Spanish for NICU nurses — the first hold after six days at the isolette, the NG-to-breast transition at day 44, and the family meeting after a grade III IVH
Day six in the NICU. Marisol Fuentes, 28, arrived at 8:10 AM the same way she has arrived every morning since her daughter was born: by the elevator, turn left, second door, same chair. The chair is two feet from Valentina’s isolette. Marisol has never moved the chair closer. She does not know she can.
Valentina was born at 32 weeks and 2 days, weighing 1,480 grams, after a placental abruption. She was intubated in the delivery room. By day 3 she was extubated to CPAP. By day 5 she was on low-flow nasal cannula at 1 liter, FiO2 21%. Today she is 1,540 grams — up from her day-3 nadir of 1,380 grams — and her temperature is stable in the isolette. Her oxygen saturation is 94–96% on room air at low flow.
The NICU nurse today is Carla. She has not had this family before. She reads the chart before she goes in. The chart contains, in the nursing notes, three entries over the past four days that say: “skin-to-skin discussed with mother.” There is no note about what was said, what Marisol understood, what was prepared, or whether an invitation that was acted on was extended. Carla looks at Marisol through the window for a moment before going in. Marisol is looking at Valentina’s chest rise.
Carla goes in.
What this post covers
This post covers three scenarios from the NICU, all involving Spanish-speaking families at inflection points that the standard NICU nursing visit often misses. The first scenario is Marisol and Valentina — the mother who has been at the bedside every day and has never been clearly told she can hold her daughter, and the nurse who makes the invitation explicit and then carries it through. The second scenario is Gloria Vásquez and Camilo — a mother who pumped eight times a day for 44 days expecting the first breastfeeding attempt to work the way she remembers from her older child, and the nurse who explains what a practice feed actually is before the disappointment happens. The third scenario is Luciana and Roberto Reyes — the parents of a 25-week preemie who have just learned their son Diego has a bilateral grade III intraventricular hemorrhage, and the nurse who comes in at 3 PM, after the attending has left, to receive what the family has been sitting with for the last ninety minutes.
These three scenarios do not share a patient. They share a structure: a family at the moment the standard visit fails to reach them, and a nurse who goes past the standard visit. In each case, the specific Spanish phrase is not decoration. It is the mechanism by which the failure is repaired or prevented.
Scenario one: the first hold
Carla sits down next to Marisol and introduces herself. Before anything else, she asks:
— ¿Cuánto tiempo lleva viniendo todos los días?
How long have you been coming every day?
Marisol: — Desde que nació. Seis días.
Since she was born. Six days.
Carla looks at the chart note entries — “skin-to-skin discussed” on days 3, 4, and 5 — and asks a question she would not need to ask if any of those notes had contained an answer:
— ¿Le han explicado qué es el método canguro — cargarla piel con piel?
Has anyone explained what kangaroo care is — holding her skin to skin?
Marisol: — Más o menos. Me dijeron que era bueno. Que ya pronto podía. Pero no me dijeron cuándo.
More or less. They told me it was good. That soon I could. But they didn’t tell me when.
Carla does not explain why the previous conversations did not produce an invitation. She moves directly to the thing that matters:
— Hoy, si quiere, puede cargar a Valentina. No tiene que esperar más.
Today, if you want, you can hold Valentina. You do not have to wait any longer.
Marisol looks at her. She does not say anything immediately. Carla waits.
Marisol: — ¿Ya está lista para eso?
Is she ready for that?
— Sí. Valentina tiene la temperatura estable, está en cánula de flujo bajo, y ha estado subiendo de peso. Está en un momento en el que el contacto piel con piel le hace bien — a ella y a usted.
Yes. Valentina has a stable temperature, she is on low-flow nasal cannula, and she has been gaining weight. She is at a point where skin-to-skin contact is beneficial — for her and for you.
The preparation: what Carla does before the hold
The invitation is not the end of the conversation. It is the beginning of a preparation that Marisol needs to see and understand before she holds her daughter for the first time. Carla does not assume that Marisol’s relief at hearing “today” means she knows what happens next.
