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Dr. Miller: You've been told that your baby that's about to be born could have a medical or surgical complication. We're going to talk about what happens next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: I'm here today with Dr. Mariana Baserga, and she is a neonatologist and also a pediatrician. She is a specialist in the care of little tiny babies. And Mariana is going to tell us a little bit about what happens during delivery and right after delivery. So let's suppose that you are a mother or you're a family that has been told that the delivery may result in a child that has some significant medical complications. Can you describe for the mother-to-be what might happen during that delivery so that we can best help the child?

Dr. Baserga: As a group of specialist in pediatrics that take care of newborn babies that may came with problems at birth, we have a team in the neonatal intensive care unit that can provide the family with the support needed at the time of delivery. The way this is planned is that ahead of the delivery, we do meet once or twice, as many times as needed, with these families to discuss the plan for the delivery.

Dr. Miller: So now, I would think that most mother's families would find out about the baby's condition through some of the modern tests that we have, such as . . .

Dr. Baserga: Ultrasound.

Dr. Miller: . . . ultrasound or echoes of the child in utero, in the womb as well as maybe some genetic testing that's done from time to time. Is that usually how these problems are picked up by the obstetrician?

Dr. Baserga: Correct. The technology now allows us to do very sophisticated ultrasounds that can pick even small defects when the baby is being developed in utero. And if we know that the baby is going to be born with a problem that would need medical assistance after birth in the NICU, the team is present at the time of delivery and the baby is passed from the OB or obstetrics delivery room through a window into the neonatal intensive care unit.

Dr. Miller: And that could happen quite quickly.

Dr. Baserga: Yes, right after the delivery.

Dr. Miller: And so the mother might not be able to hold the baby necessarily.

Dr. Baserga: Correct.

Dr. Miller: This could happen rapidly and the mother would probably know about what was going to happen that she may not be able to hold that baby or see the baby.

Dr. Baserga: Correct.

Dr. Miller: The surgical team or medical team would quickly take the baby and then perform whatever procedures are needed.

Dr. Baserga: Right, depending on the diagnosis that the baby may have, we need to pass their babies through the window to the intensive care unit rapidly.

Dr. Miller: Talk to me a little bit about this window.

Dr. Baserga: Yeah, that's a real window with glass and everything that slides open. And there are three of them in the intensive care unit to communicate with the operating rooms. So if there's a C-section or caesarean section, we have opportunities to pass the baby to the neonatal intensive care unit. And one is communicated to our regular delivery room. So a vaginal delivery can also be achieved in that manner.

And then, in the intensive care unit, we have a special bed called a warmer, where we put the baby so the baby can stay warm. We will have specialists that are able to put a tube in their airway if needed, to assist the baby in ventilation. We have very specialized nurses that will be putting IV lines if we need to, to provide fluids and sugar to the baby.

And once the baby is medically stable, if the baby needs to be transferred to a surgical center, we can call the neonatal or prenatal transport team that has specialized equipment to transport the baby to level 4 NICU for any special procedures that have to happen including surgery by specialized pediatricians.

Dr. Miller: So it sounds like most pregnant women are advised about the process that could take place. So they're usually aware of what's probably going to happen, and that I would think that lessens their anxiety some.

Dr. Baserga: Yeah, the families want to know where the baby is going to be, who is going to be taking care of the baby, what's the plan. When is the first time they would be able to touch the baby and hold the baby?

Dr. Miller: How very important. So as I understand it, the baby goes through the window, and perhaps, there's surgery. It could be neurosurgery, it might be cardiac surgery, it could be general surgery, it could be some other type of intensive care. Then does the baby come back after the procedure to an intensive care area? What happens then?

Dr. Baserga: So the procedures that are needed to resolve the baby's problem may differ. We are even able to perform surgery in the NICU in Primary Children's if a patient is too sick to go to the operating room. But, having said that, if the baby goes to an operating room, following surgery, the baby would recover in the neonatal intensive care unit and most likely would stay there until discharged home. We don't typically transfer babies to other areas of the hospital since we have the specialists that can help them achieve that discharge time.

