Neonatal Intensive Care Unit

These days it’s not unusual to hear about a child weighing only one pound at birth, going home after a lengthy stay in the hospital and living a normal life. What was considered a miracle 20 years ago has become commonplace medicine in neonatal intensive care nurseries across the nation.

At Brenner Children’s Hospital, families not only receive state-of-the-art care, they are provided a plethora of resources and programs readily available to them both inside the hospital walls and in their homes. 

For many babies admitted to Brenner Children’s Hospital, care begins immediately after birth with our specially-trained transport team. Serving the western half of North Carolina, these pediatric-trained nurses stabilize the infant and bring them to Brenner Children’s Hospital – named one of the nation’s 30 best children’s hospitals by Child magazine.

Upon arrival, the baby is cared for by a pediatric-trained treatment team with expertise in over 27 areas of pediatric medicine. The family is also welcomed, and begins to immediately learn about their child’s care.

Behind the scenes, neonatologists work to develop new treatment modalities and pave the way for healthier beginnings for these children. By participating in research programs, babies can immediately benefit from therapies that others might have to wait years to receive.

And once the crisis has passed and the infant is ready to go home, programs and services are in place to make the transition a smooth one for both baby and family.

Through this extensive continuum of care provided only at Brenner Children’s Hospital, babies and their families can enjoy what 20 years ago would have been considered extraordinary.

State-of-the-art expertise close at hand

Brenner Children’s Hospital currently has 10 neonatologists on staff. In addition, a team of over 75 pediatric trained subspecialists are on standby, ready to help each baby overcome challenges during his or her hospitalization.

From cardiac and pulmonary care to surgical specialties, physicians work with other highly-trained respiratory therapists, nurses and staff to ensure that each baby receives a fighting chance at life.

Many of our physicians offer procedures found only in this region at Brenner Children’s Hospital. For example, Michael Hines, M.D., a pediatric heart surgeon at Brenner Children’s Hospital, is the only pediatric heart surgeon in the southeast to offer minimally-invasive surgery to repair a common heart defect, called patent ductus arteriosus (PDA), in children.

Hines and his staff performed the video-assisted surgery live via a free webcast, sponsored by Wake Forest University Baptist Medical Center. An archived version of the webcast can be viewed at the Wake Forest University Baptist Medical Center Web site: www.wfubmc.edu. 

Other pediatric surgical specialists work to correct many defects common at birth including: gastrointestinal, spinal, and urological abnormalities. Children also have the option of minimally-invasive surgery at Brenner Children’s Hospital, which has the largest pediatric surgical department in the western half of the state.

The benefits of performing surgery in a children’s hospital include having all the critical pediatric specialists on hand – anesthesiologists, nurses, and pharmacists all trained specifically to care for children. This further ensures that the outcome will be both safe and successful.

The NICU at Brenner Children’s Hospital is also staffed with nurses highly trained in specialized areas of neonatal medicine. Diane Hudson Barr, Ph.D., is a registered nurse with expertise in pain management. She recognizes when a baby is in pain and works to make each patient more comfortable during their stay.  

In addition to highly qualified staff, the NICU is equipped with technology to help infants breathe easier and keep their vital signs within normal limits. 

“Two of the most common problems a premature infant faces are respiratory distress syndrome and pulmonary hypertension,” said Steven Block, M.D., a neonatologist and Director of Brenner Children’s Hospital’s NICU. “Over 40 percent of infants transferred to the NICU will experience breathing difficulties. At Brenner Children’s Hospital we have unique ventilators – the only ones of their kind in this region – to help support a baby’s breathing. As the babies’ health improves, their lungs become more pliable. These specialized ventilators detect the changes and adjust to provide a more gentle flow. The machines help us avoid over inflating the lungs and damaging them.”

Physicians at Brenner Children’s Hospital also serve as the regional resource for babies diagnosed with pulmonary hypertension.

“Many babies born in other parts of the state are transferred here when the diagnosis of pulmonary hypertension is made,” Block said. “We conduct ongoing research to better understand this condition and provide better treatment for it.”

Brenner Children’s Hospital’s neonatologists also staff the NICU at Forsyth Medical Center, providing a solid base of medical expertise for all babies born in Forsyth’s birthing center.

