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>> The leading cause of death among premature infants
is still lung disease of prematurity,
which is because of the deficiency of surfactant
in the premature lung.
Over time, this disease can progress
into chronic lung disease that is seen in premature infants,
also known as bronchopulmonary dysplasia
and its associated issues, such as pulmonary hypertension.
We also treat a large number of infants
who are referred from various centers
in the state and beyond
with congenital anomalies of the lungs,
such as diaphragmatic hernia
or other lung conditions that may affect the newborn.
The second leading cause of death
in premature infants is the intestinal conditions
such as necrotizing enterocolitis
and certain conditions that a baby might be born with,
such as Hirschsprung's disease or gastroschisis.
In some of these infants, the intestine might not
function normally for prolonged periods of time
or it might be anatomically short,
causing these infants to stay in a neonatal ICU-like setting
for several weeks to months.
The third set of conditions which continue to affect
neonatal survival are the brain disorders,
which might be secondary to birth asphyxia,
intercranial bleeds because of seizures,
and we also see a large number of these infants
who have encephalopathy because of congenital,
genetic, or metabolic conditions.
The fourth set is related to cardiac conditions
which may be because of congenital anomalies
of the heart or major blood vessels
that may require surgery within the newborn fetus
or at least major stabilization that would eventually
pave the way to safe surgery.
The fifth condition is affecting the kidney.
These infants may either be born with kidney anomalies
or might develop kidney failure
because of their critical illness.
In addition, we have increasingly seen a large number
of newborns with complex genetic
or multisystem conditions
that require multidisciplinary care.
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The Johns Hopkins Children's Center
houses the Sutland/Pakula Newborn Critical Care Center,
which is a state of the art facility
to provide multidisciplinary care
to medically and surgically complex newborn infants.
At this center, we work very closely with obstetricians
who specialize in maternal fetal medicine or in fetal care.
We also work very closely with pediatric subspecialists
who provide care to infants with diagnoses
related to the heart, the brain, the kidney,
and various other organs.
A major benefit of care at Johns Hopkins Children's Center
is that you have access to not only the latest
in medical and surgical therapy,
but you also have access to all the latest research
that is going on in various medical and surgical fields.
The Division of Neonatology
at Johns Hopkins Children's Center
includes several nationally and internationally
renowned experts who treat infants with conditions
affecting the brain, the lung, and the intestine.
We also work very closely with subspecialists
who provide care to infants for cardiac, renal,
neurological, genetic, and various other conditions.
For instance, if a baby has suffered birth asphyxia,
we not only provide the latest whole body cooling programs,
but we also have intensive, state of the art
monitoring programs that may not be available universally.
Along with our obstetricians, our division is probably
one of the most experienced in the entire United States
in providing care to fetuses
that may have complex congenital anomalies
that may require treatment even before birth.
These may include twins or multiple fetuses
that may have abnormalities with the placenta.
They may have congenital diaphragmatic hernia,
neural tube defects, or urinary abnormalities.
Care at Johns Hopkins Children's Center
brings you not only the state of the art treatment
given for medical and surgical conditions
that affect newborn infants,
but our efforts are also to bring you access
to all the latest research
that is being conducted at this institution,
and yet ensure that our care remains
patient-focused and family-centered.
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If a baby requires a complex surgical procedure,
the family will typically meet with neonatologists,
surgeons who might specialize
in general pediatric procedures
or in one of the organ-based
subspecialized surgical programs.
In these discussions, we also typically have obstetricians
who specialize in maternal fetal medicine or fetal care
and also pediatric anesthesiologists.
One of the major strengths
at Johns Hopkins Children's Center
is the close interaction between pediatric anesthesiologists
and the critical care specialists that work together
in the pediatric ICU.
After the baby has undergone a surgical procedure,
the infant may receive initial care in the
pediatric ICU for initial stabilization and recovery.
In our experience, this improves the safety
of these procedures and improves outcomes.
Once the baby has recovered to a reasonable extent,
the baby then gets transferred back
to the neonatal ICU for subsequent care.
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Our goal is to provide the most comprehensive care
to your infant at a site
which is most convenient to the family.
If a baby has a complex medical or surgical condition,
the initial care might have to be
at Johns Hopkins Children's Center,
but once the baby has recovered to a reasonable degree,
subsequent care can be provided
at Johns Hopkins Bayview Medical Center,
Johns Hopkins Howard County General Hospital,
or at Frederick Memorial Hospital.
Each of these sites is staffed by neonatologists
who are part of the same Division of Neonatology
at Johns Hopkins Children's Center.
Once the baby has stabilized for routine care,
the baby can most often be transferred
to one of the institutions that partner
with us across the state.
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Our division has major research strengths
in neurological conditions, particularly birth asphyxia,
neonatal encephalopathy, and seizures,
where we provide state of the art treatment
and monitoring regimens.
We also have significant expertise in intestinal conditions
such as necrotizing enterocolitis,
Hirschsprung's disease, and gastroschisis,
which are major causes of morbidity and mortality
in newborn infants.
In addition, there are leaders who perform research
in neonatal immunology, infectious disease,
communication, and quality and safety.
Our goal is to provide comprehensive, multidisciplinary care
to infants with complex medical and surgical conditions.
In this effort, we work closely with obstetricians
who specialize in maternal fetal medicine and fetal therapy
and with all the medical and surgical
pediatric subspecialists.
We understand the kind of stress a situation like this
can impose on both the family and the referring team.
Our efforts will be always to communicate clearly
with both and provide all support that we can.
If I can be of help,
please feel free to reach out to me personally.
Thank you.
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(babies and young children laughing)