5 - Reasons Your Baby may be Admitted to the NICU (Dr. Dennis Rosenblum)

Dr. Dennis Rosenblum, neonatologist, joins Dr. Dustin Arnold, chief medical officer, to discuss reasons your baby may be admitted to the neonatal intensive care unit, or NICU.

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Transcript

Dr. Arnold:        
This is LiveWell Talk On...Reasons your Baby may be Admitted to the Neonatal Intensive Care Unit or NICU. I'm Dr Dustin Arnold, chief medical officer at UnityPoint Health - St. Luke's Hospital. Our guest today is Dr. Dennis Rosenblum, a neonatologist at St Luke's. Thanks so much for coming by.

Dr. Rosenblum:     
My pleasure, glad to be here.

Dr. Arnold:         
You know, I think to start off, the term neonatology is not familiar to a lot of people, even to physicians. So could you take us through what is a neonatologist and what is the training that it requires?

Dr. Rosenblum:      
Sure. What a neonatologist is, is somebody who specializes in neonatal perinatal medicine. So what a neonatologist, in terms of their training, does a three year pediatric residency and then does another three years of fellowship taking care of newborns, particularly those that are high risk, those that are ill premature and ill sick, full term babies as well.

Dr. Arnold:        
And how many beds does the unit here at St. Luke's have?

Dr. Rosenblum:      
It has 22 beds. It's a level three unit. It's the highest level rated unit in Cedar Rapids.

Dr. Arnold:        
And there's a unit higher than that.

Dr. Rosenblum:      
Yeah. The highest level is level four, which is what the University of Iowa is. The reality is, is that in a level three unit, we take care of babies that are 22, 23 weeks, which is and up, which is the lowest limits of gestation. And we do everything that a level four does except for complex surgical cases.

Dr. Arnold:        
Okay. And in your, how long have you been a neonatologist?

Dr. Rosenblum:     
Too long [laughs]. No. I think since I finished my fellowship in 1992. So I guess it's been 27 years.

Dr. Arnold:        
And in that time, you said you're at 22 weeks now, what has, have you, how much have you seen it lower? Where were we in 1992 compared to now?

Dr. Rosenblum:      
Sure, sure. I think the, certainly the lowest limits at that point were considered 23 weeks. By that time, the survival rates were only about 10%. That was in some of the, you know, best hospitals in the world and I was fortunate to be able to train in Boston. Now the survival rate's at 23 weeks, in our own units they're about 60%. So that's changed significantly. So the limits of viability have been kind of pushed to 22 weeks, not all places in the United States will do that, but we'll take care of those babies in those types of situations.

Dr. Arnold:         
I can only imagine, I have two healthy daughters, and been fortunate that they've been healthy their entire lives. But I can only imagine the stress and the worry and the concern new parents might have if their baby ends up in the NICU or the neonatology unit. What should they expect, the family?

Dr. Rosenblum:      
Yeah, well, I think, you know, in terms of what we tried to do for the family is that we all have, we have 22 rooms, but they're all private rooms. So we try and maintain a family's privacy. And at St. Luke's we've been fortunate enough to actually win some family centered care national awards. So we try and involve the families as much as possible in their baby's care. We do our best to keep them involved in their baby's care on a day to day basis. We are fortunate enough to have a family liaison support individual that will help them with their needs, as well as social workers and care coordinators. And in addition, I believe we're still the only hospital in the state that has a Ronald McDonald Family Room, which provides free meals, free hot meals for the families, snacks, sleep rooms and it's a, you know, a place where parents can get away and just relax under those stressful situations. For babies that are here for a long time, we often will have several family conferences just to kind of make sure parents have a really good understanding that, we obviously we talk to them on a day-to-day basis and make sure that they're fully involved in the baby's plan and discussion.

Dr. Arnold:         
What are the top reasons that a newborn would be placed in the NICU?

Dr. Rosenblum:     
Yeah, probably the biggest three reasons that babies are placed in the NICU are primarily respiratory distress is probably the first one, prematurity and infection. Babies that are born prematurely very often have respiratory distress syndrome, which means that the lungs aren't fully developed and they'll have problems actually really just opening up their lungs in the first place. Whereas for example, respiratory distress in a full term baby very often could be from retained fetal lung fluid or pneumonia or aspiration. So there's different categories along that, but those usually the major three reasons that I would say.

