Neonatology: Then and Now

sbu_thenandnowCHOC Children’s has always done a great job of treating premature babies, and infants with heart problems, infections or birth defects. Over the last 50 years, I’ve seen technology and medicine change a lot in neonatology.

An extra special place at CHOC is its Small Baby Unit, a program within its neonatal intensive care unit (NICU). Reserved for the smallest and sickest babies, this unit gives hope to babies who wouldn’t have had a chance in 1964.

There, every newborn receives care from dedicated staff members. The space also has shrouded incubators to keep light away from the baby’s sensitive eyes and everyone (even family members) speaks gently to help create a calm, comforting and healing environment.

Kangaroo Care is another technique in neonatology that has grown in popularity since 1964. As babies spend time lying on their parents’ chests, they become more alert, cry less often and even a find feeding rhythm. Premature babies benefit from this practice by facing fewer complications, gaining weight and growing closer to their parents.

I know the doctors and nurses at CHOC care about the precious lives in the NICU. They provide exceptional service, but they’re not just focused on treating symptoms or reading monitors. They are also committed to giving newborns and families a strong chance of living healthy lives.

Tell me how CHOC helped your newborn baby and family by using the hashtag #thxCHOC on social media.


CHOC Children’s 67-bed NICU includes four multi-patient rooms, six single care rooms, four private rooms for “rooming in,” and two four-bed suites. The unit also features a two-bed Extracorporeal Membrane Oxygenation (ECMO) unit. The life-saving ECMO unit is the only one of its kind in Orange County and CHOC also offers Orange County’s only ECMO transport unit.

Parents and Preemies

A premature or preterm baby is born before 37 weeks of gestation. Preemies often require hospitalization but mom can help her preemie from day one, says Dr. Bixby, a CHOC Neonatologist. “Early on, the best way for a preemie to grow is with the mother’s milk. Moms can start pumping in the hospital and should start pumping as soon as possible after delivery. We also have found that having the parents place the infant on their chests, skin to skin (called “kangaroo care”) helps the baby grow, breathe better and develop better.” Parents should ask their neonatologist and pediatrician about medical issues to watch for as their preemie grows. Keeping up with standard vaccinations and special vaccinations for preemies is also important, says Dr. Bixby.  Parents should also keep up with their vaccinations, particularly influenza and pertussis vaccines, which will protect the baby until the babies immune system has matured and the standard vaccines are completed.

“Premature infants are at risk for developmental delays so parents should be watchful of the developmental milestones, taking into account the appropriate delay from an early birth,” says Dr. Bixby. Preemies visit CHOC’s Early Developmental Assessment Clinic at 6 months of age for a full assessment of the baby’s development and nutritional needs and a referral to the appropriate specialist if necessary, she said, adding, “Parents and families should create a loving and engaging home environment so the baby is encouraged to move around and reach for things and interact with the world and learn.”

Pregnant women are encouraged to seek prenatal care as soon as possible to help prevent a premature delivery and to identify any potential problems that could lead to a preterm birth, says Dr. Bixby. “Pregnant women should see their family practice doctor or obstetrician regularly and get a referral to a specialist if there are concerns about the pregnancy. Good dental care helps too. Research shows that dental disease or poor dentition is associated with preterm delivery. Mom should take care of herself, get some exercise in consultation with your obstetrician and eat well.”


    • Annual cost to society for premature births: $26 Billion+
    • Percent increase over the last 25 years in premature births in the U.S.: 36
    • Number of premature babies born each year in the U.S. (1 IN 9 BABIES): 500,000

View the full feature on Parents and Preemies

Dr. Christine Bixby
Dr. Christine Bixby
CHOC Neonatologist

PHYSICIAN FOCUS: Dr. Christine Bixby

Dr. Bixby completed her fellowship in neonatology at Harbor UCLA Medical Center and also completed her residency and internship training in pediatrics at Harbor UCLA Medical Center. She completed a fellowship in neonatology in a joint program between CHOC and Harbor UCLA Medical Center. Dr. Bixby specializes in caring for premature infants and is involved in research studies focusing on issues related to breast milk, establishing a milk supply and using breast milk for premature babies.

Dr. Bixby’s philosophy of care: “My philosophy of care is to bring in the parents and family as part of the health care team and making sure they are educated and comfortable with the care we are giving their children.”

University of California, Davis, School of Medicine

Pediatrics Neonatal-Perinatal Medicine

More about Dr. Christine Bixby

This article was featured in the Orange County Register on April 28, 2104, and was written by Amy Bentley.