— Antes de que la cargue, le voy a explicar exactamente qué voy a hacer y qué va a ver. Primero voy a preparar el cuarto: pongo la silla reclinada más cerca, muevo el cable del saturométro para que no haya tensión, ajusto la cánula para que le quede bien cuando la tenga en el pecho. Después la transfiero — ella no se desconecta de nada, yo la muevo con todos los cables puesto. Y me quedo aquí mientras la tiene.
Before you hold her, I am going to explain exactly what I will do and what you will see. First I will prepare the room: I move the reclining chair closer, rearrange the oximeter cable so there is no tension, adjust the nasal cannula so it fits well when she is on your chest. Then I transfer her — she does not disconnect from anything, I move her with all the cables on. And I stay here while you have her.
Marisol nods. Carla continues:
— Si suena una alarma mientras la tiene, eso no significa que usted hizo algo mal. Significa que el monitor está trabajando. Yo leo las alarmas. Su trabajo es quedarse quieta, respirar normal, y hablarle si quiere. Su voz es lo que Valentina más reconoce de todo lo que hay en este cuarto. La ha oído desde adentro.
If an alarm sounds while you are holding her, that does not mean you did something wrong. It means the monitor is working. I read the alarms. Your job is to stay still, breathe normally, and talk to her if you want. Your voice is what Valentina recognizes most of anything in this room. She has heard it from inside.
Marisol: — ¿Puede oírme?
Can she hear me?
— Sí. A las 32 semanas el oído ya está funcionando. No como el de un adulto, pero sí distingue voces. La suya es la que ha oído por más tiempo.
Yes. At 32 weeks the hearing is already functioning. Not like an adult’s, but she does distinguish voices. Yours is the one she has heard the longest.
Carla prepares the room. This takes four minutes. She moves the chair to twelve inches from the isolette, repositions the cable from the pulse oximeter, checks the nasal cannula prongs. She unbuttons Valentina’s onesie and removes it, leaving Valentina in a diaper and a small knit hat. She asks Marisol to unbutton her shirt enough to hold Valentina skin to skin at chest level. She shows Marisol where to put her hands: one at the base of Valentina’s head, one supporting her lower back and hips, the baby positioned chest-to-chest with her head to one side so the nasal cannula rests against Marisol’s collarbone and the tubing runs across Marisol’s shoulder. The oximeter probe transfers from the isolette monitoring system to the portable unit that will travel with Valentina.
Carla counts to three and moves Valentina from the isolette to Marisol’s chest.
The hold
Valentina’s oxygen saturation at the moment of transfer: 94%. Heart rate: 148.
Marisol does not move for the first six minutes. She breathes in small increments, as if she is afraid to expand her chest too much. She looks down at Valentina and does not look up.
Carla sits at the edge of the room and watches the monitor. At minute three, Valentina’s saturation is 97%. Heart rate 144. At minute six, saturation 98%, heart rate 138. At minute eight, saturation 99%.
Carla says, quietly:
— Puede respirar normal. Su respiración le hace bien.
You can breathe normally. Your breathing is good for her.
Marisol takes a full breath. Her shoulders drop half an inch.
At minute twelve, Marisol says: — ¿Me puede oír si le hablo?
Can she hear me if I talk to her?
— Sí. Dígale lo que quiera decirle.
Yes. Say whatever you want to say to her.
Marisol says: — Valentina.
Just the name. She says it three times, in a low voice. The third time, she says: — Soy tu mamá. Ya te tengo.
I am your mother. I have you now.
Valentina’s saturation: 99%. Heart rate: 132.
Carla does not say anything. She documents on the bedside tablet: SpO2 improved 94% → 99% during skin-to-skin contact. HR normalized from 148 to 130–134 bpm. Infant stable throughout. Mother tolerated well. No alarms requiring intervention.
The hold lasts 58 minutes. Marisol does not want to stop. Carla explains that 60 minutes is the target for the first session and that they can extend the next hold, and Marisol says: — ¿Mañana puedo volver a cargarla?
Tomorrow can I hold her again?
— Sí. Todos los días. La enfermera que la cuide mañana lo va a saber — lo escribo en las notas de esta noche.
Yes. Every day. The nurse who takes care of her tomorrow will know — I will write it in tonight’s notes.
Carla writes, in the nursing note: First facilitated skin-to-skin contact, 58 minutes. SpO2 improved and maintained at 99%, HR stabilized. Infant and mother tolerated well. Mother highly engaged, spoke to infant by name. Recommend facilitated skin-to-skin contact offered at start of each shift. Mother available bedside daily. Note that prior nursing notes document “skin-to-skin discussed” on days 3, 4, 5 without record of a facilitated hold. Today was mother’s first hold.
The note that matters
Three previous nursing notes said “skin-to-skin discussed.” None of them produced a hold. Carla’s note ensures the next nurse does not have to rediscover whether this mother has held her daughter. The note contains the specific instruction, the specific clinical response, and the specific fact that today was the first time. The next nurse who reads this chart will know that this mother held her daughter for 58 minutes and that Valentina’s saturation improved to 99% and held. She will not have to wonder whether the invitation was extended. She will know it was, and she will know it worked.
A nursing note that says “skin-to-skin discussed” is a note about a conversation. A nursing note that says “first facilitated skin-to-skin contact, 58 minutes, SpO2 94% → 99%, HR normalized, mother and infant tolerated well; recommend daily facilitated contact, mother available bedside” is a note about an intervention and its outcome. The next nurse who reads the second kind of note knows what to do on day 7 without having to ask anyone.
Scenario two: the NG-to-breast transition
Baby Camilo was born at 30 weeks, weighing 1,320 grams, to Gloria Vásquez, 31. He is now on day 44 of his NICU stay, at 36 weeks corrected gestational age, weighing 2,190 grams. He has been on NG tube feeds since day 2, when parenteral nutrition transitioned to enteral feeds of expressed breastmilk. He has been receiving bolus NG feeds for the past twelve days, taking 55 mL every three hours without residual.
Gloria has pumped eight times a day, every day, for 44 days. She has not missed a pump session. She has a 3-year-old at home named Dante who breastfed for 14 months, and she knows what breastfeeding looks like. She has been waiting to do it again with Camilo since the night she pumped for the first time in a hospital lactation room while her son was under a warming light twenty meters away.
The feeding team has cleared Camilo for breastfeeding practice. The assessment: ready to attempt breast, goal 10–15 minutes at breast before NG completion of remaining feed. The NICU nurse today is Raquel. This is the first breastfeeding attempt, and Raquel has read the feeding team’s note before going in to Gloria’s room.
The conversation before the attempt
Raquel sits down before she explains anything. Gloria has the nursing pillow already positioned. She is ready.
Raquel says:
— Señora Vásquez, antes de que empecemos quiero explicarle cómo va a verse esto — porque puede que sea diferente de lo que usted recuerda con Dante, y no quiero que esa diferencia la alarme.
Señora Vásquez, before we start I want to explain what this is going to look like — because it may be different from what you remember with Dante, and I don’t want that difference to alarm you.
Gloria: — ¿Diferente cómo?
Different how?
— La primera vez que un bebé prematuro intenta tomar del pecho, no es la misma que la primera vez que amamantó a un bebé de término. No porque usted haga algo diferente — sino porque Camilo todavía está aprendiendo a coordinar tres cosas al mismo tiempo: succionar, tragar, y respirar. Esa coordinación tiene que desarrollarse, y en un bebé prematuro se desarrolla con el tiempo y con la práctica. A las 36 semanas corregidas, muchos bebés en esta etapa todavía se están entrenando en esa coordinación.
The first time a premature baby tries to feed from the breast is not the same as the first time you breastfed a full-term baby. Not because you are doing something differently — but because Camilo is still learning to coordinate three things at the same time: sucking, swallowing, and breathing. That coordination has to develop, and in a premature baby it develops with time and practice. At 36 weeks corrected, many babies at this stage are still training that coordination.
Gloria listens. Raquel continues:
— El objetivo de hoy no es que Camilo tome toda su toma del pecho. El objetivo de hoy es que pruebe. Que sienta el pecho, que intente succionar, que coordinemos juntas. Si mama ocho o diez minutos y se queda dormido, eso no es fracaso — eso es exactamente lo que esperamos. La sonda va a completar la toma después. Eso está planeado, no es un plan B.
