Pediatrics Article Highlights Big Outcomes in CHOC’s Small Baby Unit

CHOC Small Baby Unit (SBU) is improving quality and outcomes in extremely low birth weight (ELBW) infants (babies born at 28 weeks gestation or less and weighing less than 1,000 grams), according to results of an article CHOC physicians and staff published in a recent issue of Pediatrics.

“In recent years, the survival rates for ELBW infants have improved with the latest advances in neonatal intensive care, but many are still released from the hospital with significant challenges, including neurodevelopmental delays and/or chronic medical problems,” said Mindy Morris, DNP, the SBU program coordinator and the article’s co-author. “Our goal was to improve these outcomes by utilizing a dedicated team with expertise in the care of these patients.”

The objective of the CHOC neonatology team was to care for ELBW infants in a single location physically separated from the main Neonatal Intensive Care Unit (NICU). This space became the 12-bed SBU, which consisted of four individual patient rooms, two of which are surgical suites, and three four-bed pods. Different from a traditional NICU, this smaller unit allows for a darker, quieter environment that encourages developmentally supportive care. The goal is to create an environment that respects and supports the physiologic needs of the baby to grow and develop after being born so prematurely. Grouping this population also provides parents an opportunity to form strong bonds with other families sharing similar experiences.

Outcomes from the two years before and four years after the SBU’s opening in March 2010 include:

• Reduction in chronic lung disease from 47.5 percent to 35.4 percent. A common condition for premature babies, chronic lung disease can have long-lasting ramifications including re-hospitalization and poor neurodevelopment.

• Rate of hospital-acquired infection decreased from 39.3 percent to 19.4 percent.

• Infants being discharged with growth restriction (combined weight and head circumference, < 10th percentile) decreased from 62.3 percent to 37.3 percent. (These factors are linked to cognitive and physical disabilities.)

• Reduction in laboratory tests (from 224 to 82) and X-rays (from 45 to 22).

Additionally, there was a reduction in illness and complications among infants after leaving the SBU.

Moving forward, the SBU’s goal is to continue to improve patient outcomes, as well as family and staff satisfaction, while also becoming a destination for the care of extremely preterm infants.

CHOC’s NICU Is Expanding to Better Serve the Families of OC and Beyond

NICU expansionFor several decades, CHOC has offered highly specialized care for the most critically ill babies. CHOC’s neonatal intensive care unit (NICU) proudly offers 67 beds in Orange, 22 beds in Mission Viejo, and a team of premier neonatologists who provide coverage at hospitals throughout Southern California.

To enhance our patient- and family-centered care experience and meet the growing demand for services, CHOC will expand its NICU with the build out of 36 private rooms, with potential for more beds in a second construction phase. Located on the fourth floor of the state-of-the-art Bill Holmes Tower, the expanded unit is scheduled to open in summer 2017.

Private NICU rooms are setting a new standard for improved patient outcomes. A recent study published in the journal Pediatrics found that infants cared for in single-family rooms weighed more at discharge and gained weight more rapidly than those cared for in an open design. Also, they required fewer medical procedures, had increased attention, and experienced less stress, lethargy and pain. The researchers attributed these findings to increased maternal involvement.

Further, the private-room setting provides the space and privacy that parents need in order to be more intimately involved in the care of their baby, including breastfeeding and skin-to-skin contact, and parents can actually spend the night with their child. In addition, private rooms give staff more access to and interaction with the family and patient.

The unit will also feature a multipurpose family room, additional office space and other enhanced amenities.

CHOC’s NICU was recently named one of the nation’s “top 25” by U.S. News & World Report, reflecting the NICU team’s unwavering commitment to the highest standards of patient care and safety.

Learn more about our NICU expansion plans. 

Alicia’s story: Repairing a right-sided congenital diaphragmatic hernia

CHOC Surgical NICU

Alicia was born at full term, beautiful with 10 fingers, 10 toes and a life-threatening defect buried inside her tiny chest.

