Neonatology: Unit Here Ups Survivals, Fights Against Defects

              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