The goal today is not for Camilo to take his whole feed from the breast. The goal today is to try. To feel the breast, to attempt to suck, to coordinate together. If he feeds for eight or ten minutes and falls asleep, that is not failure — that is exactly what we expect. The NG tube will complete the feed afterward. That is planned, not a backup plan.
Gloria: — ¿Y la sonda sigue ahí después de la toma?
And the tube stays in after the feed?
— Sí. La sonda no sale hoy. La sonda sale cuando Camilo pueda tomar consistentemente el cien por ciento de su toma en un tiempo razonable sin cansarse. Eso no pasa en el primer intento — lleva días, a veces semanas. Lo que pasa hoy es que empezamos.
Yes. The tube does not come out today. The tube comes out when Camilo can consistently take one hundred percent of his feed in a reasonable amount of time without tiring himself. That does not happen on the first attempt — it takes days, sometimes weeks. What happens today is that we begin.
The attempt
Raquel positions Camilo at the breast. She uses a dancer hold — Gloria’s hand supporting the breast at the base with her thumb on one side and fingers curled under, chin slightly down, which gives Camilo a more stable target and supports his jaw during the suck. Raquel explains each adjustment as she makes it:
— Le voy a mostrar cómo sostener el pecho para que Camilo tenga más apoyo en la maníbula. Los bebés prematuros a veces necesitan que el pecho esté un poco más firme para poder succionar bien. Así.
I am going to show you how to hold the breast so Camilo has more jaw support. Premature babies sometimes need the breast to be a bit more firm to suck well. Like this.
At two minutes, Camilo latches. The latch is shallow by a term-baby standard — his mouth does not open as wide as it will in a few weeks — but he begins sucking. Raquel counts audible swallows. He sucks six times, pauses. Sucks four times, pauses. Sucks three times, pauses.
At minute seven, Camilo falls asleep at the breast. He has not fully let go. Raquel waits thirty seconds to see if he reinitiates. He does not. She looks at the scale weights — they weighed Camilo before the feed and will weigh him after. The pre-feed weight: 2,190 grams.
She removes Camilo gently and lays him on the scale. Post-feed weight: 2,198 grams.
Eight milligrams.
Raquel says:
— Ocho mililitros.
Eight milliliters.
Gloria looks at her. She is trying to decide if that is good.
— Ocho mililitros — eso es real. Que Camilo sepa coordinar esos ocho mililitros es lo que hoy nos dice que el proceso puede seguir. Que Camilo haya coordinado succionar, tragar y respirar el tiempo suficiente para transferir ocho mililitros — eso es lo que hoy estamos buscando. No el volumen. La coordinación.
Eight milliliters — that is real. That Camilo can coordinate those eight milliliters is what today tells us the process can continue. That Camilo coordinated sucking, swallowing, and breathing long enough to transfer eight milliliters — that is what we are looking for today. Not the volume. The coordination.
Gloria: — Pero con Dante era diferente desde el principio.
But with Dante it was different from the beginning.
— Dante nació a término. Camilo nació diez semanas antes de que esos circuitos estuvieran listos. Dante nunca tuvo que aprender eso — su cerebro ya lo sabía cuando nació. Camilo lo está aprendiendo ahora, seis años antes de lo que un cerebro empieza a aprender en condiciones normales. Lo que hizo hoy es exactamente lo que corresponde a esta etapa.
Dante was born at full term. Camilo was born ten weeks before those circuits were ready. Dante never had to learn that — his brain already knew it when he was born. Camilo is learning it now, six weeks before the brain learns it under normal conditions. What he did today is exactly what corresponds to this stage.
Gloria is quiet for a moment.
— ¿Y cuándo va a poder tomar todo del pecho?
And when will he be able to take everything from the breast?