She had a congenital diaphragmatic hernia (CDH), a condition where a hole in the diaphragm allows abdominal organs to move into the chest. And this case was especially serious.

Though less common, hernias on the body’s right side are more dangerous because the liver, a larger organ, can move into the chest cavity, impairing lung development, impeding blood vessel functionality and ultimately causing pulmonary hypertension, says Dr. Mustafa Kabeer, Alicia’s surgeon at CHOC.

Just 20 percent of CDH cases are right-sided, and about 40-50 percent of babies nationwide survive their treatment; conversely, more common left-sided hernias yield about an 80-90 percent survival rate, Dr. Kabeer says.

Prenatal meetings remain key

After the diagnosis, Alicia’s mother Marlen began meeting with Dr. Kabeer and other specialists to prepare for her baby’s birth and treatment afterward.

“It helped because we had the prenatal meeting,” Dr. Kabeer says. “That way, parents can connect a face to a particular job in the care of their baby. They are educated and know what to expect during treatment.”

Just hours after her birth, Alicia’s condition began dramatically deteriorating. A transfer to CHOC was necessary, and Marlen and her husband were warned that Alicia would not likely survive the 2-mile ambulance ride.

But she made it, and quickly began treatment under a life-saving device called extracorporeal membrane oxygenation (ECMO) to help her compromised lungs. First pioneered at CHOC about 40 years ago, ECMO is a heart and lung bypass machine that can be used to rest a failing heart or lungs, providing complete support until the organs recover.

About a week later, Dr. Kabeer performed the procedure to repair the diaphragmatic hernia, all while Alicia remained on ECMO with substantially high risks of uncontrollable bleeding due to the blood thinners needed while on the treatment.

Alicia sailed through the surgery with little bleeding, but within the next day or so, Dr. Kabeer needed to perform two separate procedures to relieve pressure building inside her abdomen that compromised blood flow to the lower half of her body.

Two weeks old and five surgeries

Shortly after this surgery, Alicia began to bleed. During the next four days, she had ongoing bleeding and during the fourth day, lost about 1,500 mL of blood, or about six times her normal blood volume. Hospital staff kept her stable, and Alicia was taken off of ECMO. Two days later, Dr. Kabeer performed a final surgery to close her abdomen, which had been left open all of this time to decrease pressure.

“All of those surgeries were very high-risk surgeries,” Marlen says. “There was a very high chance she wouldn’t make it, but she did perfectly.”

Throughout the entire process, Dr. Kabeer communicated with Marlen and Omar about the risks of the surgeries. And like every other time Alicia’s parents were cautioned about her survival, the tiny infant fought back.

Baby Alicia today.
Baby Alicia a few months after her surgeries.

“Even though it’s a difficult subject, and a complicated, emotional and anxiety-provoking issue, we want parents to understand the problem their child is facing and that we’re trying to help them and their baby overcome it,” Dr. Kabeer says. “That connection and rapport are very important and it all stems from honesty.”

“It involved a very transparent discussion,” Dr. Kabeer said. “I laid out for them all of the issues and all of my concerns, and made them see that we’re going to do our best and face these challenges together. I want to give parents reassurance and security to know that not only are they in a good place, but they’re with staff who are well trained.”

Coordinated care in the Surgical NICU

Between her five surgeries and afterward, Alicia was closely monitored inside CHOC’s Surgical Neonatal Intensive Care Unit, a special part of the hospital’s main NICU dedicated to the care of babies who need surgery.

In the unit, the team cares for patients jointly, discussing the cases of children like Alicia as a group and forming a treatment plan that often calls for the expertise of other specialties at CHOC.

After several months in the Surgical NICU, Alicia went home with her family. Today, she is a happy, charismatic four-year-old.

alicia-today-beach
Today, Alicia is a thriving four-year-old.

“Alicia’s case reinforces the fact that babies are extremely resilient,” Dr. Kabeer says. “It’s amazing that she tolerated all of this. Every patient is unique and this is a perfect example of why we should give them every chance possible.”