By Jonny Lupsha, Wondrium Staff Writer
Health risks for premature babies led to neonatal intensive care units (NICU). Currently, accepted standards are to immediately test a newborn to ensure they’re in stable condition. Findings of research studies could change NICU practices.
As little as 60 years ago, hospitals didn’t have neonatal intensive care units (NICU). Now, however, they’re in any hospital with an obstetrics unit. As science and medicine continue to advance and refine, standard practices change. One such practice—in which prematurely born babies are taken immediately for testing and care to ensure a stable condition—may soon change.
New data on low-weight infants born in five nations, including Ghana and India, suggests that it may be better for premature newborns if their trip to the incubator is postponed until after the baby and mother spend skin-to-skin time together.
In his video series Medical School for Everyone: Pediatrics Grand Rounds, Dr. Roy Benaroch, Adjunct Assistant Professor of Pediatrics at the Emory University School of Medicine, explained how NICU innovations save lives.
Caring for Respiratory Distress Syndrome
One health issue facing premature babies is respiratory distress syndrome (RDS). Near the due date, the fetus develops a slippery chemical in the lung sacs called surfactant, which allows easy expansion of the lungs. If a baby is born prematurely, the surfactant may not have formed yet, leading to the breathing difficulties associated with RDS.
These days, caring for RDS relies on two medical innovations.
“One is mechanical ventilation, now a cornerstone in the ICU care of children and adults,” Dr. Benaroch said. “Mechanical ventilation essentially replaces the work that a patient has to do to breathe, by holding the airway open with a plastic tube that’s then connected to a machine, called the ventilator.
“The ventilator pushes and pulls air in and out of the tube, forcing the patient to breathe.”
Dr. Benaroch said that people in a coma or under general anesthesia will make no effort to breathe, so the mechanical ventilator—which can be adjusted for pressure and to deliver extra oxygen—can breathe for them. The predecessor to mechanical ventilators was the so-called “iron lung,” which couldn’t keep the airway open.
“The other innovation is that we can now administer surfactant to babies, giving it through the same tube that attaches to a ventilator.”
President John F. Kennedy and First Lady Jacqueline Kennedy Onassis had a son, Patrick Bouvier Kennedy, who was born prematurely in August 1963 and, tragically, died of RDS. Had today’s medical technology existed back then, Dr. Benaroch said, he almost certainly would have lived.
The Apgar Score
Another important, but simple, tool for use in the NICU is the Apgar score. It isn’t only reserved for premature babies, nor is the NICU itself.
“That’s a scoring system used to judge the health of a newborn, still in very wide use,” Dr. Benaroch said. “It was proposed by pediatrician Virginia Apgar in 1953, whose studies showed that babies with the highest scores were very likely to survive, while babies with low scores were more likely to die. The scoring system gives them from zero to two points in each of five areas, including color and breathing effort, so a newborn could get a theoretical high score of 10.”
In terms of test categories, Apgar is an acronym which stands for Appearance, or skin color; Pulse, or heart rate; Grimace response, or reflexes; Activity, or muscle tone; and Respiration, or breathing rate and effort. Scores between zero and two are given.
For example, when grading skin color, a newborn with bluish-gray or pale skin all over will get a zero. A newborn with normal color but bluish hands and feet will receive a one, while a newborn with normal skin color from head to toe will receive a two. Similar qualifications are made for each of the Apgar categories.
“When we say ‘Apgars of nine and nine,’ we mean it was nine at one minute of life, and nine at five minutes,” Dr. Benaroch said. “The first number reflects the health of the baby at birth, and therefore, the health of the circulation right at delivery; the second number reflects whether resuscitation of an ill baby was successful.
“For instance, Apgars of one and seven mean a baby was born very depressed and ill but responded rapidly to help given in the delivery room—and that baby will probably do well.”