Dr. Miller: So they stay right in that unit until the time when they're ready to be discharged home with their mom?

Dr. Baserga: Correct.

Dr. Miller: So as I understand it here in the University of Utah, when delivery occurs, if there are certain medical procedures that are necessary then that little Neonatal little transfer to cross to Primary Children's Hospital, where those specialist work and perform their procedures.

Dr. Baserga: Correct.

Dr. Miller: So once the baby transfers through the window, the little baby goes through the window, they don't go right to surgery or to some other procedure. You will probably stabilize the little baby. Is that right? You perform whatever you need to do to make sure that baby is stable.

Dr. Baserga: Yeah. The main thing is to make sure that the baby is safe for transport. So to establish that, we have to make sure there is stable airway. So if the baby needs intubation or a ventilator, we have to provide that. We have to make sure we have access to give medications through an IV. And once we see that the baby is stable enough, then the baby can be transferred to a children's hospital for neonatal surgery.

Dr. Miller: And how is the information communicated back to the mom who is obviously separate now from the baby after the delivery?

Dr. Baserga: Yeah, that's very important. After the baby is transferred back to the hospital where the surgery will happen, us, the neonatologists, are the ones that keep the parents informed. Typically if the father is present, he goes with the transport team, and he stays with the baby during the whole process to the children's hospital. Mom, unfortunately after having a caesarean section or a vaginal delivery cannot go right away, but after few hours if she is feeling well, we can provide transport for mom to be taken in a wheel chair to Primary Children's to see the baby also.

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Dr. Miller: What does a neonatologist do? We're going to talk about that next on Scope Radio. I'm Dr. Tom Miller.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm here today with Mariana Baserga. She is a physician, a pediatrician, and she's also a professor of Pediatrics at the University of Utah. Mariana, if you were at a party and somebody asked you what you did and you told you were a neonatologist, what would you tell them? What does a neonatologist do?

Dr. Baserga: Neonatologist is a specialist that will take care of newborn babies that do not . . .

Dr. Miller: Newborns.

Dr. Baserga: Newborn babies.

Dr. Baserga: Little ones.

Dr. Miller: Tiny ones.

Dr. Baserga: The tiny ones or the not-so-tiny ones that can run into trouble after delivery. So most of the babies that come to the ward don't have a problem transitioning from mom's womb to alive, but when they do, that's where we come in to help.

Dr. Miller: So most of the time, healthy babies, healthy births. But, occasionally, a woman might have an issue with a new baby, and that's where you step in.

Dr. Baserga: Correct. There are about half a million deliveries that are pre-term in this country, and that's by definition of a baby born less than 37 weeks or less than 5 pounds. And those babies are the ones that a neonatologist will be taking care of in the NICU.

Dr. Miller: So if they're less than 5 pounds or less than 37 weeks at gestation, that doesn't necessarily mean that they need to go a neonatology unit, but that you would assess them. That would be part of a routine examination that you would perform on this type of a newborn.

Dr. Baserga: Correct. Babies that come out early may need help with breathing, may need help with giving them sugar because they can't feed well. They can have an increase in sense of infections. And in those cases, they cannot be in the regular well-baby nursery and they have to be in the neonatal intensive care unit.

Dr. Miller: So the great thing about this specialty is that you're available in there in case you're needed. So it's almost like every baby that is born could be seen by a neonatologist and evaluated. And then what percent of the time might they end up going to a unit that cares for these little tiny babies?

Dr. Baserga: So premature babies less than 34 weeks gestation all will come to our neonatal intensive care unit. And there is a mid-ground, and those babies that are between 34 and 37 weeks, what we call "late pre-term babies," that can go either way. It depends on how the baby does. So I would say half of those babies may need to be in the intensive care. And depending on the hospital, they can be in a specialized well-baby nursery.