— Esa es la pregunta que vamos contestando con los intentos. Cada día que practicamos, la coordinación mejora. En dos semanas muchos bebés en esta etapa están tomando el cincuenta por ciento de su toma del pecho. Después de eso, la sonda va disminuyendo — no de golpe, sino gradualmente, a medida que Camilo puede más. La terapeuta de alimentación va a revisar con usted cómo va avanzando. Pero ese camino empieza con el día de hoy, con esos ocho mililitros.
That is the question we answer with the attempts. Every day we practice, the coordination improves. In two weeks many babies at this stage are taking fifty percent of their feed from the breast. After that, the NG tube decreases — not all at once, but gradually, as Camilo can do more. The feeding therapist will review with you how it is progressing. But that path begins today, with those eight milliliters.
The NG tube delivers the remaining 47 mL over the next twenty minutes. Camilo sleeps through it. Gloria watches the pump and does not look disappointed. She looks like someone who understood what she was told.
What this conversation prevents
Without the preparation Raquel gave before the attempt, Gloria would have experienced the following: her first breastfeeding session with her son, after 44 days of pumping, lasted eight minutes. He fell asleep. He took 8 mL. A tube fed him the rest. If no one told her in advance what eight minutes and 8 mL meant at 36 weeks corrected, she would have concluded, reasonably, that breastfeeding had failed. She might have offered less at the next attempt, holding back some of her anxiety by reducing her investment in the outcome. She might have stopped asking to try. She might have quietly decided that pumping was what she was capable of doing for Camilo and let go of the idea that he would ever feed directly from her.
The conversation that happens before the first attempt determines how the mother understands every attempt that follows. An 8-mL transfer after eight minutes is an excellent first practice feed for a 36-week-corrected premature infant. It is only excellent if the mother knows it is excellent before the feed happens, not after she has had time to measure it against a full-term feeding session in her memory.
Scenario three: the grade III IVH family meeting
Baby Diego was born at 25 weeks and 1 day, weighing 730 grams, to Luciana Ramírez and Roberto Reyes. He is on day 8 of life. A routine head ultrasound on day 7 showed bilateral grade III intraventricular hemorrhage — bilateral germinal matrix hemorrhage with extension into the lateral ventricles and ventricular dilation.
The neonatologist met with Luciana and Roberto at 1:30 PM with a trained Spanish interpreter by phone. The meeting lasted twenty-two minutes. At 2:55 PM, the NICU nurse assigned to Diego — Ana — goes in to check on the family before the next assessment. The interpreter has been released. The family is in the room. Roberto is in the chair next to Diego’s isolette. He has not moved from the chair since the meeting. Luciana is standing at the window, looking out. She has been crying.
Ana checks Diego’s vitals first. He is on CPAP at 6 cmH2O, FiO2 28%, heart rate 158, temperature stable. She adjusts nothing. She turns to the family.
— Buenos días — soy Ana, la enfermera de Diego esta tarde. ¿Cómo están?
Good afternoon — I am Ana, Diego’s nurse this afternoon. How are you doing?
Roberto: — Tratando de entender.
Trying to understand.
Ana sits down in the second chair, not standing.
— ¿Me pueden contar qué entendieron de lo que les explicó el doctor esta tarde?
Can you tell me what you understood from what the doctor explained this afternoon?
What asking the question reveals
Roberto: — Que tiene sangre en el cerebro. Que eso puede causar problemas. Que no saben qué va a pasar.
That he has blood in his brain. That it can cause problems. That they don’t know what is going to happen.
Luciana, from the window, without turning: — Que puede necesitar una cirugía. Que puede no desarrollarse normal.
That he may need surgery. That he may not develop normally.
Ana notes what is there and what is not there. The grade — what grade III means versus grade IV — is not in either description. The monitoring plan — the repeat head ultrasound in one week — is not there. The cause — why this happens in premature infants and what it means about causation — is not there. What is there is the three most frightening pieces: blood, surgery, development.
Ana does not correct what they have. She builds on it.
— Lo que me contaron — sangre en el cerebro, posible cirugía, incertidumbre sobre el desarrollo — es correcto. Eso es parte de lo que el doctor les explicó. ¿Me permiten agregar algunas cosas que pueden ayudarles a entender más?
What you told me — blood in the brain, possible surgery, uncertainty about development — is correct. That is part of what the doctor explained. Will you allow me to add some things that may help you understand more?
