The neonatal intensive care unit (NICU) is a special hospital department dedicated solely to caring for babies born prematurely or with serious medical conditions. In the NICU, doctors and nurses use medical equipment developed to care for and treat the tiniest of patients, providing hope to families and saving the lives of babies.
Coastal Virginia is home to Children’s Hospital of the King’s Daughters (CHKD), which has the region’s only level IV NICU, providing the most advanced medical care for infants. Dr. Tom Bass is a neonatologist at CHKD and professor of pediatrics at Eastern Virginia Medical School. “I’ve been practicing here for 30 years, and it has been exciting to see all of the advances that have occurred during that time,” he says.
One of those advances is the high-frequency jet ventilator. The machine breathes for the baby at a much more rapid rate than other ventilators. “It’s a safer way to ventilate the most critically ill babies, helping to reduce the risk of lung injury,” notes Bass.
Noninvasive positive-pressure ventilators are another form of assistance to help babies breathe. “This type of ventilator doesn’t require intubation and has been shown to help reduce the number of NICU babies requiring more invasive ventilation,” Bass says.
To protect a baby’s brain, NICU staff use cooling units to provide therapeutic hypothermia, also known as whole body cooling. Using either a cooling cap placed on the baby’s head or a water-filled cooling blanket, staff slowly lower the baby’s temperature to 92 degrees Fahrenheit. “This therapy can protect the brain by slowing metabolism, reducing the likelihood of death and disability in babies deprived of oxygen during birth,” Bass says.
To support the circulation of blood and oxygen in critically ill newborns with heart and lung conditions, doctors turn to cardiopulmonary bypass units. The units can take over for a baby’s heart by pumping blood and stand in for a baby’s lungs by supplying oxygen.
Noninvasive medical advances in the NICU include echocardiography to test for cardiac disease. Echocardiography uses soundwaves that bounce off different areas of a baby’s heart to produce images of that organ. Ultrasound can also be used to diagnose brain and kidney abnormalities in babies.
Another treatment, extracorporeal membrane oxygenation (ECMO), uses a pump to circulate blood through an artificial lung. During the process, oxygen is added into the blood and then pumped back into the baby’s bloodstream. This treatment is used for critically ill newborns with heart and lung disease. For infants with heart defects that can cause unoxygenated blood to enter circulation, prostaglandin therapy can help. Prostaglandin, a substance produced by the body, causes blood vessels in the lungs to widen, improving the flow of oxygen.
Not all of the medical advances in the NICU are machines. Says Bass, “Numerous treatments have been developed over the years, including the use of antenatal steroids, which are medications given to pregnant women expecting a pre-term delivery, and surfactant, a therapy intended to treat a premature infant’s immature lungs, decreasing the likelihood of death and disability from immature lung disease and intracranial bleeding.”
The availability of cutting-edge care and technology for critically ill newborns at CHKD has helped families from all over Coastal Virginia, eastern North Carolina and the Eastern Shore. “Without the CHKD NICU, critically ill or premature babies would require transportation to Charlottesville or Washington, D.C.,” says Bass. “Having all of this equipment available allows the staff at CHKD to initiate treatment sooner and gives local families the added benefit of having their babies cared for closer to home.”
Jamie McAllister
