Congenital Diaphragmatic Hernia - Cdh - The first days - Fetal surgery - Ecmo - Chop - 5 of 10

>> 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.