Roberto: — Sí.
Yes.
Explaining the grade
— El sangrado que tuvo Diego ocurre en una zona del cerebro que se llama la matriz germinal. Esa zona tiene vasos muy pequeños y frágiles en los bebés que nacen antes de tiempo — no están listos todavía para la presión de estar fuera del útero. Cuando esos vasos sangran, el sangrado puede quedarse en esa zona — eso se llama grado uno o dos — o puede entrar en los espacios donde circula el líquido del cerebro. Eso es lo que pasó con Diego. El sangrado entró en esos espacios y los está ensanchando. Por eso se llama grado tres.
The bleed Diego had occurs in a part of the brain called the germinal matrix. That area has very small and fragile vessels in babies who are born early — they are not yet ready for the pressure of being outside the uterus. When those vessels bleed, the bleed can stay in that area — that is called grade one or two — or it can enter the spaces where the brain’s fluid circulates. That is what happened with Diego. The bleed entered those spaces and is widening them. That is why it is called grade three.
Roberto: — ¿Y el cuatro?
And grade four?
— El grado cuatro es cuando el sangrado entra en el tejido del cerebro mismo — no solo en los espacios del líquido, sino en la sustancia del cerebro. El de Diego no es grado cuatro. Eso no significa que el grado tres no es serio — lo es. Pero no quiero que piensen que tiene el peor. No lo tiene.
Grade four is when the bleed enters the brain tissue itself — not only the fluid spaces, but the substance of the brain. Diego’s is not grade four. That does not mean grade three is not serious — it is. But I do not want you to think he has the worst. He does not.
Luciana turns from the window.
Explaining hydrocephalus monitoring
Ana continues:
— El grado tres nos preocupa por dos cosas. La primera es el líquido. El cerebro produce un líquido que normalmente circula y sale por canales naturales. Cuando hay sangre en esos canales, pueden obstruirse — y si eso pasa, el líquido puede acumularse y crear presión. Eso se llama hidrocefalia. No siempre pasa — estamos viéndolo activamente con ultrasonidos de la cabeza. Si pasa, hay maneras de tratarlo.
Grade three concerns us for two reasons. The first is the fluid. The brain produces a fluid that normally circulates and drains through natural channels. When there is blood in those channels, they can become partially blocked — and if that happens, the fluid can accumulate and create pressure. That is called hydrocephalus. It does not always happen — we are monitoring it actively with head ultrasounds. If it does happen, there are ways to treat it.
Roberto: — ¿Ese es el que necesita la cirugía?
Is that the one that needs surgery?
— Posiblemente, si ocurre y si la acumulación es significativa. Pero eso no lo sabemos hoy. El ultrasonido de la semana que viene — el que le van a hacer el martes — nos va a decir si los espacios están estabilizándose o si se están agrandando. Si se están agrandando, el equipo de neurología que va a verlo va a evaluar si es necesario intervenir y cómo. Esa decisión no se toma hoy y no se toma sin ustedes.
Possibly, if it occurs and if the accumulation is significant. But we do not know that today. The ultrasound next week — the one they will do on Tuesday — will tell us if the spaces are stabilizing or expanding. If they are expanding, the neurology team that will see him will evaluate whether intervention is needed and how. That decision is not made today and not made without you.
Explaining the development question
Luciana sits down now. She asks:
— ¿Va a poder tener una vida normal?
Will he be able to have a normal life?
Ana does not answer quickly. She sits with the question for a moment.
— Esa es la pregunta más importante que me pueden hacer, y quiero ser honesta con ustedes. No lo sé todavía. Y quiero explicarle por qué “no sé” en este caso no es que el equipo no tiene información — es que la información que necesitamos para contestar esa pregunta se va a ir generando a lo largo de meses y años, no en los próximos días.
That is the most important question you can ask me, and I want to be honest with you. I do not know yet. And I want to explain why “I don’t know” in this case does not mean the team has no information — it means the information we need to answer that question will develop over months and years, not over the next few days.
Luciana: — El doctor dijo que podría tener problemas del desarrollo.