Dr. Arnold:        
And so the difference between 21 and 22 weeks is, is primarily lung development?

Dr. Rosenblum:      
Yeah, it is. It's, you know, the biggest changes in survival rates are really from 22 to 25 weeks. There's really an incremental increase and then after that, you know, in our unit at 25 weeks, survival rates are over 90%. And so it kind of plateaus off. But really there's just, your air spaces in your lungs are only so well developed and they have to be close enough to the blood vessels. And actually the blood vessels in the lungs get closer to those air spaces to allow oxygen to come in and carbon dioxide to go out as gestation increases. So 21 weeks is maybe the next step. It will be after my, I'm done. They're actually now doing animal models where they have artificial placentas and that may be the next step. But again, that'll be probably a few years down the road.

Dr. Arnold:         
You're rapidly heading towards the world of science fiction on some level with some of the advances.

Dr. Rosenblum:     
Yeah, it's actually amazing. There's the animal studies are being done at Children's Hospital of Philadelphia and they've, if you go on Youtube, you can actually look and see the studies that they've done on fetal lambs and doing artificial placentas. And, uh, I think the plan is to start human trials within the next year or so.

Dr. Arnold:         
That is fascinating. Do we ever take care of full term babies, 40, 42 weeks? I'm showing my lack of knowledge there in that, but, do you ever have those admitted to the unit?

Dr. Rosenblum:      
Sure. Yeah, I think about 5% of all full term babies are actually ended up in a Neonatal Intensive Care Unit. And actually one in 10 million actually requires some degree of resuscitation. That's something that most parents are not aware of. Everybody expects to have a healthy, full term newborn, and obviously we want them to have a healthy, full term newborn, but occasionally, you know, for the reasons that I discussed like respiratory distress or infection or low blood sugars, they will end up in the Neonatal Intensive Care Unit and we have the ability to take care of pretty much any problem that a full term baby has.

Dr. Arnold:         
I think that's important to mention that you have 22 beds, and the adult intensive care unit has about 16 and you know, it's good to remember that your patients have the same amount of organs, the same amount of problems. They just might be smaller, but yet it's still very high level of care that's going on over in the neonatology unit. Does the mother's health impact the possibility that a baby might end up in the unit?

Dr. Rosenblum:      
Yeah, absolutely. You know, we've seen an increase in the United States over the past several years in obesity and diabetes, and particularly with diabetes, the baby's lungs sometimes don't fully develop even at term and they may have heart problems and they may have low blood sugars. So we're seeing an increased incidence of admissions to the NICU for, that's just one example. You know, another thing that's occurring unfortunately across the United States is there've been an increase in maternal substance abuse, particularly opioids. And so we've gradually seen an increase since I've been at St. Luke's in Cedar Rapids and that as well. And those are just two prime examples. We're also lucky enough within the past year to have hired Dr. Stephen Pedron, who's a specialist in maternal fetal medicine, or high risk pregnancies. And he has actually added, been quite an asset to our services. He's probably one of the most dedicated and personable physicians that I know. I think, you know, if I was having a high risk pregnancy, or part of a, the father with a mom who was having a high risk pregnancy, I'd be seeking him out for his advice and consultation.

Dr. Arnold:         
Yeah and a little Inside Baseball, I know Dr. Rosenblum, you were instrumental in getting him here and I think, you're being a little bit too humble in setting that program up, which we're appreciative of. How can patients and patients or parents, specifically find more information about the neonatalogy program?

Dr. Rosenblum:     
Yeah, probably the two easiest ways are, one is just go on our website, just go to the St. Luke's website, go to the babies and children's section, and you'll see a whole list of information about our Neonatal Intensive Care Unit about maternal fetal medicine, the birth care center, classes and you know, and you can find out a wealth of information just from looking at the website itself. Another way is to actually take a birth care, and that also can be set up online as well. And then if you see your obstetrician, and you have specific questions for a neonatologist, or one of our neonatology team, you can have your obstetrician call us and we will set up an appointment with you as well.