Tips for Mitigating the Risk of Preterm Labor

Prematurity is the number one killer of babies worldwide, says Dr. Tony Soliman, a CHOC Children’s neonatologist. Even if a woman does everything right, her baby can still be born prematurely. In this CHOC Radio segment, Dr. Soliman addresses this serious health concern and offers tips for mitigating the risk of preterm labor.

Dr. Soliman encourages women to partner with health care providers even before getting pregnant. Prenatal care and eliminating high risk behaviors, such as smoking, are crucial. In addition, stress can have a huge impact on the health and well being of mom and baby.

Learn more by listening to Dr. Soliman and CHOC Radio host Bryan Mundia.

Extremely Low Birth Weight Program Provides Significant Outcomes for Tiny Patients

Medical advances are improving the survival of babies born at lower gestational ages, but survival – alone – isn’t the best measure of success, says Dr. Tony Soliman, a CHOC Children’s neonatologist.

In this CHOC Radio segment, Dr. Soliman shares his and his team’s commitment to ensuring not only the survival of this very fragile patient population but to ensuring bright, healthy futures for these babies.

According to Dr. Soliman, there’s no program on the West Coast like CHOC’s extremely low birth weight program, which is designed to address the unique needs of infants born at less than 28 weeks gestation and weighing less than 1,000 grams. He says having a specialized team, specific care guidelines and a separate unit – versus the main Neonatal Intensive Care Unit – have resulted in significant outcomes for his patients.

Tune in to hear more about the success of this very special program.


Caring For The Smallest Patients


When she would check in at the front desk to visit her prematurely born twin girls in the new CHOC Children’s neonatal intensive care unit (NICU) at St. Joseph Hospital, Mary Aguilar typically would be greeted with expressions of concern from hospital employees.

Aguilar would respond, “Actually, it’s cool up there.  I never feel like I’m going to a sad place.”

“Up there” is the 13-bed, CHOC Children’s-staffed-and-licensed Level IIB neonatal intensive care unit that, since opening Feb. 11, 2013, has been making life a lot easier for mothers, families and their newborns at CHOC’s adult hospital neighbor—and their newborns who need specialized care.

Aguilar’s girls, Lily and Ella, born just shy of 32 weeks, were among the first patients and the first set of twins to be cared for in the CHOC NICU at St. Joseph Hospital, whose opening coincided with a new mother-baby unit at St. Joseph.

Never far from mom

The NICU, staffed by a team of CHOC neonatal experts, is designed for newborns with low to moderate medical needs—typically, premature babies suffering from respiratory and circulatory problems. Newborns needing a higher level of critical care are sent to CHOC’s 54-bed NICU, located in the CHOC North patient care tower.

Lacy Pester, BSN, RNC-NIC and clinical manager of the CHOC NICU at St. Joseph Hospital said that prior to the opening of the new NICU, it sometimes was inconvenient for mothers to have to make the trip to CHOC’s NICU.  At nights, if there were no volunteers available to accompany them, mothers were not allowed to make the trek, Pester said. No longer.

Now new mothers like Aguilar are only steps away and can visit their babies easily.

The NICU provides accommodations for parents after a mother’s discharge as well.

For 27 days, Lily and Ella—who both weighed around 3½ pounds at birth—were cared for by a team of newborn intensive care nurses, respiratory therapists and physicians who relied on sophisticated monitoring equipment to closely follow their vital functions around the clock, including heartbeat, respiratory status, temperature and blood pressure.The girls got the Twin Room—the only two-bed room among the 12 rooms that make up the new NICU.

Choosing to have her babies at St. Joseph Hospital was easy for Aguilar. Her mother worked there as a security guard in the 1980s and her grandmother was a housekeeper in the emergency department. When her twins arrived early, Aguilar was grateful to hear that her babies would be receiving care in the new NICU.

annual-report-2013-caring-for-the-smallest-patients-2“I was excited, thinking we would have more privacy and our own nurse,” Aguilar says. “It was fantastic. We were in the corner of the unit and everything happened in one room. I loved it.”

Lanky Lily, kind of silly and prone to making pterodactyl noises, and chunky Ella, a happy baby with a sweet disposition, now are healthy babies closing in on 20 pounds. Aguilar, who lives with her husband, Ramon, and their twins in Corona, credits the expert team of neonatal specialists at the CHOC NICU at St. Joseph Hospital, including Christine E. Bixby, M.D., with her babies’ health.

“They always had the girls’ best interests in mind,” Aguilar said. “They are all very loving people. I feel like all the care they received helped set up my girls for success.”

Related articles: