Proceed With Caution

This semester the technology of the NICU, both the past and present as well as mobile and non-mobile was discussed. Not much is documented on what the future holds. However, I have a few ideas. Currently, we obtain blood samples by poking the babies in the heel or trying to find a vein. In the future a hand held scanner will be waved over the baby that would calculate all lab tests. MRI's, CT scans and x-rays will also be performed via the scanner. Medications and nutrition will be administered transdermally through skin patches. Eventually, I in vision premature babies submerged in an amniotic like type fluid until 34 weeks gestation. Sounds sci-fi, but when a parent is given to option that submerging their child for several months is the only chance for survival, more than a few might just go for it.
Technology in the NICU has come a long way quickly since the days of the Incubator-Side Shows. The future is full of exciting possibilities. Society must take time to consider the consequences not just the benefits. Proceed with caution!



Works Cited


Buchanan, Kim. “Failed Neonatal Transport” Advances in Neonatal Care 9:2 (2009): 82-84. Print

Karlsen, Kristine A. Transporting Newborns The S.T.A.B.L.E. Way. Utah 2001. Print

Mask, Mitchell F. The Bronchotron: Theory, Setup and Use Mitchell F. Mask, 2008 Web 11 Nov. 2009.

Merenstein, Gerald B. and Sandra L. Gardner. Handbook Of Neonatal Intensive Care. 6th ed. Missouri: Mosby, 2006. Print

Phillip, Alistair G.S. “The Evolution of Neonatology” Pediatric Research 58.4 (2005): 799-812. Print

“Pragel Newborn Transport Incubator ca. 1949” Neonatology on the Web. 2009. Web. 20 Sept. 2009

Silverman, William A. “Incubator-Baby Side Shows” Pediatrics 64.2 (1979): 127-141. Print

Vu, Huyen. “12.5ounces at birth, baby set to go home.” Pittsburgh Post-Gazette 30 May 2009: Print

Teeny Tiny

Taylor Rideout born on March 12, 2009 now holds the world's record for being the smallest baby born alive and to survive. She weighed in at 12.5ounces or 350grams and was 10 inches long. She was born at Magee Women's Hospital in Pittsburgh, PA at 26 weeks gestation. Babies born before 37 weeks gestation are considered to be premature. Usually a baby is considered to be non-viable if they are born under 500grams and no heroic measure will be done to save their lives. Now that Taylor survived being born at 350grams, I suspect more parents will want everything possible done to save their micropremie. It is interesting that only 46 years ago the son of President Kennedy, Robert Bouvier Kennedy, died of respiratory distress syndrome or hyaline membrane disease. He was 34 weeks gestation and 2110grams or 4 pounds 10 1/2ounces. His death however is said to be a contributing factor to the creation of the first NICU at Yale-New Haven Hospital. Babies born with Hyaline Membrane disease in 2004 had a mortality rate of only 15%. What a drastic change in 40 years. Now infant's are given surfactant that has been derived from bovine or porcine lung extract. Surfactant has only been in use since the early 1990s.
There are an endless amount of complications that arise from "saving" smaller and smaller babies. These infant's are at high risk for developing mental and physical disabilities such as asthma, cerebral palsy, hearing and vision disorders. These tiny patients may try to die over and over again but technology at the hands of neonatalogist save them. Survival then becomes a question of ethics, what type of quality of life does the teeniest tiniest baby have. Since babies are not able to speak for themselves, who has the final say, the physician, parents or God?

Every Breath You Take

During a transport an infant's airway must be stabilized. The neonatal transporter has a built in ventilator. Sometimes a high frequency ventilation system is used such as the Bronchotron. This ventilator delivers 200-800breaths per minute. There are tanks for air, oxygen and even nitric oxide. Pulse oximetry will let us know the oxygen saturation and the cardio-respiratory monitor will give us the heart rate and respirations. Also built in is a suction machine, which helps to clean obstructions to the infant's airway. If the proper level of oxygen is not delivered it could lead to asphyxia, which is a condition in which there is a significantly reduced oxygen supply to the tissues with build-up of carbon dioxide and lactic acid. This could lead to cell and organ damage, which in turn could lead to survival with damage or worst case scenario, death. What a drastic change the transport incubator has undergone in the last seventy years.

