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Seeing smiles in the Neonatal Intensive Care Unit

New clear masks approved, adopted for parent, primary caregiver use in the OHSU Doernbecher NICU
A mother holds her infant daughter, with her smile visible through a clear mask.
Mikal Mele-Ludtke holds her daughter, Marley Ludtke, in the OHSU Doernbecher NICU. The unit recently received approval for parents and caregivers to wear reusable clear masks so neonates can see faces and help practice visual development. (OHSU)

Bonding with babies after delivery is important in forming a strong attachment between newborns and parent(s) or primary caregiver. This is an ongoing process, and one that can be interrupted by the need for medical care and the time required for parents to recover from their own procedures.

For families with babies requiring high-level care in a Neonatal Intensive Care Unit (NICU), that first initial breach of bonding can be a traumatic experience for everyone involved. Learning to navigate new diagnoses, procedures and equipment can be overwhelming.

“Parents are really craving ways to bond with their babies,” said Emily Spaeth, a neonatal physical therapist in the OHSU Doernbecher NICU. “Our nurses do an incredible job getting parents involved in care.”

When Mollie Poor, a registered nurse in the OHSU Doernbecher NICU, saw a new opportunity to help facilitate that bonding, she acted quickly. Due to COVID-19, NICU visitors have been required to wear masks at infants’ bedsides for the last several months, which means their babies can’t fully see their faces

“So much of how babies learn is by copying the expressions of those around them,” Poor said. “When I saw in a COVID-19 update that we had clear masks available, I knew I needed to fight for our families to get them.”

Poor got to work making a formal request with OHSU Health leadership.

On Aug. 25, visitors who arrived to visit their infants were greeted with a new mask option: a clear plastic shield with two foam strips. The masks can be re-used by the same person after disinfection.

One of those parents, Mikal Mele-Ludtke, was able to look down at her daughter, Marley, while wearing the new mask for the first time.

“I think this is an awesome opportunity,” Mele-Ludtke said. “I feel so fortunate that the nursing team is trying to innovate and get creative on ways for parents to connect with their babes – they truly want what’s best for the babies in every single aspect of their care.”

Marley was born at 29 weeks and 1 day via emergency cesarean section delivery and has been in the OHSU Doernbecher NICU since July 10. 

“Having a child during a global pandemic is scary enough. It never would have crossed my mind that wearing a mask would run the risk of delaying Marley’s development,” Mele-Ludtke shares.

An infant’s visual system is the last sensory system to develop, and it’s the least developed system at birth. The final alignment and organization of columns and connections in the visual cortex is driven by sensory experience. For a neonate, the most salient visual stimulation is a parent’s face.

Spaeth says the ability to see contrast in facial features – like lips, nostrils and eyebrows, helps with infants’ visual tracking. This developmental ability should be fully mature six to eight weeks after a baby’s due date, but emerges around 36 weeks for babies who are born prematurely, so they can start practicing tracking before term.

“When masks are covering a caregiver’s mouth and nose, it makes it impossible for babies to see them smile,” she said. “Smiling is one of the most important ways we communicate with one another.”

And, it turns out, it’s how babies learn to smile themselves.

“One of the ways that we learn social interaction is by copying faces,” Spaeth said. “It’s essential for babies to be able to see these facial contrast lines, because that’s all they can see at first. Their brains are changing so quickly, it’s unbelievable.”

The new masks have made a big difference for parents and caregivers, too.

“I’ve already seen so many happy parents whose babies finally get to see their faces,” Poor said. “It’s been so rewarding for me to see the big smiles on a mom’s face as she breastfeeds her baby, or a dad doing his first diaper change with the mask.”

Balancing the need to protect families and employees in the midst of a pandemic with the many other demands that go hand-in-hand with NICU care is challenging.

“I wouldn’t wish this journey on anybody, but all things considered, it’s been a really positive experience,” Mele-Ludtke said. “My husband and I are forever grateful for the nurses in the NICU and it is extra reassuring that they are doing everything they can to ensure COVID doesn’t affect the babies more than it has to.”

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