The doctor said he could have developmental problems.
— Es correcto. Eso es verdad. Lo que puedo decirles es esto: hay niños con un sangrado como el de Diego que crecen y hacen cosas que el equipo no esperaba que pudieran hacer. Y hay niños que necesitan más apoyo durante más tiempo. No sé todavía cuál es la historia de Diego. Lo que sí sé es que el equipo va a seguir con él muy de cerca, y que ustedes van a saber lo que sabemos nosotros — no después de que lo decidamos entre nosotros, sino cuando lo sepamos.
That is correct. That is true. What I can tell you is this: there are children with a bleed like Diego’s who grow up and do things the team did not expect them to be able to do. And there are children who need more support for longer. I do not yet know which story is Diego’s. What I do know is that the team will follow him very closely, and that you will know what we know — not after we decide among ourselves, but when we know it.
The question that was not asked
Ana is quiet for a moment. Roberto is looking at Diego through the isolette porthole. Ana asks:
— ¿Hay alguna pregunta que todavía no me han hecho?
Is there a question you have not yet asked me?
Roberto does not answer immediately. Then, without looking away from Diego:
— ¿Por qué le pasó esto?
Why did this happen to him?
Ana recognizes the question. She has heard it many times. She knows what is inside it.
— El sangrado que tuvo Diego se llama hemorragia periventricular. Ocurre cuando los bebés nacen muy antes de tiempo — los vasos en esa parte del cerebro son muy frágiles a las 25 semanas, no están listos para la presión que viene con el nacimiento y los primeros días de vida afuera. El equipo hace varias cosas para reducir el riesgo — controlamos la presión arterial, evitamos cambios bruscos en la temperatura y el oxígeno, limitamos las manipulaciones en las primeras horas. Y aun así, a veces ocurre. No ocurrió porque ustedes hicieron algo. No ocurrió porque el equipo hizo algo mal. Ocurrió porque Diego nació antes de que esos vasos estuvieran listos.
The bleed Diego had is called periventricular hemorrhage. It occurs when babies are born very early — the vessels in that part of the brain are very fragile at 25 weeks, they are not ready for the pressure that comes with birth and the first days of life outside the womb. The team does several things to reduce the risk — we control blood pressure, avoid sudden changes in temperature and oxygen, limit handling in the first hours. And still, sometimes it happens. It did not happen because you did something. It did not happen because the team did something wrong. It happened because Diego was born before those vessels were ready.
Roberto nods slowly.
— Sé que esa pregunta a veces tiene otra pregunta adentro: ¿pudo haber sido diferente? Y la respuesta honesta es: hicimos lo que se puede hacer para proteger el cerebro de Diego en las primeras 48 horas. El sangrado no fue consecuencia de algo que faltó.
I know that question sometimes has another question inside it: could it have been different? And the honest answer is: we did what can be done to protect Diego’s brain in the first 48 hours. The bleed was not a consequence of something that was missing.
Luciana: — Gracías por decirlo.
Thank you for saying it.
Before Ana leaves
Ana stands to go. Luciana asks:
— ¿Usted va a estar mañana?
Will you be here tomorrow?
— No — mañana tengo día libre. Pero le voy a escribir en las notas de esta noche para que la enfermera que cuide a Diego mañana sepa exactamente qué les explicamos hoy y no tengan que empezar de cero.
No — tomorrow is my day off. But I will write it in tonight’s notes so the nurse who takes care of Diego tomorrow knows exactly what we explained today and does not have to start from zero.
Roberto: — ¿Le puede escribir que queremos hablar de nuevo con el neurólogo — con más tiempo, y con intérprete?
Can you write that we want to speak again with the neurologist — with more time, and with an interpreter?
— Se lo escribo ahora.
I will write it now.
Ana writes, in the nursing note: Family present at bedside, 3 PM visit. Post-family-meeting follow-up re: bilateral grade III IVH. Parents verbalized understanding of: germinal matrix hemorrhage mechanism; grade scale (grade III vs. IV); hydrocephalus monitoring via weekly HUS; neurology consult pending; developmental trajectory uncertainty — addressed honestly, no false reassurance given. Parents expressed grief and fear. Both parents asked to speak again with neurology with more time and with trained interpreter present. Interpreter not available at this visit; nurse-provided Spanish explanation delivered directly. REQUEST: schedule family meeting with neurology team, interpreter, and attending once neurology consult complete.
