Taking Pediatric Intensive Care to the Next Level

September 15, 2000
News Office: Janet Basu (415) 502-4608

The history of neonatal intensive care is, in many ways, the story of learning to help babies breathe. It is a very recent history - UCSF Children's Hospital's intensive care nursery (ICN), one of the world's first, was formed in 1964.

At the time, 40,000 American newborns each year were dying as they struggled for their first breaths. Today, the 48-bed ICN of the UCSF Children's Hospital fills three wings at the top of UCSF Medical Center, with a grand view of the Golden Gate.

A variety of severe problems bring newborns to the ICN. Very premature birth and life-threatening birth defects are just some of the conditions seen routinely by ICN staff. UCSF Children's Hospital's neonatal doctors and nurses are among the world's most experienced in caring for newborns who need surgery for heart, lung, gastrointestinal and other abnormalities. They are the leaders in caring for babies whose first surgery was performed before birth, by UCSF Children's Hospital's pioneering maternal-fetal surgeons.

More than 1,000 infants are treated each year. Many receive intensive care from the moment they are born in the UCSF Medical Center Birth Center down the hall. Approximately 350 children each year arrive by emergency transport from Northern California and across the United States.

Why UCSF Children's Hospital's Intensive Care Nursery is a Model for Care
A number of services and procedures make the UCSF Children's Hospital's ICN a model for care. Nurses with special training manage ECMO (extracorporeal membrane oxygenation) machines to take over the work of failing hearts and lungs. A 24-hour laboratory provides vital information in minutes, using information provided by a single drop of blood. An operating room in the nursery allows babies to receive many procedures without a ride down the elevator to the Pediatric Surgical Center.

Should a fragile newborn need resuscitation in the Birth Center, neonatal doctors and nurses stand by in a special neonatal set-up room adjacent to the delivery room. As scientists at UCSF and elsewhere make new discoveries that could save or improve the lives of newborns, ICN clinicians have the expertise and infrastructure to carefully evaluate and apply the knowledge to the babies under their care.

Babies born far from UCSF also can benefit from these special services. In cooperation with a network of 24 hospitals in Northern California, UCSF Children's Hospital cares for the most fragile at-risk newborns. Most such babies arrive in the care of the UCSF Pediatric Transport service, whose doctors, nurses and nurse practitioners take a specialized neonatal transport unit by air and ambulance to the baby's bedside at any location throughout the West.

Whenever possible, once a baby is stable, she or he is transported back to a hospital close to the family. When parents must stay in San Francisco and are far from home, ICN social workers help them find safe, affordable housing near the hospital.

UCSF Doctors Learn How to Save Babies' Lungs
One of the most important figures in UCSF's fight to save newborns is John Clements. In the 1950s, Clements discovered how we keep our lungs inflated as we breathe. He proved that normal lungs produce a soapy substance called surfactant which reduces surface tension, preventing tiny air-filled chambers in the lung, called alveoli, from collapsing every time we breath out.

Others used Clements' experimental methods to show that premature babies who died of respiratory distress syndrome (RDS) do not produce sufficient amounts of surfactant in their lungs. Newborns without surfactant struggle against the collapse of their lungs. They die of exhaustion. In 1982, Clements developed an artificial surfactant called Exosurf that now routinely saves the lungs of preemies around the world.

Once they understood the cause of the breathing problem that killed so many premature newborns, doctors at UCSF and a few other medical centers around the world began to search for methods to save the babies' lives. Pediatrician William Tooley, working with Clements at the Cardiovascular Research Institute at UCSF, discovered that careful monitoring and quick response to changes in vital signs could save some infants.

In 1964, he joined with nurse Teresa Poirier to establish a neonatal care unit that was radical at the time: one nurse was assigned to care for each baby. This combination of expert specialized nursing care with a continual search to translate the discoveries of science into life-saving treatment has been the mark of UCSF's leadership in neonatal intensive care ever since.

In 1969, UCSF Children's Hospital's George Gregory made the first breakthrough in the search for practical methods to help babies with RDS survive. CPAP stands for continuous positive airway pressure, a method for keeping a continuous positive pressure on the lung gases so that when a baby breathes out, the lung chambers will remain inflated.

Other Discoveries
UCSF Children's Hospital physicians have made other significant contributions to neonatal medicine:

  • Discoveries about the ductus arteriosus, a vessel that diverts blood flow from fetal lungs and sometimes does not close properly after birth
  • The invention of carbon dioxide (CO2) electrodes to speed up readings of blood gases
  • The discovery of a cause and treatment for anemia of prematurity
  • Clinical trials of new types of mechanical ventilation to support breathing yet reduce harm to infants' lungs
  • Demonstration of a method to prevent disease from meconium aspiration
  • Clinical proof that nitric oxide can be used to reduce high blood pressure in lungs without dangerously lowering blood pressure in the rest of the body.
  • Other problem areas are under investigation by UCSF Children's Hospital researchers. UCSF researchers are studying how lungs develop during the transformation from a water-dwelling fetus to an air-breathing newborn. They use the new tools of molecular developmental biology to look at the level of genes and proteins for events that cause that process to go awry. Other UCSF Children's Hospital scientists are looking for ways to detect brain injuries in newborns and treat the affected brain cells in time to head off lifelong damage.

    A timeline of UCSF Children's Hospital advances is available.