MVH History — NICU

Sitting in her kangaroo chair, Carrie DeWeese cradled her young son in the Neonatal Intensive Care Unit of Miami Valley Hospital. Five and a half months after his birth in June 2012, the infant who was no bigger than a Barbie doll when he was born would be discharged the next day.

“Finally,” said Carrie, smiling at the news neonatologist Marc Belcastro, DO, had given her moments earlier. “It’s been a trying time.”

Born at just 25 weeks and two days of gestation, son Chase had a shaky start in the world. Weighing 1 pound and 3 ounces, the first child of Carrie and husband Dustin would endure one of the longer stays in MVH’s NICU (pronounced “nick-u”).

The NICU is for any baby who cannot go immediately to a regular hospital nursery. That’s typically around 15 percent of all newborns. Some, like Chase, require extensive care, IV medication, help with temperature regulation, tube feeding and 24-hour monitoring using sophisticated equipment.

"Planning and having a baby is one of the most cherished times in our lives,” said Dr. Belcastro, the NICU’s medical director since 2004. “When a family's dreams are changed by a premature baby or other newborn complication, their world is suddenly turned upside down. Our joy and mission is to recover this dream for each and every family that finds themselves in our NICU with their new baby."

Some history

Since its earliest days, MVH’s NICU has enjoyed a tradition of being a leader and practitioner of cutting-edge medicine in the Dayton region, if not the state and nation. First, a little background:

The NICU opened in 1970 under the direction of Alfred Hicks II, MD. In 1975 it became a Level III (highest level of care) center for high-risk obstetrical and newborn care. It was the only center of its kind in the Dayton region.

By 1982, the NICU advanced to the point where it no longer needed to transfer its sickest babies to Children’s Medical Center of DaytonOff Site Icon; the babies could stay put at MVH until discharge, unless the baby required a specialist at Children’s.

Four years later, it was the first NICU in Ohio and just the eleventh in the United States to start using a controversial new therapy called ECMO, which stands for Extracorporeal Membrane Oxygenation. ECMO provides cardiac and lung support through tubes inserted into the chest. The treatment is still used today.

Just a year later, in 1987, the NICU began using Surfactant Replacement Therapy, a groundbreaking treatment in the fight against neonatal respiratory distress syndrome. (A surfactant promotes ease of breathing by reducing surface tension of the fluids that coat the lungs.) This was a full seven years before the U.S. Food and Drug Administration approved SRT. The NICU accomplished this by working under strict protocols with researchers at The Women and Children’s Hospital of Buffalo in New York.

SRT was one of many therapies that benefitted Chase DeWeese in his long NICU experience.

“That by far has been the breakthrough that has saved more lives than I’ll ever see in my career,” Dr. Belcastro opined.

Around the same time, the NICU started using Jet ventilation, another experimental treatment that uses high-frequency mechanical ventilation to reduce ventilator-induced lung injury. Once again, by working with large research institutions, MVH’s NICU was using a beneficial therapy years before FDA approval.

Explained Dr. Belcastro: “We just contacted research institutions, made connections and developed relationships with them because we wanted to get in on the front line of things.”

A new home

Fast forward to 1990. The NICU moved to its new home in MVH’s new $21 million Berry Women's Health Pavilion, the Dayton area’s first and only freestanding maternity building. Serving 17 counties, the center had 43 beds, up from 25 in its prior home in the McIntire Perinatal Health Center. Dr. Neil Kantor was the Medical Director at the time.

Also that year, MVH became the fifth hospital to join the Vermont Oxford Network (VON) database, which collects data on all preterm infants weighing less than 1,500 grams (3.3 pounds). That data, in turn, is used to help NICU’s improve their operations and patient care. Today, more than 900 NICU’s worldwide belong to VON.

In 1995, Belcastro and other MVH neonatologists joined Pediatrix Medical Group, one of the nation’s leading providers of maternal-fetal, newborn and pediatric subspecialty physician services. The company focuses on medical care and quality improvement and provides physicians access to a nationwide neonatal network.

