>> CLEARLY, ONE OF THE BENEFITS OF THE SPECIAL DELIVERY UNIT
IS THE PROXIMITY OF THE PLACE OF THE ACTUAL BIRTH
TO THE NEONATOLOGY TEAMS.
>> PRIOR TO THE SPECIAL DELIVERY UNIT, A BABY WOULD BE BORN ACROSS
THE CITY, COULD BE ACROSS THE STREET, COULD BE IN
A DIFFERENT TOWN.
AND THERE WERE A LOT OF STEPS THAT HAD TO HAPPEN TO GET
THE BABY HERE.
>> AND THIS WOULD, OF COURSE, BE VERY HECTIC FOR FAMILIES.
FOR DADS AND OTHER FAMILY MEMBERS, THEY WOULD VISIT
MOM IN ONE HOSPITAL AND THE BABY IN THE OTHER HOSPITAL.
AND, OF COURSE, VERY DIFFICULT FOR MOM, WHO WOULD PHYSICALLY
BE SEPARATED AND UNABLE TO VISIT WITH HER BABY DURING
THIS VERY TRYING TIME.
>> THE SDU WAS DESIGNED WITH THE KNOWLEDGE THAT NICU AND CARDIAC
ICU NEEDED TO BE VERY CLOSE SO THAT MOTHERS COULD VISIT AS
FREQUENTLY AS THEY WANTED OR OTHER FAMILY MEMBERS AND STILL
RECEIVE THE CARE THAT THEY NEEDED FROM AN OBSTETRIC
POINT OF VIEW.
>> SO EVERYTHING IS REALLY BROUGHT TO THE FAMILY,
THE MOTHER IN THE SPECIAL DELIVERY UNIT, THE BABY
AT THE TIME OF DELIVERY, AND THEN AFTER BIRTH, CARE IN THE NICU.
>> IT REALLY ALLOWS THE FAMILY TO BE A FAMILY
FROM THE VERY BEGINNING.
AND IT ALLOWS US TO TAKE CARE OF THE BABY FROM THE VERY
BEGINNING TO MINIMIZE TRANSITIONS, TO MINIMIZE CHANGES,
TO MINIMIZE RISKS.
AND SO I THINK IT'S BEEN A GREAT THING FOR BOTH FAMILY AND BABY.
>> WE'VE CREATED MECHANICAL VENTILATION GUIDELINES TO GENTLY
VENTILATE THESE INFANTS WITH SMALL DELICATE LUNGS.
>> GENTLE VENTILATION IS A MODE OF VENTILATION,
WHICH JUST MEANS THAT YOU DON'T USE MORE THAN YOU NEED.
>> ONE DOES NOT WANT TO INDUCE INJURY FROM THE VENTILATION
IN THESE TINY DIMINUTIVE LUNGS BY BREATHING FOR THEM
WITH TOO HIGH PRESSURES.
THAT CAN CAUSE DAMAGE AND SUBSEQUENT COMPLICATIONS
AND EVEN DEATH.
>> THESE INFANTS, BABIES WITH CDH, ARE VERY UNIQUE.
THEY ARE VERY DELICATE AND THEIR PHYSIOLOGY IS QUITE BRITTLE.
THEY CAN CHANGE FROM MINUTE TO MINUTE, HOUR TO HOUR.
>> IN THE ACUTE PERIOD, OR INITIALLY AFTER THE BABY'S BORN,
THEY OFTEN CAN SEEM REALLY, REALLY STABLE.
WE CALL THAT THE "HONEYMOON PERIOD," AND IT LOOKS LIKE
THINGS ARE GREAT.
AND THEN THEY CAN START TO HAVE A SPIRAL WHERE JUST CHANGING
THEIR DIAPER OR HAVING A LOUD NOISE IN THE ROOM CAN ACTUALLY
MAKE THEM DESATURATE OR DO SOMETHING WE CALL "SHUNT."
>> THEY'RE NOT GETTING BLOOD EFFECTIVELY FROM THEIR HEART
INTO THE PULMONARY VASCULAR SYSTEM.
IT'S BYPASSING THE LUNGS ENTIRELY.
>> SO, IF WE HAVE TO USE HIGH PRESSURES, OR WORST STILL,
HAVE TO BE ON HIGH OXYGEN AFTER A TIME PERIOD,
THEN THAT'S A BABY THAT WE NEED TO GIVE THE LUNGS REST.
>> IF WE HAVE THAT SITUATION, WE HAVE ECMO AS AN OPTION.
>> EXTRACORPOREAL MEMBRANE OXYGENATION IS REALLY A BYPASS
FOR THE LUNGS.
IT DOES THE WORK OF THE LUNGS WHEN THE LUNGS ARE VERY FRAGILE
AND NOT ABLE TO DO THE WORK.
>> THAT BASICALLY INVOLVES A SURGICAL PROCEDURE IN
THE INTENSIVE CARE NURSERY PUTTING A CANNULA IN THE COMMON
CAROTID ARTERY, A CANNULA IN THE INTERNAL JUGULAR VEIN,
THE VENOUS BLOOD DRAINS OUT INTO THE ECMO MACHINE,
WHICH HAS AN OXYGENATOR TO OXYGENATE THE BLOOD AND A PUMP
THAT WILL PUMP THE BLOOD BACK TO THE BABY THROUGH
THE ARTERIAL CANNULA.
>> SO A BABY ON ECMO HAS A LOT OF EQUIPMENT IN THE ROOM.
I THINK FAMILIES ARE OFTEN A LITTLE TAKEN ABACK,
ESPECIALLY IN THE FIRST DAY OR TWO OF LIFE.
>> THE FIRST TIME I WALKED INTO THE ROOM WHEN SHE WAS ON ECMO,
IT WAS SO HARD.
BECAUSE I LOOKED, AND SHE WAS, LIKE, ALL THE WAY DOWN
THE HALL AND YOU JUST SEE THIS BIG MACHINE AND A LITTLE, TINY BED.
AND SHE WAS SO SMALL IN COMPARISON TO ALL THE MACHINERY
THAT WAS AROUND HER.
>> FOR A BABY WITH A CDH ON ECMO, THAT AMOUNT OF TIME
IS ON AVERAGE A COUPLE OF WEEKS.
IT'S LONGER THAN MOST OF THE NEONATAL PROBLEMS
THAT NEED ECMO.
AND IT'S VERY IMPORTANT THAT FAMILIES REALIZE THAT,
YOU KNOW, ONCE WE GO ON, WE'RE USUALLY THERE FOR A WHILE.