May 20, 2013 - By Erin Digitale
Jackson Thomas, who was oxygen deprived at birth, underwent controlled hypothermia at Packard Children's to help him. Diana Powell is a nurse in the hospital's neonatal intensive care unit.
Protecting the brain health of premature and dangerously ill newborns is the focus of an ambitious new effort at Lucile Packard Children's Hospital. On April 23, the hospital launched the Neuro NICU, which provides specialized neurology care for babies at risk of brain injury.
The Neuro NICU, consisting of six beds inside the Packard Children's neonatal intensive care unit, is one of just a small handful of such units around the country. These units represent advances in treatments and technologies that allow physicians not only to keep fragile babies alive, but reduce their risk of suffering neurological problems.
"Survival rates of critically ill premature and term babies are now quite robust, but we are realizing that some of these surviving babies have developmental problems," said Packard Children's neonatologist Krisa Van Meurs, MD, medical director of the Neuro NICU. Fortunately, Van Meurs added, new neurologic research has provided a diverse set of tools for improving vulnerable infants' developmental outcomes and giving them the best chance at starting strong in life.
Several conditions can leave infants susceptible to brain injury or developmental deficits, including premature birth, early-life infections, birth defects such as congenital heart defects, and oxygen deprivation during labor and delivery. These patients have the greatest need for the Neuro NICU team's expertise.
"The challenge and exciting thing about treating these tiny babies is that the brain is developing on a literally day-by-day basis," said Courtney Wusthoff, MD, a neonatal neurologist at Packard Children's. Wusthoff arrived at the hospital in September 2012 to help launch the Neuro NICU.
Jackson, shown here at age 13 months, has been doing well since leaving Packard Children's.
In addition to bringing Wusthoff on board, the hospital has purchased a wide array of new diagnostic and monitoring equipment for babies' brains, and is providing specialized training for all its NICU practitioners on the latest research and treatments in infant neurology. The options for protecting and nurturing babies' quickly changing brains are expanding rapidly, Wusthoff said. "We have more and more opportunities for interventions."
In early 2012, the Thomas family of San Jose benefited from several such interventions after their younger son's unexpectedly difficult birth at a hospital in San Jose. When she arrived in labor, Heather Thomas was found to have suffered a placental abruption. The baby was not getting any oxygen and needed to be delivered immediately. Upon delivery, baby Jackson did not breathe. He had a seizure within one minute of birth.
After Jackson was resuscitated, a physician asked Heather and husband Gary to consider immediately transferring their son to Packard Children's to receive controlled hypothermia, a recently developed treatment for preventing brain injury after oxygen deprivation. In this procedure, the infant is placed on a blanket impregnated with tubes that carry cool water. The baby's body is cooled to 92.3 degrees Fahrenheit for three days. Research conducted at Packard Children's and elsewhere has shown that, if begun within six hours of birth, cooling slows damaging metabolic processes and gives the brain time to heal.
"Until relatively recently, we could only provide supportive care for full-term babies who suffered brain injury in the labor process," Van Meurs said. "About 25 percent of neonatal mortality is due to birth asphyxia, so controlled hypothermia has the potential to have a big impact." Packard Children's participated in one of the earliest clinical trials of hypothermia and has offered it since 2000, she noted.
After Jackson's body temperature was returned to normal, he received a magnetic resonance imaging scan to check for signs of brain damage. Use of MRIs for newborns' brains is also innovative; it provides a non-invasive way to find brain injuries.
"There were no signs of brain damage," Heather remembered. "We burst into tears."
During Jackson's hospital stay, the Packard Children's team also monitored his brain with a modified electroencephalogram technique tailored to infants. Brain monitoring technologies allow caregivers to check a baby's brain-oxygen levels and detect seizures.
"In the past, it's been assumed that you could just tell by looking if a newborn was having a seizure," Wusthoff said. But it turns out that 80 to 90 percent of seizures in this age group cause no outward changes. "Newborns' brains are not developed enough to show on the outside what's happening on the inside."
Fortunately, Jackson had no more seizures. He has been doing well ever since he left the hospital at 2 weeks of age. Now 15 months old, he loves to play with his big brother, totes his favorite toy shark everywhere, and, best of all, has no sign of developmental problems.
In addition to the techniques that helped Jackson Thomas, patients in Packard Children's Neuro NICU will also benefit from multidisciplinary care by clinicians from neonatology, neurology, neurosurgery, developmental medicine, neuroradiology and psychiatry. And patients' families will receive services, such as consultations with social workers, to assist with parents' practical concerns during their baby's hospitalization.
New research is on the horizon, too. For premature infants, physicians are working to understand how to make brain development in the NICU more closely mimic development in the womb. Another nascent treatment, erythropoietin, protects babies' brains by helping their bodies make more oxygen-carrying red blood cells.
However, perhaps the biggest benefit of the six Neuro NICU beds will be that all of Packard Children's NICU caregivers are receiving more training and experience in caring for infants' brains. "We're heightening awareness of babies' neurologic needs for everybody and giving them the best chance possible to start life strong," Wusthoff said. "And the best part is knowing that the impact can be so huge: We're enabling a lifetime of better outcomes for infants and their families."
Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.