Transcription:
The UVA Health System NICU

Melanie Cole (Host): Hi. My guest is Dr. David Kauffman. He is a neonatologist at UVA Children's Hospital. Welcome to the show, Dr. Kauffman. Let's talk about the NICU at the University of Virginia Health System. What type of patients do you typically see there?

Dr. David Kauffman (Guest): Well probably most people think of a NICU as a place for pre-term babies, and we take care of some of the most immature babies born at 22, 23 weeks of gestation, when pregnancies are complicated by preterm labor or need to deliver early. But we also take care of a lot of term infants. For some families, unfortunately, there may be a child with a birth defect or there's a difficult delivery, and the babies need additional care after it's born.

Melanie: So, term infants and premature babies are there. Now, what types of conditions might make a baby be in the NICU, and in such a scary place for the parents, too? So first, speak about the conditions a little bit. What are you doing for them?

Dr. Kauffman: Some of the most difficult situations is when someone is expecting a normal, healthy child, and something happens around the time of delivery and the baby needs additional support, whether it's a ventilator or some oxygen. But oftentimes, these babies might be at risk for brain injury because of the difficulties at delivery. So one thing we have at UVA is a cooling protocol, in which kids who may be at risk for brain injury get cooled from normal temperature, 98.6 degrees to 92 degrees for three days. This helps prevent some of the cells that might be in shock from what happened at delivery to recover and improve outcomes for those families and those kids.

Melanie: You mentioned that one of the more difficult is when you're expecting a healthy delivery, and all of a sudden, something does go wrong. Now, are many of the things that you see things that have been predicted so the parents kind of have a little bit of an expectation that they're going to deliver a baby that's going to be in the NICU?

Dr. Kauffman: Yes. Sometimes, with birth defects, families will be referred to UVA, our perinatologists who help take care of them while they're pregnant. We as the neonatologists take care of the baby and the family after delivery. One of those defects is called the congenital diaphragmatic hernia. For example, these patients would be referred here. We have an excellent team that includes pediatric surgeons, the neonatologist. Everyone in the NICU is specialized in neonatology, from the nurses, neonatal nurse practitioners, and all the care partners. These babies, their diaphragm of their lung has a hole, and the intestines migrate into the chest, preventing normal lung development. So they can be very sick at birth and need sort of general ventilation. At times, they may be very, very sick and need to be put on a heart lung bypass machine for several days. With this team and this approach, we have great outcomes similar to major centers elsewhere, and it's good that those patients can get that care right here in Charlottesville.

Melanie: Speak about the team approach. Who is involved in the NICU? What is the team that really works with the babies and with the parents? Because as I said before, how scary for parents. They've been expecting this very happy time, and all of a sudden, it's turned into something that could be very serious and scary. How does your team deal with both the parents and the baby, and who is involved?

Dr. Kauffman: Well, initially, there are a lot of people from just getting greeted at the desk when they come in by our health care coordinators, and then, at the bedside, the nurse plays an invaluable role in just meeting the family, orienting them to everything that is happening to the baby, and the physicians and neonatal nurse practitioners as well. I think the biggest thing when we've looked at what families need is they need to feel they can trust us and they sort of know what's going to happen the next 24 hours. So I think them getting to know us and us communicating openly, talking about everything that happened and what's going to happen the next hour or the next 24 hours, it helps families give trust. Obviously, we want and they want to be with their baby at home, and to give up that care to the NICU is challenging. So I think establishing a good relationship and communicating what's going on really helps ease families through this roller coaster in the NICU.

Melanie: Dr. Kauffman, what makes them so specialized, the nurse practitioners and doctors such as yourself? I mean, this specialty, you have to really be trained to do this, correct?

Dr. Kauffman: Yes. So for the physicians, they go through a three-year pediatric residency and then additional three years of neonatal medicine. The nurses, in addition to nursing school, get special training when they first get to the NICU for about half a year to a year, and then their years of experience. Similarly, the nurse practitioners are nurses who then go through a two-year training to become neonatal nurse practitioners.

Melanie: It takes a lot extra training and a certain amount of empathy for what these parents are going through. So speak about how you deal with the parents, because some are probably more difficult to deal with than others. How do you calm their fears?

Dr. Kauffman: Well, I think listening to families really helps us know what each family needs. Sometimes they just need to know what's going on. Sometimes they just need to know how much the team cares about their baby who's in the NICU. And I think just listening to their questions and trying to guide them to what's happening. They're worried if the baby will survive or not come home or not come home this week versus a week from now. You know, it's really about trying to figure out what they need to know to help. The other thing we try to do is get them involved in the care, even if it's the littlest thing of touching their baby. Like at 24 weeks, the baby is so small. Their wrist is as big as a wedding band ring, and people are afraid. They don't know if they can touch their own babies. So just helping them know they can do that, they can read to their child, and they can still care for the baby, they know we're doing it together with them.

Melanie: That's really great to hear, Dr. Kauffman. We've all seen those little babies in there and what they look like, and they're just so small and so helpless, and so I can only imagine what parents are going through, and I certainly applaud all the work that you do. Now, what about outcomes? The real positive stuff, give us some of the hope that you've seen going on.

Dr. Kauffman: Well, through the years, it would be unthinkable for certain babies to survive, but even at pregnancy where someone has to deliver at 23 or 24 weeks, the majority of those babies can now survive where 20 years ago, almost all of those babies would not be able to go home with their families. Every week makes a big difference as far as how the babies do. All have some risks of developmental delay, and that's something we work and follow the kids once they leave the hospital. But for example, at 24 weeks, about 80 percent of the kids survive now, and about 70 percent have normal outcomes. Then once you get to 28 or 29 weeks, 90, 95 percent of the kids are surviving with good outcomes.

Melanie: That's great information for parents that are scared and that the UVA Health System in the NICU, these doctors are specially trained, as are the nurse practitioners. They're sensitive to what you're going through and have such positive outcomes that there is really a lot of hope that things are going to go well. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.