“Our services provided at the Sara Lee Center for Women’s Health and Brenner Children’s Hospital complement each other nicely,” said Michael O’Shea, M.D., a neonatologist and chief of neonatology at Brenner Children’s Hospital. “Our neonatologists handle prenatal consultation for the high-risk fetus and delivery room stabilization at the Sara Lee Center for Women’s Health and then manage a neonate’s care for the first week of life. Once a baby has stabilized and transferred to Brenner Children’s Hospital, our neonatologists continue to manage the infant’s care, provide input into discharge planning and follow up and provide any treatments necessary to help each baby start life on the best possible foot.”

Research brings new therapies to improve care for the neonate

The neonatal intensive care nursery at Brenner Children’s Hospital is one of 16 nurseries in the country participating in a National Institutes of Health sponsored neonatal research network, bringing new treatments and therapies to premature infants.

“By taking part in the network, we are able to participate in clinical trials of new therapies so that our babies receive the benefit of these therapies even before they become widely available,” said O’Shea. “The network also provides us with the opportunity to interact frequently with experts in neonatal care from across the country.”

The National Institute for Child, Health and Human Development administers the federally funded grant to academic medical centers over a five-year period. These centers may choose to share resources with other area hospital nurseries to improve care for the entire region. Since Brenner Children’s Hospital faculty provide services for the neonatal nursery at Forsyth Medical Center, this allows Forsyth’s nursery to be involved as well.

Many of the babies participating in clinical trials receive treatment based on the latest research. For example, as part of a recent study premature babies received vitamin A injections. Vitamin A reduced their risk of chronic lung disease, one of the major complications with a premature infant.

“Babies who participated in that study received a beneficial treatment before it became standard medical practice,” O’Shea said. “We are currently researching whether inhaled nitrate oxide provides additional benefit in the reduction of chronic lung disease.”

New equipment is also provided to network participants through the grant – giving these centers a technological advantage over other neonatal nurseries in the state. In addition, each medical center in the network receives information related to quality assurance.

“We are compared with 15 high-quality institutions, giving us valuable feedback on how we are doing and helping us to target areas for improvement” he said. “This feedback showed us that babies cared for in the nursery at Brenner Children's Hospital do as well as babies in the other 15 network centers, all of which are outstanding medical facilities.”

Faculty and staff from the network meet an average of five times a year to discuss the current research studies and share ideas on ways to improve the resources and care provided to these babies. 

Research extends beyond clinical areas and into searching for ways to provide a soothing and comforting environment within the nursery as well. 

Harpist Debby Jennings was awarded the Elizabeth and Clifford Guy Award from the Forsyth County Arts Council to conduct a pilot study to find out whether music she plays on a regular basis has a calming effect on the infants in the NICU. Jennings played selections from “Romeo and Juliet” to babies as her assistant recorded the baby’s vital signs.

Babies in the study heard music three times a week for about an hour during their stays in the nursery. In addition to measuring heart rate, respiration, blood pressure, and weight gain, the study measured cortisol, a hormone that is a marker for stress. Preliminary findings indicate that harp music does decrease the stress levels of the babies.

Transport team provides a mobile intensive care unit

Each year more than 550 infants and children are transported to the neonatal intensive care unit (NICU) via the Medical Center’s specially-equipped transport ambulances or by AirCare, North Carolina Baptist Hospital’s helicopter transport system. The transport team includes experienced registered nurses and respiratory therapists who specialize in the care of critically ill children. The team’s scope of expertise includes advanced intubations, placement of intravascular catheters and chest tube placement. This skilled care is provided by the team in the referring community hospital and during transfer.

In addition, the Brenner Children’s Hospital transport team is one of only three critical care transport teams in the state that can transport a baby on Inhaled Nitric Oxide (INO). If an infant has been placed on INO and is not responding well, the baby must be transferred to Brenner Children’s Hospital, the region’s only Extracorporeal Membrane Oxygenation (ECMO) referral center.

“Our goal is to provide the same level of care and expertise in the referral hospitals and the transfer units that the infant would receive in our intensive care nurseries,” said Mitzi Amerson, RN, and Coordinator of the Critical Care Transport Service. “We begin using advanced skills and expertise the moment the team arrives at the referral hospital.”

The Neonatal-Pediatric Transport Service at Brenner Children’s Hospital transports neonates and pediatric patients up to the age of 4 years, from a 20-county region of western North Carolina, southern Virginia, and eastern Tennessee. Children over the age of 4, are transported via the medical center’s ambulance or helicopter.