Dr. Arnold:        
So as a parent, and my child is admitted to the unit, is there any longterm complications that I would be worried about? I mean, can you go out to the mall and see teenager to go 'well, they were in the NICU. They weren't,' I mean tell us about that. I guess what I'm saying is if my child is in the unit, I can still be optimistic they're going to have a normal life and normal development.

Dr. Rosenblum:      
What I usually tell parents is that if your baby's born prematurely they're at a slight increased risk for just about everything you possibly think of that can happen to your child, like for example, attention deficit disorder or, cognitive problems, things like that. But there's a very slight increase in risk. Obviously the more premature you are, the higher that risk goes up. But you know, again, a vast majority of time, even if you have a premature baby, particularly babies born, you know, beyond 25 weeks, you know, the chances of having good long term development are quite good.

Dr. Arnold:         
The LifeGuard, the helicopter, I know you have a transport team. I'm not, I'm familiar with the adult side of that, but can you tell us about the neonatology side of the transport?

Dr. Rosenblum:     
Sure. We've been doing transports even before I was here. We were actually one of the first centers in the Midwest to actually do transports, what's called a high frequency ventilator, which means babies, particularly premature babies, we get very tiny breaths, which helps prevent significant lung damage and we can do that on transport itself. But we have a dedicated neonatal transport team, which has a core group of nurses and a core group of respiratory therapists that are specifically trained for transport and can take care of high risk situations. We transport babies and from places such as Waterloo, Dubuque, Waverly, Manchester, just to name a few. So we do several transports a year.

Dr. Arnold:        
So up to an hour, almost two hours away?

Dr. Rosenblum:      
Yeah, we've gone up actually as far as the northern portion of the state, around Mason city and things like that. So we will occasionally, you know, we'll go up there as well if we were asked to.

Dr. Arnold:         
Interesting. The, I think it's good to mention that your team is comprised of physicians and nurse practitioners and a PA, physician's assistant, and I know how well trained they are and their dedication, but do you want to give some insight into the fact that someone's in house, available for emergencies and take it from there?

Dr. Rosenblum:      
Sure. We are, our group, our team, our neonatologists, nurse practitioners and physician assistants are always here, 24/7, 365 inside the hospital. And when we're covering the NICU, our only job is to make sure that we're taking care of your baby to the best of our abilities. Obviously it's a team effort because we have experienced nurses, respiratory therapists, but our core group of neonatologists and nurse practitioners and physician assistants all have 10 years of experience, past fellowship or past their training and beyond. So we're a very experienced group, we've been doing this a long time, and, you know, like I said, we're, I'm very fortunate to be surrounded by people that, um, are dedicated and experienced and know what they're doing.

Dr. Arnold:         
One last question. Why did you choose neonatology?

Dr. Rosenblum:     
Yeah, that's an interesting question. I actually, when I started medical school, I thought I was gonna go into internal medicine and actually deal specifically or primarily with people in geriatrics. So, elderly population. And obviously I ended up on the complete...

Dr. Arnold:        
The other end of the spectrum.

Dr. Rosenblum:      
Opposite end of the spectrum. Yeah. And I think the thing that drew me to pediatrics, and neonatology in particular, was that you can make the highest difference right away at the start of a patient's life that can lead to a positive outcome for the extent of their lifetime. And, you know, I was fortunate to have excellent mentors and that's led myself to have hopefully a reasonably successful career.

Dr. Arnold:       
Well I can confirm that you have had a reasonably successful career, beyond measure quite honestly. This is really great information, I really appreciate you coming by because I know you're busy. Again, this was Dr. Dennis Rosenblum, neonatologist at UnityPoint Health - St. Luke's Hospital. To learn more about our level three Neonatology Intensive Care Unit, visit unitypoint.org/babies. If you have a topic you'd like to suggest for our Talk On... podcast, shoot us an email at stlukescr@unitypoint.org. And we encourage you to tell your family, friends, neighbors about our podcast. Until next time, be well.