The Front Line

New, state-of-the-art nurseries at Texas Children's

In Texas Children's new level 3 NICU, James M. Adams, M.D., and Amy Harnden, Child Life Specialist, giving bedside care. (photo by Jim deLeon, Texas Children's Hospital)

In early 2004, Texas Children’s Hospital opened a new 138-crib nursery featuring state-of-the-art medical technology that is used to extend and improve the lives of the newborns placed in our care.

The Texas Children’s Newborn Center® treated almost 2,900 critically ill newborns in 2003, and the new nursery was part of the hospital’s $345-million expansion. The new neonatal intensive care unit (NICU) has 76 cribs dedicated to the most critically ill newborns (level 3) and 62 beds for those who are less critical (level 2) and provides numerous new facilities for parent support.

The nursery design promotes a womb-like, peaceful environment for babies. Sound-deadening materials help to decrease noise reverberation to below the minimum required standard, and a series of individual lighting controls allows physicians to direct lights so they can efficiently see patients as they care for them while minimizing light stimulation and the babies’ stress levels.

“A more efficient, less stressful, less intrusive, high-technology environment will meet the needs for several years to come and improve the outcomes of our patients,” said Dr. Leonard Weisman, chief of neonatology at Texas Children’s and professor of pediatrics at Baylor College of Medicine (BCM). The amount of space per patient in the new nursery is increased by 50 percent—larger than the recommended standard. “The increased space and design of each bed improves the efficiency with which care is provided, decreases the stress of the patient and family, and improves the comfort of the baby and encourages the family to spend more time at the bedside,” Dr. Weisman said. The area also allows more technology at the bedside, a necessity for delicate bedside surgeries for some of the most fragile infants. Independent bedside workstations include a computer and a mobile physiologic monitoring system to provide caregivers a focal point for each patient. In addition, partial walls between each patient bed increase privacy for families.

Parents of hospitalized infants also have a home away from home nearby at the 20-room Ronald McDonald House. Plus, the nurseries have space at each bedside for parent recliners, storage, and communication needs (telephone, bulletin board, mail boxes).

Texas Children’s nurseries are the largest and busiest in the U.S. Of babies admitted in 2003, many were premature with many risk factors that make survival a challenge. “Texas Children’s Newborn Center routinely cares for the smallest, most fragile infants while maintaining tremendous outcomes,” said Dr. Weisman. Since 1999, the survival rate at Texas Children’s for an infant weighing less than 1,000 grams (less than about 2 pounds) has been 82 percent—a rate that is among the highest in the nation. But just a few decades ago, many newborn infants did not survive. “A lot of babies had immature lungs, were born prematurely, and were dying,” said Dr. Joseph A. Garcia-Prats, professor of pediatrics at BCM and a practicing neonatologist at Texas Children’s.

Outcomes improved though as knowledge expanded with the early research and dedication of pioneering physicians such as Murdina Desmond, Arnold Rudolph, Reba Hill, and others.

The NICU at Texas Children's Hospital in 1974. (photo by Jim deLeon, Texas Children's Hospital)

Collaboration is key in the advancement of medical science as well as to relationships between institutions at the Texas Medical Center. During the mid 1950s, Texas Children’s neonatologists treated newborns in collaboration with St. Luke’s Episcopal Hospital, in a 25-crib nursery that admitted about 400 patients each year. In 1971, Texas Children’s created its own neonatology service with 4 NICU beds, and by 1974 the two institutions had joined their nurseries for a combined total of 69 cribs.

In 1975, the field of neonatology became a subspecialty of pediatrics and the American Board of Pediatrics established subboard certification in neonatal-perinatal medicine. BCM established an accredited fellowship program in neonatal-perinatal medicine in the early 1970s and, with Texas Children’s as its primary teaching institution, has since graduated a great proportion of the new neonatologists in the U.S.

The 1970s saw vigorous growth in Texas Children’s nurseries. Greater understanding of infant mortality and morbidity led BCM physicians to develop and implement the Neonatal Transport Team (Kangaroo Crew®) in 1978 and the Perinatal Outreach Program and Neonatal Nurse Practitioner Training in 1979.

Lisa Beal, RN, and Michael E. Speer, M.D., consult in the new level 3 nursery. (photo by Jim deLeon, Texas Children's Hospital)

By 1979, Texas Children’s nurseries treated about 1700 infants each year—400 percent more in 20 years. The Kangaroo Crew transported babies to Texas Children’s from hospitals in a 100-mile radius from Houston. Today the radius of the Kangaroo Crew continues to expand, as do the services and vision of BCM physicians in the Texas Children’s nurseries.