A physician wishing to request the Neonatal-Pediatric Transport service should call the Physician's Access Line at 1-800-277-7654. The call will be transferred to a neonatologist or pediatric intensivist who will assist in arranging transport of the patient to Brenner Children’s Hospital.

Home resources help make the transition to home smooth

Once a baby has been discharged, resources and follow-up clinics are available to help families integrate the care of their newborn into their routines and households.  

“One of the best resources we have is the Infant Follow-up Program, made possible by the Developmental Evaluation Clinic at Amos Cottage,” O’Shea said.

“This clinic allows us to keep a check on the babies to ensure they are progressing in their developmental milestones and to detect and address problems early if necessary. It also gives parents an opportunity to ask questions or share any concerns they might have. This follow-up care is provided almost free of charge to patients. Developmental toys are given to the babies and travel monies are available to patients so they can bring their babies to appointments after being discharged from the hospital.”

This program at Brenner Children’s Hospital is currently in its second year of grant funding and O’Shea says he plans to apply for additional funding once this grant has expired.

“Participating in the network allows Brenner Children’s Hospital to continue providing excellent care to babies in western North Carolina,” he said.

Additionally, the Wake Forest University Health Sciences Developmental Evaluation Clinic received a $536,000 grant in January 2003 from the Duke Endowment to provide three full-time and a part-time early interventionist in the NICUs at both Brenner Children’s Hospital and Forsyth.

“These early interventionists will work with the NICU staff to write an Individual Family Service Plan (IFSP) that will ensure the availability of community resources and services in their home counties,” said Don Goldstein, Ph.D., Director of the Developmental Evaluation Clinic at Amos Cottage.

Previously, babies discharged from the nurseries had to wait three to four months once they arrived home to be enrolled in the early intervention programs in their counties and before their individualized treatment plan could be written.

“Now we send those babies home already enrolled in the program and with a completed IFSP so services can begin immediately,” Goldstein said. “The family will also have their early interventionist as a contact in case questions or concerns arise.”

The early interventionist will also make a home visit to help the family transition from the hospital into their daily routines.

This program is one of six programs in the state and will serve 20 counties in western North Carolina, Goldstein said.  

Training tomorrow’s experts

Brenner Children’s Hospital has six fellows in training to become neonatologists. As one of the largest training programs in the state, fellows receive instruction from the top specialists in the region on care for the premature infant.

In addition, Neonatal Nurse Practitioners from other institutions come to the children’s hospital for training and expertise in neonatal care. 

For more information about the NICU at Brenner Children’s Hospital or other services and programs, call Health On-Call at 1-800-446-2255.

NICU at a glance

• Ten neonatologists staff intensive care nurseries at Brenner Children’s Hospital and Forsyth Medical Center. These experts care for over 600 babies at Brenner Children’s Hospital and more than 1,200 babies at the Sara Lee Center for Women’s Health each year.
• The nursery has 37 intensive care beds with a 2:1 nursing ratio to patient. When needed, 1:1 care is provided.
• The unit serves 20 counties in western North Carolina, Virginia, Tennessee and South Carolina.
• Michael Hines, M.D., a pediatric heart surgeon at Brenner Children’s Hospital, is the only pediatric heart surgeon in the Southeast to offer a minimally-invasive surgical procedure to repair a common heart defect in children.
• The neonatal intensive care nursery at Brenner Children’s Hospital is one of 16 nurseries in the country participating in a National Institutes of Health sponsored neonatal research network, bringing new treatments and therapies to premature infants.
• Six fellows are in training to be the next generation of neonatologists.
• Brenner Children’s Hospital is staffed by over 75 physicians specializing in over 25 areas of pediatric medicine.
• Brenner Children’s Hospital was named one of the nation’s 30 best children’s hospitals by Child Magazine.
• Brenner Children’s Hospital opened a new state-of-the-art inpatient and outpatient facility in May of 2002, bringing the latest treatments to children in a friendly environment. The facility is geared to meet the needs of the entire family and to make their stay as comfortable as possible.
• Brenner Children’s Hospital is part of Wake Forest University Baptist Medical Center, which is consistently ranked as one of America’s best hospitals by U.S.News & World Report (top 50).
• The Sedation Suite at Brenner Children’s Hospital provides a state of the art family centered setting for children who are undergoing procedures.

Staff nurses at Brenner Children’s Hospital have specialty training in pediatric care and pediatric critical care for newborns through adolescents.