Saving Babies for 30 Years
“CAN YOU IMAGINE,” asks Leonard Newman, M.D., “an infant with a life-threatening disease having to go over the Tappan Zee Bridge or through traffic on the Bronx River Parkway to get to the hospital?”
That’s the way it was three decades ago. Severely ill or premature babies born in the lower Hudson Valley could be stabilized in their local community hospitals, but when they required advanced care in a regional neonatal intensive care unit (RNICU), the closest options were New York City and Albany.
In the early 1980s, a group of forward- thinking physicians at Westchester Medical Center decided to change that. That group included Dr. Newman, a pediatric gastroenterologist who now chairs the Department of Pediatrics, and the late Harry S. Dweck, M.D., who was recalled as “a giant in the field of neonatology” when he passed away in 1998. “Some people didn’t think the advanced regional unit we had in mind was needed,” says Dr. Newman. “So we visited every county in the region, met all the physicians and convinced them of the need.”
The Medical Center then worked with state officials to get the necessary approvals to open the new RNICU, and it accepted its first patients 30 years ago, in 1982. Today, the Level IV RNICU (the highest classification) accepts the sickest babies from 11 community hospitals across the region. It operates a highly organized system of patient transport and care coordination among those hospitals involving helicopters, ambulances and the highest level of technical skill.
But 30 years ago, says Dr. Newman, it was a different story. “Many of us doctors would go out ourselves and help in the transportation as well as the care of infants,” he says. “Once, in mid-winter, a doctor went out to Poughkeepsie and got stuck on the Taconic in the snow, and we had to send a second ambulance to bring back the doctor and the child.” And medical helicopter service was “in its embryonic stage,” he adds. “We would rent a helicopter and often a doctor and nurse traveled with the pilot because there was no staff of emergency medical technicians on board.”
Over time, Dr. Dweck, Dr. Newman and their colleagues built a fully equipped, fully staffed unit. “In 1999 I became the fourth neonatologist here,” says Edmund La Gamma, M.D., now Chief of Newborn Medicine and Director of the RNICU. The staff of doctors, nurses and nurse practitioners kept growing, and with the advent of Maria Fareri Children’s Hospital, where it is now centered, the RNICU has become one of the nation’s busiest. “Our patients are drawn from 23,000 babies born in this region each year,” says Dr. La Gamma. “The smallest and sickest babies get referred to us.”
Such regionalization of care, which is practiced all over the country, has significantly improved survival, he says. “We now have babies born at 23 weeks and weighing just 1 pound who survive,” he says. “Some of these babies actually spend more time in the RNICU than in the womb—and still survive.” And the region now fully embraces the RNICU. “Those physicians who said ‘We will never need you’? Two years later those same doctors sent us the most patients,” Dr. Newman says. “The loyalty of regional physicians and hospitals is now very strong. Of course, we all hope you never need to know about us. But if you have a sick newborn, you should be happy this place is here.”
A CLOSER LOOK AT ADVANCED NEONATAL CARE
The amazing successes now achieved in treating the tiniest newborn babies are due in large part to technology. And one of the most advanced pieces of equipment now in use in neonatal intensive care units is called an extracorporeal membrane oxygenation (ECMO) system.
Westchester Medical Center’s Maria Fareri Children’s Hospital is the only institution between New York City and Albany, and one of very few in the state, to offer ECMO. ECMO is an extreme intensivecare treatment that takes over for a baby’s weakened or damaged heart and lungs so they can recuperate and grow stronger before returning to function. “It’s basically a heart-lung machine, scaled down to baby size, that helps us keep babies with cardiac or pulmonary failure alive until they are strong enough for an operation or can recover on their own,” says Edmund La Gamma, M.D., Chief of Newborn Medicine and Director of the Regional Neonatal Intensive Care Unit.
The ECMO is run by specially trained technicians who literally sit at the bedside 24/7 to keep blood flowing at safe rates and pressures. Dr. La Gamma says the ECMO is needed about a dozen times a year. “It’s really essential,” he says. “It makes a life-ordeath difference.”
FOR MORE INFORMATION ABOUT THE REGIONAL NEONATAL INTENSIVE CARE UNIT AT MARIA FARERI CHILDREN’S HOSPITAL AT WESTCHESTER MEDICAL CENTER, PLEASE CALL 877.WMC.DOCS OR VISIT WESTCHESTERMEDICALCENTER.COM/RNICU