May 26, 2015

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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