Technology Means Survival for Premature Infants at John Muir Medical Center

John Muir Medical Center–Walnut Creek, already recognized this past summer by U.S. News & World Report as one of America’s best hospitalsis about to make care in its neonatal intensive care even better.

A new unit will open in April that provides 27 beds so parents can stay overnight with their premature babies. 

“These babies don’t go home until they reach close to full term,” said Stacie Bennett, a hospital neonatologist. “They have to be able to eat all their food, breathe without apnea and be robust enough to survive outside an incubator before they can leave.” 

A baby born at 26 weeks may spend close to three months in the hospital. Currently, the babies at John Muir receive care in one large nursery in which parents have limited privacy and overnight stays are not possible. 

“It’s a huge stress for parents to leave their babies at night—and visits from siblings have to be restricted to protect other babies,” Bennett said.

This situation will change with the new unit. The American Academy of Pediatrics Journal reports that skin-to-skin care has a significant, positive impact on a pre-term infant’s development. So the close proximity of parents, which will be increased in the new unit, is sure to improve the health and well-being of these tiny babies and their families.

The department's staff is eager for this unit to open, but, in the meantime, they have found other ways to improve the outcome for the infants, whose premature births place them at risk for a frightening list of complications. The department has acquired state-of-the art incuabators and nutrional supplements and instituted training that helps staff better prepare for these babies in need. 

“They are fully formed,” Bennet said about premature infants. “Parents expect missing parts, but everything is there, it’s just tiny.”

What may not be there are motor skills, which most frequently affect the legs. Cognitive difficulties, including attention deficit disorder, learning disabilities and visual problems ranging from the need for glasses to complete blindness, also are possible.

“Most people think of 24 weeks as the limit of viability,” Bennett said. “You hear about the 11-ounce baby that survives, but it’s extremely rare. Chance of survival at 23 weeks is less than 10 to 20 percent. And the chance of having an outcome without disabilities [at that age] is very low.” 

Bennett said the biggest difficulty in treating the most premature babies is their small mouths and tracheas. Without tiny equipment to match, helping the infants to breathe is complex.

Surfactant, a protein our fully-formed lungs produce to help us breathe, has to be provided through an endotracheal tube to pre-term babies, adding another invasive procedure and increasing the risk of infections. 

“There are studies looking at an inhaled surfactant that could be delivered with a mask or through a nebulizer that produces a mist, but they are still in the research stage,” Bennett said, as the conversation turned to present and future technological developments.

One of the biggest improvements is non-invasive testing. Doctors can measure carbon dioxide, oxygen and bilirubin levels through the skin instead of with blood draws, reducing the number of pokes a preterm infant receives. 

“With these newer sensors, we get a constant reading, which helps, especially with babies on a ventilator. We used to have to do a blood gas test hourly and now, we maybe do that one time a day.”

In a one-week period, that’s 161 fewer sticks: The relief in Bennett’s voice as she spoke was obvious.

Intravenous nutrition has improved in recent years, with better proteins that cause fewer liver problems and more closely match the quality of nutrition that a fetus in utero would receive from its mother.

In the neonatal unit, improved incubators more closely mimic the dark, moist, warm environment babies experience in the womb. Modern ventilators are equipped with smart pumps, reducing the risk of human error.

But it’s simulation-based training for neonatal doctors and nurses that is having the greatest impact on the outcomes for preterm babies. 

“We used to have mannequins that maybe had a balloon to inflate like lungs do,” Bennett said. “What we have now looks, behaves and sounds like an actual infant. It’s operated by a remote.” 

Doctors can make the simulated baby’s heart rate go up and down and its lungs make sounds as if they are collapsing. The “infant” can suffer seizures and its blood levels can be made to spike or fall.

If the neonatal team follows the correct procedures, the baby improves. Even better for training is that you can make the simulated baby struggle and not get better. "That somrtimes happens in life, and we need to learn about that too.," Bennett said.

In addition to general training, an intensive care team at a hospital can practice procedures before a high-risk baby arrives from another facility. 

Despite the advances, treating premature infants comes with a heavy burden. 

“We sit down with parents of any premature baby and discuss the chances of survival and long-term problems," Bennett said. "We can calculate the outcome based on age, gender and whether or not they have been on steroids.  Sometimes, we have to talk to families about stopping care and providing comfort care for their baby."

What comforts Bennett is the amazing potential of her tiny patients. 

“We don’t always know how a baby is going to do," she said. "Even if a baby leaves who has had a rocky course, he or she may do well with continued stimulation. It’s hard for us to know what will happen in the future.”