Practical phrases for NICU nurses
These eight phrases recur across the three scenarios above and apply to any NICU encounter with a Spanish-speaking family.
For the first hold:
Hoy puede cargarla. No tiene que esperar más. Yo preparo todo antes de que la toque y me quedo aquí con usted.
Today you can hold her. You do not have to wait any longer. I prepare everything before you touch her and I stay here with you.
For the alarm warning:
Si suena una alarma mientras la tiene, eso no significa que hizo algo mal — significa que el monitor está trabajando. Yo leo las alarmas.
If an alarm sounds while you are holding her, that does not mean you did something wrong — it means the monitor is working. I read the alarms.
For the voice question:
Su voz es lo que más reconoce de todo lo que hay en este cuarto. La ha oído desde adentro.
Your voice is what she recognizes most of anything in this room. She has heard it from inside.
For the practice-feed goal:
El objetivo de hoy no es que tome toda la toma del pecho. El objetivo de hoy es que pruebe. La sonda completa lo que falte — eso está planeado.
The goal today is not for him to take the whole feed from the breast. The goal today is to try. The tube completes whatever remains — that is planned.
For the 8-mL transfer:
Ocho mililitros — eso es real. Que Camilo sepa coordinar esos ocho mililitros es lo que hoy nos dice que el proceso puede seguir.
Eight milliliters — that is real. That Camilo can coordinate those eight milliliters is what today tells us the process can continue.
For asking what the family understood:
¿Me pueden contar qué entendieron de lo que les explicó el doctor?
Can you tell me what you understood from what the doctor explained?
For the IVH grade explanation:
El sangrado de Diego entró en los espacios del líquido del cerebro. Por eso se llama grado tres. No es el peor — el grado cuatro llega al tejido del cerebro, y el de Diego no llegó ahí.
Diego’s bleed entered the fluid spaces of the brain. That is why it is called grade three. It is not the worst — grade four reaches the brain tissue, and Diego’s did not reach there.
For the cause question:
No ocurrió porque ustedes hicieron algo. No ocurrió porque el equipo hizo algo mal. Ocurrió porque Diego nació antes de que esos vasos estuvieran listos.
It did not happen because you did something. It did not happen because the team did something wrong. It happened because Diego was born before those vessels were ready.
What connects these three scenarios
Marisol held her daughter for the first time on day 6 — not because Valentina was not ready on day 4, but because no one extended an explicit invitation. The chart said “skin-to-skin discussed” three times. Not one of those conversations produced a hold. Carla changed one thing: she said “today, if you want, you can hold her.”
Gloria understood that the first breastfeeding attempt did not fail because she was told before it happened what a practice feed was, what 8 mL meant, and why the tube completing the feed was planned and not a backup plan. Without that preparation, 8 mL after eight minutes would have been the beginning of a story about breastfeeding not working. With it, it was the first step on a path that started today.
Luciana and Roberto left the room on day 8 carrying three things that most NICU families in their position do not carry: an understanding of what grade III means and does not mean, an honest statement that the developmental future is genuinely uncertain rather than a reassurance that it will be fine, and a nursing note that records their request to speak with neurology again — with more time, with an interpreter — so the next nurse and the attending know it without being told again.
In all three cases, the Spanish phrase was not the point. The point was what the phrase made possible: a mother holding her daughter, a first feed that was understood rather than grieved, a family that did not leave with less than they came in with. The Spanish is what removed the barrier between the nurse’s intention and the family’s experience.
That is the work.
ClinicaLingo is language training for working US clinicians — not medical interpretation. For any clinical decision that depends on accurate communication, use your facility’s qualified interpreter or your language line. This post is for nurses. The clinical content is consistent with standard-of-care nursing practice; it is not a substitute for institutional protocol or physician guidance.
Practice clinical Spanish scenarios free →
Download the 50-phrase ED Spanish PDF →