Dr. Miller: So do you think that most expecting mothers, mothers who are near delivery, know that a neonatologist might be involved in the care of their child if needed? Are they aware of your specialty, do you think?

Dr. Baserga: I would say half about, especially in the United States, most people are aware of the possible need that the baby will need help after being born. But we still in Utah, for example, see a lot of deliveries that happen at home, and everything goes well. So the times where we may need to transport babies into the NICU are when those deliveries don't go well.

Dr. Miller: How long do these babies typically spend in the unit?

Dr. Baserga: They can spend from one day to a year. It depends on how sick they are. Babies that are born at 23, 24 weeks gestation. . .

Dr. Miller: These are really tiny babies.

Dr. Baserga: Those babies are about a pound or half a kilo. And those babies may stay with us three, four month sometimes.

Dr. Miller: But usually what would you think, maybe several days for most babies that are not in that weight range?

Dr. Baserga: Yeah. The NICU has one of the longest stays in the hospital because babies need help for a longer period of time because they have to mature, they have to learn to eat. So what we tell families, when they're getting ready to go home and that's a question they like to ask, is, "When can I take my baby home?" Baby has to be able to control their own temperature. That means no need for an isolette.

And particularly when they're about three pounds, not before that, it's rarely to see the baby outside of an isolette. They have to be able to be taking all feedings by mouth without any tubes to help them gain weight. And they have to be breathing on their own without having what we call "prematurity apnea". And in those cases when the babies are still having apnea. . .

Dr. Miller: Apnea is the. . .

Dr. Baserga: Stop of breathing.

Dr. Miller: Stopping breathing.

Dr. Baserga: They kind of, what we say, forget to breathe because their brain is not mature, and those babies need to be in the hospital.

Dr. Miller: So what would be the more common reasons that little babies would end up under your care?

Dr. Baserga: Most cases are prematurity, being born early.

Dr. Miller: And what would follow that? So inability to breathe is one of the things you've said.

Dr. Baserga: Yeah, so secondary would be sepsis or infection. They need to be in the intensive care. And then we have a big group of babies that are born with congenital malformations, and will. . .

Dr. Miller: Usually cardiac or different kinds?

Dr. Baserga: There are different kinds. We have cardiac malformations. We can have brain malformations, what we call "abdominal wall defects," such as gastroschisis. Those babies all will need intensive care in the NICU. And in most case scenarios, we are aware that this is the case, and we have what we call "antenatal consultations" with these families. And by the time the baby is born, they know that the baby will need intensive care.

Dr. Miller: Now, another thing is that you have an entire team of specialists, including nurses and nutritionists. Can you talk a little bit about the team that surrounds the care of the newborn that goes to your unit?

Dr. Baserga: So the NICU is a big family. We have the neonatologists with the doctors, and then we have specialized nurses. We also have nurse practitioners that are specialized in neonatology. We have respiratory therapists that deal with the airway and ventilators and respirators. We have occupational therapists that are the ones that are dedicated to the development of these babies. And these babies are in an isolette. They don't move much around. And they assist them with neurological development, as well as starting feedings, because they are very immature in their skills to eat. So this is a big team that will help them . . .

Dr. Miller: Just like a big village taking care of these little babies, right?

Dr. Baserga: Yes, it is.

Dr. Miller: So for an expecting mother or families of an expecting mother, one thing that they might wonder about is . . . Well, if their baby is in the neonatal intensive care unit, are they able to visit? I think there may be some fears that they won't be able to see the babies or visit the babies.

Dr. Baserga: So our intensive care unit is family-oriented. It's family-centered and we are open 24/7. There are no visitation hours. The summertime, we even allow siblings and little toddlers to come.

Dr. Miller: You have no visitation hours. You don't . . .

Dr. Baserga: No restriction on visitation hours. So we don't have a policy that limits the time the parents can be at the bedside. Having said that, they're even invited to be present during nurses' sign out. We used to not allow families at that time and now we're an open unit so that they can always be at the bedside. They even hear the report nurses are giving to each other.

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