Neonatology: Unit Here Ups Survivals, Fights Against Defects
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Ann Landers 2-B Television 6-B Entertainment 7-B Health/Medicine The Times UpdateShreveport-Bossier City Jan. 27, 1981 Neonatology Unit here ups survivals, fights against defects By SALLY REESE Times Medical Writer There are baby dolls bigger than some of the infants in the neonatal unit at LSU Hospital. One baby weighs only 17V2 ounces, barely more than a pound. Her little head is not much bigger than an orange. Her tiny fingers are no bigger than match sticks. She is perfectly formed, but she needs a machine to help her breathe. The baby breathes through a tube in her throat, and her breath sounds are so wispy they are difficult to hear. She cannot go home until she has been nourished to a proper size. The baby must grow so its lungs will grow and be able to breathe on their own. She is a premature baby, born before term and entering the world with only an ounce and a half of blood in her tiny body. She might have died but for the attention she gets in the neonatal intensive care unit on the fifth floor of LSU Hospital. Because of neonatal medicine, more premature babies are surviving today, and fewer without brain damage. At LSU Hospital, the mortality rate of high-risk newborns has fallen by almost 15 percent in the past 10 years, estimates Dr. Joseph A. Little, chief of pediatrics. Previously, it was 22 per 1,000 live births, he said. Today it is about 14 per 1,000 born in the hospital. The public's contributions to the March of Dimes have helped to make this possible. The local chapter has given about $200,000 in the past 10 years for care of area newborns with birth defects, prematurity being just one of them. The first March of Dimes contribu-tion went to the Birth Defects Center at LSU Hospital, which is headed by Dr. Harold Chen, chief of the genetics section in the LSU School of Medicine. That center was set up by Dr. Little, Dr. G. Peyton Kelley of the March of Dimes board, and Dr. Edgar Hull, first dean of the medical school. Afterward, the March of Dimes chapter turned its attention to the intensive care unit and started fund-ing some of the equipment required by neonatology, including a breathing machine. In the past four or five years, the Dimes funds have defrayed the costs of transporting sick newborns here from other hospitals in the Ark-La-Tex area, and have sup-ported continuing education to ensure adequate staffing for the sophisticated care of such babies. A specially equipped ambulance is garaged at E.A. Conway Hospital in Monroe for rapid transport of sick newborns, but LSU Hospital can put a team together, outfit an ambulance and roll whenever a call comes in from the area. Treatment starts at the receiving end. A transport incubator keeps the infant warm and breathing while en route to Shreveport. Of 627 admissions to the neonatal ICU last year, 139 were born in other hospitals. Thirty-three had birth de-fects other than prematurity, con-genital disorders probably being the most common. Kelley, a pediatrician, said such babies should be born in a hospital with a neonatal ICU. "At least three-fourths of the high-risk infants can be predicted," he said. "A mother who has previously de-livered a premature baby can be ex-pected to deliver another." Dr. Arun Pramanik ...holds tiny stethoscope Chronjc abortion, diabetes, and age — 16 and younger and 35 and older — are other reasons to anticipate birth of a high-risk infant, said Kelley and Little. So are vascular disorders, high blood pressure, congenital heart dis-ease, and blood disorders such as the RH factor and sickle cell anemia. Other maternal conditions which threaten the fetus or neonate are tuberculosis, epilepsy, malnutrition, drug addiction, smoking, and alcoholism. Adolescent pregnancies are a pro-blem, the doctors said. (Some girls are pregnant at 12, delivered at 13, they -reported.) Maternal malnutrition is the usual concern, they said. Fetal and neonatal difficulties can be expected if Mama eats only junk food during pregnancy. Neonatal disorders occurring soon after birth are usually the result of prenatal difficulties, the physicians said. A neonatal intensive care unit, where the skills of subspecialties merge in the care of a baby with problems, is especially prepared to cope with those disorders, they em-phasized. Prematurity is the birth defect Dr. Arun Pramanik sees most frequently in the LSU Hospital NICU. A baby is premature if born before the 37th week, said Pramanik, the neonatologist in charge. Such a baby is small because of early delivery and impaired intrauterine growth. The premature infant is not ready to cope with the life into which it has been flung too soon. The last three months in the mother's womb are crucial to a baby's growth, says Pramanik, and the premature baby has not had them. Being so small, the infant is ill-equipped to conserve body heat, to breathe without help, to move. A term baby gathers himself up in a fetal position; it comforts him to have his knees drawn up under his stomach, his arms by his sides. The preterm baby lies the way it is placed. The tiniest one in the LSU unit, now nearly (Times photos by Mike Silva) Drs. Ramasubbareddy Dhanireddy, Cecilia Nervez consult at Med Center a month old, opens her eyes, but others lie flat in their special in-cubators, their heads turned sideways, their eyes closed. Constant, special care is crucial to their survival, said Pramanik. Con-tinuous monitoring of the heart and lungs, multiple biochemical tests on tiny quantities of blood, and conserva-tion of body heat are basic. Many checks of the respiratory rate are necessary because tiny lungs make breath sounds difficult to hear. Intensive care implies ventilatory support, oxygen therapy, and manipulation of environment. Vigilence is fundamental, said Pramanik, who t r a i n e d in neonatology at Children's Hospital in Cincinnati after receiving his M.D. in India. Respiratory distress is the big-gest problem the NICU team deals with. Cerebral edema can be present, implying a risk of intracranial pre-ssure. "We have to watch for bleeding in the head, because the blood vessels of the brain are not well-supported. Any change in blood pressure and/or blood carbon dioxide can cause bleeding." One-to-one care is the rule in the ICU, the specialized equipment serv-ing as support, he said. A machine cannot pick up sounds of diminutive hearts. Pramanik said babies remain there an average of six weeks. Meanwhile, they are close to the specialists and diagnostic and therapeutic techniques which, Little said, "can make a dent in infant mortality." "If a baby comes in with a heart defect, we've got the expertise and equipment to treat it," said the pediatrics chief. "Our unit is set up to take care of any problems that may arise." Little noted that Louisiana is the second in the nation in premature infant mortality. The average birth weight of those treated at LSU Hospital is 2Vz pounds, he said. That weight, Pramanik com-mented, is lower than any he encoun-tered before coming to Shreveport. It is not good, the neonatologist murmured, for the lower the weight the higher the risk. He is counting on the March of Dimes to help cut the odds. "We must continue to train people for neonatal care, to step in when somebody quits," he said. "We must keep abreast of changing equipment." Therefore, the Mothers March on Jan. 30-31 is of special significance to him. And to the babies in his care. B
|Title||Neonatology: Unit Here Ups Survivals, Fights Against Defects|
Neonatal Intensive Care Unit (Louisiana State University Health Sciences Center - Shreveport)
Pramanik, Arun K.
Nervez, Cecilia T.
|Notes||Photo of Dr. Arun Pramanik, Ramasubbareddy Dhanireddy, and Cecilia Nervez|
|Identifier||See reference URL on the navigation bar.|
|Source||Louisiana State University Health Sciences Center Shreveport Medical Library (http://lib.sh.lsuhsc.edu)|
|Coverage-Spatial||Shreveport (Caddo, La.)|
|Rights||Physical rights are retained by Louisiana State University Health Sciences Center Shreveport. Copyright is retained in accordance with U.S. copyright laws.|
Neonatology: Unit Here Ups Survivals, Fights Against Defectsfor