The Heat is On

Why would it be necessary to use a transport isolette? Is it really necessary just to travel from the Labor and Delivery Unit to the NICU? Absolutely! Thermoregulation is one of the main functions of the transport isolette. A temperature probe is placed on the neonate's skin which in turn controls the air temperature of the transporter. If a baby were to become hypothermic the effects could be detrimental. The newborn could develop metabolic acidosis or Pulmonary Hypertension. Cold stressed infant's are also at risk for developing hypoglycemia (low blood sugar). When an infant is cold, oxygen consumption is increased, blood oxygen levels will begin to fall. In addition to relying on the transporter for warmth, a porta-warm (chemical thermal) mattress or warmed blankets from a blanket warmer are used. For extremely low birth weight babies we also place their bodies in a zip-loc bag for transport (not for freshness or storage). Next time I will discuss other functions of the transport isolette.

All in One

Last time I discussed technology in the NICU. Specifically the Giraffe Omnibed, the combination of a warmer and incubator. I would like to go one step further and discuss the transport incubator or isolette.
The first newborn transport icubator was made by J.L. Pragel in 1949. It looked like a stainless steel toolbox. It had a hinged lid with handle on top. There was two little sliding plexiglass viewing windows on the top. As well as a thermometer inside the lid.
The transport isolette we use today is basically a mobile NICU. It provides thermoregulation support. Cardiorespiratory support which monitors heart rate, rhythm and respirations. Pulse oximetry which tells use what the oxygen level in the blood is. Blood pressure monitoring both invasive and non-invasive. Oxygen and ventilator support. It also supports fluid infusion. What a drastic change since 1949. For my next post I will discuss how and why the transport isolette is used.

Technology as Objects in the NICU

Did you know that neonatal intensive care units(NICUs) did not exist until the early 1960s? Neonatology did not begin until the 1970s. There are many types of technologies in the NICU. My focus will be on technology as objects. Some types of technologies that are found in the NICU are incubators, warmers, ventilators, monitors, infusion pumps, and diagnostic imaging, just to name a few. A main focus of the NICU is caring for premature infants who should be their mother's womb. Using technology a combination incubator/warmer was invented and is used to mimic a womb like environment. Two different types of these machines are the Versalet made by Air Shields and the Giraffe Omnibed made by GE Healthcare. Personally I believe the Giraffe Omnibed is fantastic. Incubators have come a long way. From 1896 to 1943 there existed Incubator Baby Side Shows. At Coney Island one could pay an entrance fee to see the incubator babies. Parents would allow this because they were not able to afford incubator care. It does not seem like that long ago. Must not have been HIPPA around.

References: http://www.neonatology.org/tour/technology.html
http://www.advancesinneonatalcare.org

My major field of study is nursing. More than one category comes to mind when thinking about how technology has affected the medical field. The most obvious one would be technology as objects. Machines allow nurses to monitor patients without even laying hands on them. This is a good thing when you care for a extremely premature baby who does not tolerate physical stimulation. This can be tied into using technology as knowledge and activities. By placing umbilical lines in a newborn vital signs can be monitored, blood can be drawn and fluids administered. In the intensive care nursery different categories of technology are used to create a womb like environment. When a preemie is born they are placed into a Versalet, which a combination of a warmer and isolette or incubator. A temperature probe is then placed on the baby. The Versalet then controls the air temperature based on the temperature of the baby. The baby can also be placed on a K-pad, which a heated water pad. In very low birth weight baby a simpler form of technology is used. A piece of Saran Wrap is placed over the patient. Simple but it works. We must not forget about documentation. Most hospitals are making the switch to computer charting. We are currently undergoing this process at my place of employment. Soon the cardio-respiratory monitors will be connected to the computer recording the vital signs. Gone are the days of paper flow sheets and manually entering the vital signs into the computer. So many categories of technology have affected the medical field. Narrowing it down in the next couple of weeks will be challenging. Wish me luck.