bond to their baby if they don't immediately hold, love and care for them," said Alene Miller, a registered nurse in the ICU. "Years ago people never got to see their babies for the first 12 hours, and they still bonded."
In the ICU a team of doctors, nurses and specialists work to help the premature baby live. They also work to help baby and parents bond. The first step is for parents to understand their baby's situation and needs.
"The thing we've found in working with this situation all the time is that it is critical and important to do for the baby what needs to be done, and then to help the parents understand the situation," said Dr. Ronald Stoddard, a neonatalist at Utah Valley. "We don't look at it like we're just admitting a baby, we look at it like we're admitting a family."
According to Dr. Trevor McKee, a professor of child development at Brigham Young University, a preemie's state of development is different from that of a full-term baby, and until the physiological state is stable, bonding needs aren't primary.
"If parents know what the deficiencies are, know what developmental stage the baby is at, they can respond promptly and appropriately to the needs of the child," McKee said.
At Utah Valley Regional Medical Center this educational process begins when a mother is first brought to the hospital in premature labor.
"Dr. Stoddard came in while I was in labor and explained what was going to happen, what the ICU was like and showed us pictures of other babies born at the same stage of development so I wouldn't be shocked when I saw everything he was going to be hooked up to," Kerstin Brignone said. "At that point, I calmed down, because I knew what I was in for."
When the baby is stabilized, the doctor will meet with the parents to explain the baby's situation and what they can expect. This communication is continued throughout a baby's stay and contributes to parents and child bonding together.
By allowing parents 24-hour access to their babies, Utah Valley also facilitates parental-infant bonding. The amount of time that parents can spend may be affected by how far they live from the hospital and other commitments - to other family members and a job, for example.
"It is important that parents spend as much time as they can with their baby, although it is not necessary that they spend all their time at the hospital," Miller said.
One mother who lived a great distance from Provo left a journal at her baby's bedside and asked nurses to make entries about her baby's care. Although unable to be with her baby often, she still was able to be a part of what was happening to it.
While time may place some constraints on bonding, so can the baby's physical condition.
A premature baby's need for touch is quite different from that of a normal baby. Parents may have to adjust their conception of this aspect of bonding.
"A premature baby's nervous system is often so delicate that it can't take much touch," Miller said.
In fact, touching the baby excessively can cause it physical stress.
On the other hand, when touch is appropriate, some parents may be afraid to touch their baby for fear of hurting it. And, Miller says, because of the baby's sensitive nervous system, parents have to learn the appropriate way to touch.
"We teach them (when the baby is ready for it) to give a big touch, to hold its leg, to put their whole hand on its body," Miller said. "They don't like to be lightly jiggled or touched. It's like having a fly land on their skin when they are gently stroked."
The hospital also allows parents to participate as much as possible in caring for their baby, facilitating this bonding mechanism.