Published in the Spring 2012 Issue of ProHealth Magazine.
|Three-year old Julia Shipley plays with her parents on a warm spring day. The picture is quite a contrast to her first few days of life, which were not so warm: Julia was cooled down to prevent the potential effects of oxygen deprivation.
Julia Shipley, who turned three on May 21, is a happy, huggable – and healthy child. She’s one cool kid.
And the reason she is a cool kid today is because she was one of the first “cool babies” treated at Miami Valley Hospital’s Level III Neonatal Intensive Care Unit (NICU – pronounced nick-u).
A Precarious Birth
When Julia was born at a Dayton-area hospital in 2009, she was at risk for brain damage due to oxygen deprivation, a condition called hypoxic-ischemic encephalopathy (HIE). “Hypoxic” refers to the lack of oxygen; “ischemic” refers to the lack of blood and the nutrients it provides; “encephalopathy” refers to injury, disease or malfunction of the brain.
Prior to giving birth, Julia’s mother, Katy, experienced a placental abruption – the separation of the placenta (which supplies oxygen and nutrients to the fetus) from the uterine lining. When Julia was delivered by emergency C-Section, she was not breathing. But, seconds later, the 6 lbs. 11 oz. full-term baby was breathing on her own and showed no signs of distress.
However, that night, she suffered a seizure, a sign of possible HIE, and was transported by ambulance to MVH, where she was admitted to the NICU.
Assessment and Treatment
At the NICU, Julia underwent a series of tests to assess her condition, including an EEG, a brain wave test; and a follow-up MRI, which offers a better image of suspected brain injury. Tests confirmed HIE.
As Marc Belcastro, DO, medical director of MVH’s NICU, explains, “Some babies with HIE can get better without any long-term or lasting problems. However, if severe, HIE can lead to seizures (convulsions), mental retardation, blindness, hearing defects and/or physical (muscular) disabilities. In the worst cases, HIE can cause death.”
Traditionally, there had been no effective treatment for HIE infants other than supportive care, such as the use of respirators to facilitate breathing, medicine to control seizures and antibiotics to prevent infection. There was no way to minimize or slow down the brain damage process.
But, Julia’s timing was impeccable. She arrived at MVH’s NICU just as the unit’s neonatologists (physicians specializing in newborn intensive care) were starting to use a new treatment for babies suffering from HIE: therapeutic hypothermic (cooling) treatment.
In 2009, the cooling treatment used at the NICU was the Food and Drug Administration (FDA)-approved Cool-Cap system, a medical device that keeps the head cool. The system consists of a cooling unit, a control unit, temperature probes and a water-filled cap.
|Marc Belcastro, DO
|Julie Scanlan, RN
Cool water is piped through the cap, which is placed over the baby’s head. The lowered temperature (92° F) slows the brain’s metabolism, thereby preventing brain cells from dying and reducing swelling that can cause further damage.
More recently, a whole-body cooling system was designed and is now used by MVH’s NICU. With this treatment, often called a cooling blanket, the baby is placed on a mattress filled with cool water so the entire body is cooled. While there is no difference in outcome between using the cap or the blanket, nurses at MVH’s NICU prefer the blanket because it is easier to keep the baby comfortable and provide care.
Cooling treatment for HIE babies is most effective when it is started within six hours after birth. After 72 hours of treatment, the baby’s head or body temperature is gradually warmed over a four-hour span.
A cooling system, by itself, is non-invasive – it requires no medication, no needles and no incisions. However, babies being cooled are constantly monitored for changes in blood pressure, heart rate and other bodily functions, procedures that may require tubes and catheters. (In Julia’s case, a catheter was used to facilitate urination.) Babies being cooled are also fed intravenously.
A Significant Breakthrough
When the FDA first approved the cooling cap for the treatment of HIE in infants, Dr. Daniel Schultz, director of FDA’s Center for Devices and Radiological Health, said, “This approval brings new hope to parents of the approximately 5,000 to 9,000 babies each year who are born in the United States with moderate to severe hypoxic-ischemic encephalopathy. Until now, there has been no effective treatment for these infants other than supportive care. Up to 20 percent of them died, and 25 percent suffered permanent disability because of neurological deficits.”
At that time, the FDA reported the cooling cap was found safe and effective in a study with 234 babies with HIE. The results showed fewer deaths and fewer severe cases of neural development disability in the cooled group compared with the control group. Subsequent studies have supported these results.
“I’m proud that MVH chose to make a major investment in a technology that has proved so effective in treating HIE babies,” says Dr. Belcastro. “Therapeutic hypothermic treatment is one example of how MVH’s NICU continues to offer leading technology to the Dayton region. Our long-standing ECMO program was also enhanced because infants who require ECMO often require therapeutic hypothermic treatment as well.”
A Happy Place
At MVH’s NICU, which completed a $19 million renovation and expansion in 2009, parents are able to stay with their babies in a private room.
For the first four days that Julia was in the NICU, Katy was still recovering from Julia’s birth at an area hospital; but dad Ian stayed at his daughter’s side. On the fifth day, Katy arrived to bond with her baby girl.
And that was not the only bonding going on. NICU nurses have a habit of developing close relationships with “their” babies and their families.
Case in point is Tracy Morrison, RN, one of the nurses who cared for Julia. Tracy recalls being summoned to the NICU in the middle of the night to set up the Cool-Cap System for Julia. “She was only the second baby to be treated with the system at our hospital,” explains Tracy. “I had cared for the first baby, who had been dismissed the day before, and thus was well versed in the technology.”
|NICU nurses, Stephanie Gronlund, RN, (left) and Tracy Morrison, RN, demonstrate the Cool-Cap system used to lower a newborn’s temperature to slow metabolism. A variation of the device is the cooling blanket, which cools the newborn’s entire body.
“Tracy was the first person my husband met when he arrived at the NICU,” says Katy. “She answered all his questions and calmed his fears. She represents all that was great about our family’s NICU experience. I also must acknowledge Stephanie Gronlund, another NICU RN, who treated all of us like family during the eight days Julia was there.”
Today, Tracy proudly brings up a progression of digital photos of the little girl she cared for three years ago. “Julia came back to MVH for her one-year evaluation on my day off, but I made a point of coming in to see her,” says Tracy.
Such a loving atmosphere is one reason Julie Scanlan, RN, nurse manager of the NICU, says, “Despite the serious conditions of many of our little patients, we don’t have a lot of sadness here. The NICU is a happy place with many happy outcomes.”
Julia Shipley is one such happy outcome. While she left the NICU still taking seizure-prevention medication, today she is off all medication. Her annual check-ups have shown no signs of mental or physical abnormalities.
“Someday, when she’s old enough to understand, we’ll tell her about her first days of life when she was one cool baby,” says Katy.
MVH’s NICU: By the Numbers
- 8 – the number of board-certified neonatologists on staff
- 4 days to 4 or 5 months – duration of a baby’s stay
- 25/7, 365 days a year – coverage provided by a neonatologist and a neonatal nurse practitioner
- 53 – the average number of babies cared for per day (in 2011)
- 60 – the number of private patient rooms (67 beds)
- 200 – number of employees, including physicians, nurses, therapists, dietitians, pharmacists and social workers
- 857 – the number of babies served in 2011
Read more about MVH’s Level III NICU at www.mvh.org/nicu.