Fall 2004

Pioneering Neonatal ICU Celebrates 40th Year

Forty years ago at UCSF, a new concept was officially born -- a unit dedicated to monitoring and treating the sickest babies. UCSF's intensive care unit, now called the William H. Tooley Intensive Care Nursery (ICN), was one of the first of its kind. Over the years, the ICN at UCSF Benioff Children's Hospital and similar units worldwide have contributed to the survival and well being of hundreds of thousands of sick and premature infants.

In addition to observing the anniversary of the ICN, physicians, nurses and staff at UCSF Benioff Children's Hospital are celebrating the many UCSF-pioneered innovations that have saved so many babies in the past and the UCSF-sponsored research that promises to save yet more infants in the future.

One story begins in 1956, when Dr. John Clements, a U.S. Army scientist based in Maryland, discovered that the lungs need a soapy coating called surfactant to allow the alveoli to inflate easily during inhalation. Harvard researchers Jere Mead and Mary Ellen Avery hypothesized that Clements' discovery might be the key to the mysterious lung ailment, then called hyaline membrane disease, that afflicted premature babies. In 1959 they published research proving that babies who died of what we now call respiratory distress syndrome (RDS) did not produce enough surfactant in their lungs.

Clements joined the Cardiovascular Research Institute at UCSF in 1961 and led studies with UCSF physicians and nurses to find out if surfactant could be administered to preemies with RDS. Although the initial studies were not successful, Dr. William Tooley of UCSF realized that the constant attention given babies in the study did, by itself, lead to increased survival rates.

Tooley's observation spurred the development of the neonatal intensive care unit or NICU. Trained by UCSF nurse Teresa Mannix Poirier, the nursing staff carefully watched fragile newborns on a one-to-one basis, using scientific monitoring methods borrowed from research. The nurses and neonatal physicians were able to intervene immediately if a baby showed signs of distress. Those methods quickly were bolstered by contributions from other medical centers, as a handful of pioneers traded techniques that would become systematized as intensive care.

When UCSF's NICU became an official unit in 1964, a few similar units had been started on the East Coast, Canada and England. Since then, researchers at UCSF and in the ICN have participated in creating some of the most powerful and most widely used techniques for saving newborns.

In the mid-1960s, for instance, Dr. William Hamilton, chair of UCSF's department of anesthesia, encouraged his staff to take the concept of respiratory support from the operating room to the adult and newborn ICUs. In 1969, Dr. George Gregory, an anesthesiologist, was faced with a premature baby who weighed 8 pounds, but nonetheless struggled for breath. Gregory realized that if he kept a slight positive air pressure in the lungs, he could keep the alveoli from collapsing during exhalation, while still allowing the infant to breathe spontaneously. Over the next few years, the use of continuous positive airway pressure (CPAP) led to a dramatic decrease in mortality for preemies.

Since then, UCSF has participated in other breakthroughs in caring for premature babies:

  • UCSF researchers developed a practical electrode to measure carbon dioxide pressure in arterial blood and took this monitoring method from research to routine neonatal care.
  • Dr. Abraham Rudolph, a pediatric cardiologist, introduced surgery to close a patent ductus arteriosus. Later, he and Dr. Michael Heymann, a pediatric cardiologist, showed that indomethacin could stimulate closure of the ductus without surgery.
  • Dr. Michael J. Harrison, a surgeon, and Dr. Roy Filly, a sonologist, led the world's first successful human fetal surgery in 1981.
  • Clements' artificial surfactant EXOSURF produced a 50 percent decrease in neonatal deaths from RDS after it was approved by the federal Food and Drug Administration (FDA) in 1990.

Today, prematurity remains a health concern, but preemies worldwide survive and are healthy thanks to discoveries like these that have become standard care of high-risk infants. At UCSF Benioff Children's Hospital, where staff pioneered the NICU concept, the regional or level IV NICU continues to provide advanced diagnosis and treatment of fetuses, preemies and newborns with complicated conditions.

Pediatric Intensive Care Nursery (415) 353-1565

For 40 years, UCSF Medical Center and UCSF Benioff Children's Hospital have made groundbreaking discoveries in neonatology, or the care of critically ill newborns. The 50-bed intensive care nursery treats more than 1,000 critically ill babies each year.

 

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