Under Pediatrix, Belcastro and his colleagues in 1997 started charting patient records and progress notes electronically. This was a full decade before the rest of MVH began a similar practice. Today it’s widely accepted that electronic medical records lead to better documentation, data collection and discharge summaries, all of which leads to fewer errors and better patient care.

Also in the mid-1990s, the NICU standardized its protocol for the treatment of Congenital Diaphragmatic Hernia. This improved patient survival from 50 percent to 75 percent. The NICU also welcomed neonatal nurse practitioners to the staff, which gave the unit another

level of expertise in the care of critically ill newborns. The nurses provide 24/7 in-house coverage and delivery attendance.

Time to renovate

By the mid-2000s, it was clear the NICU needed an upgrade and would have to be expanded. Construction began in the spring of 2007 on a $19 million project that would more than double the NICU space to 51,000 square feet. The new center opened in 2009 with 60 private rooms on two floors, replacing the previous open environment. One floor serves higher-risk babies; the other serves lower-risk babies.

Each room was designed to protect the newborn from outside stimuli and to mimic the womb as much as possible. The rooms feature sound–absorbent ceilings and floor tiles, dimmer lights and sliding glass doors. They’re equipped with special incubators that provide monitored heat and humidity, in-bed scales and rotating mattresses. Specially designed rocker/recliners (the kangaroo chairs mentioned above) allow family members to cradle babies closely

Carrie DeWeese, for one, is convinced the design and features of her son’s room were instrumental in his growth and progress. “The room is nice because you can adjust the lights and recline the chair, which is great for skin-to-skin contact with Chase,” she said.

More medical advancements

In 2009, the FDA approved the Cool-Cap System, a medical device that keeps the newborn’s head cool. The cap is used for babies suffering from hypoxic–ischemic encephalopathy, brain damage from oxygen deprivation. The lower temperature slows the brain’s metabolism, which prevents brain cells from dying and reduces swelling that can cause further damage. MVH’s NICU used the cap for a while but found a cooling blanket easier to use. With this system, the baby is placed on a mattress filled with cool water so the entire body is cooled.

Around the same time, the NICU began resuscitating more severely premature babies. The resuscitation standard in recent years had been a minimum of 24 weeks gestation and an infant weight of at least 800 to 900 grams. In 2012, MVH’s NICU cared for four babies born at 23 weeks gestation. All survived.

In other advancements, a team of NICU specialists collaborated in 2010 to improve the care of babies born to drug users. Such babies are at risk for neonatal abstinence syndrome (NAS), drug withdrawal reactions that pose a serious health risk. The team includes NICU nurses, a neonatologist, social worker and occupational therapist/infant development specialist.

The NICU also adopted a multi-disciplinary approach to patient care. Instead of a doctor doing rounds alone, it became a team of professionals that included physicians and nurses, a respiratory technician, dietician, social worker and various therapists, each working closely with the infant’s parents.

“We felt like we were part of the team,” Carrie DeWeese said. “I was there almost every day for the rounds. They would include me every single time and it really meant a lot to me.”

‘Astounding’ care, commitment

By 2012 the NICU was caring for an average of 850 babies a year, or roughly 50 per day, with a proud interdisciplinary staff of 200.

“Despite the serious conditions of many of our little patients, we don’t have a lot of sadness here,” said NICU Nurse Manager Julie Scanlan, RN. “The NICU is a happy place with many happy outcomes.”

Added Dr. Belcastro, “To accomplish what our NICU has accomplished in a non-academic setting, in a city like Dayton, is astounding. It speaks volumes about the support from our administration and the commitment from our nurses, physicians, respiratory therapists and entire NICU staff, the way they’re able to ‘step out of themselves’ and do some really wonderful things for our patients.”

Just ask Carrie DeWeese.

“The place, the people, it was part of our life and daily routine,” said DeWeese, six months after her son’s discharge. “It was our other home. We tell Chase it was his first home.”

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