Last week, I described my visit to the Neonatal Intensive Care Unit (NICU) at Children’s Hospital. I reflected on my first encounter with a premature baby during my junior year rotation on pediatrics in medical school. Her mother had vanished soon after delivery. The tiny girl was cyanotic – a “blue baby.” Lacking many of the sophisticated diagnostic tools of today, the pediatrics professor diagnosed a condition for which there was no surgical therapy.
Dr. Clif CleavelandShe was placed in a glass-enclosed crib, sustained by supplemental oxygen and an intravenous line linked to a vein in her scalp. Other cribs were labeled with the names of babies. My patient was labeled “B.G. Williams,” the initials standing simply for Baby Girl.
My charge lived for a week. A wonderful nurse counseled me in the care of premature babies. When B.G. died one morning, we had a prayer and a brief moment of reflection before she was moved to the hospital morgue. Her autopsy confirmed a single ventricle in her heart.
Consider a hypothetical mother in 2017 who comes to a one of the 16 hospitals in the network for Children’s NICU. She is in advanced labor in the 28th week of her pregnancy. A transport team of a pediatrician or specialized nurse-practitioner along with a respiratory therapist immediately travels to the outlying hospital by ambulance or by helicopter, depending upon the urgency of the particular situation.
They carry a highly specialized, transport isolette – the glass-enclosed crib – that includes a ventilator for respiratory support and the capability to provide nitrous oxide for extreme respiratory distress. The team place a breathing tube, administer fluids, antibiotics and any other medications needed to make the subsequent transfer to the NICU as safe as possible. Sometimes hours are spent in the process of stabilization before the transfer can begin.
NICUs in Chattanooga, Atlanta, Knoxville and Nashville collaborate as needed. For example, if the transfer team of one hospital is engaged when another urgent request for help is received, a collaborating hospital will respond. If a complex heart defect is diagnosed in a premature baby at Children’s NICU, that infant will be transferred to Nashville for surgical treatment. All other health problems are managed by the team of caregivers at Children’s NICU.
Obstetricians who specialize in high-risk pregnancies may coordinate maternal transfers so the delivery can be managed at Erlanger Medical Center with immediate transfer of the newborn baby to the NICU. Perhaps a significant defect that may threaten survival is detected in a fetus by ultrasound, which will lead to a similar maternal transfer. Sometimes a woman in premature or difficult labor will appear in the Erlanger emergency department, having had no pre-natal care. No one is ever turned away. There is only one level of care and it’s geared toward excellence.
Babies in the NICU and their mothers have as much daily contact as feasible. By the time the baby has gained sufficient weight and strength to negotiate the transfer home, parents are fully versed in the care of their beloved baby.
When the new Children’s Hospital at Erlanger is built, the NICU will feature private rooms for each baby with sufficient room and privacy for a mother to remain with her child, rocking, touching and nursing as needed as well as having a place to rest and sleep.
In the NICU I witnessed a powerful combination of intricate technology, highly skilled staff and profound tenderness devoted to tiny, vulnerable infants who now have solid prospects for normal lives.
Contact Clif Cleaveland at ccleaveland@timesfreepress.com.