CHOC Children’s Clinicians Ensure Happy Holidays for Families

The commitment and dedication of CHOC Children’s clinicians will ensure happy holidays for many families – including the McLeods.

This will be the first holiday season for the new family of four, only recently reunited at home following son Ryan’s 17-week stay in CHOC Children’s Small Baby Unit (SBU).

Ryan was born this past winter at just 27 weeks gestation and weighing only 2 pounds and 1 ounce.

The care for babies of his size and age is the very specialty of the SBU. A portion of CHOC’s neonatal intensive care unit (NICU), the unit is dedicated to the care of babies born with extremely low birth weights – those born at less than 28 weeks gestation or weighing less than 1,000 grams, or about 2 pounds and 3 ounces.

There, “micro-preemies” like Ryan receive coordinated care in a developmentally appropriate environment. A trailblazer in neonatal care nationwide, the unit is saving babies who just decades ago wouldn’t have likely survived.

“With its coordinated care in an environmentally appropriate location, the Small Baby Unit is designed to care specifically for babies like Ryan,” says Dr. Kushal Bhakta, Ryan’s neonatologist and medical director of the SBU. “When he came to the unit, he required significant ventilator support due to an ongoing infection, and he had a long road ahead of him.”

Danielle’s breezy pregnancy took a sudden turn early in her second trimester when her doctor found in her womb a subchronic hematoma, an indicator that she might deliver her baby early.

Danielle was put on bed rest, but a few weeks later, bleeding and signs of labor showed. At the hospital, doctors were able to stop the labor and admitted Danielle to keep it from beginning again too early. But about six weeks later, Danielle’s water broke and she underwent an emergency cesarean section.

On Valentine’s Day, after two weeks of ups and downs, Ryan was transferred to the SBU at CHOC and the McLeod family began their four-month journey.

“I don’t think people understand the pain that comes with having a child and not being able to hold him immediately or not being able to take him home shortly after delivery and share him with the world,” Danielle says.

“It was difficult knowing that there were many obstacles for Ryan to overcome before he could even think about coming home,” she says. “Simple things like eating by mouth, a task that should come naturally, are challenging for babies born premature.”

During that time, while also focusing on growing, Ryan also battled chronic lung disease and a brain bleed, and learned to eat and breathe on his own. Meanwhile, Danielle and husband, Jared, learned how to care for a baby born more than three months early.

“I’ll never forget our first day at CHOC,” she says. “I was so overwhelmed, scared, and nervous. Once Ryan was settled in the SBU, his nurse came in to do his very first set of cares. I sat and watched, afraid to touch him. He was so fragile. His nurse said, ‘Get in there, mama. You can do it.’ She had me put my hand on him, my hand covering his whole little torso. She talked me though what to do when caring for an extra small baby. From then on, I felt confident to be close to my little fighter.”

After 17 weeks in the SBU, Ryan finally went home to join his parents and brother. He still receives oxygen treatment and undergoes physical therapy twice a week, but is doing well.

“During his stay in the unit, Ryan overcame great obstacles, thanks to the partnership between his care team and his parents,” Dr. Bhakta says. “Our goal in the unit is to get our patients home with the best possible outcomes. Today, Ryan is doing well and has a bright future ahead.”

Overall, Ryan is doing well. Small but mighty, he is doing great at rolling over and pushing himself up, and is working toward sitting up by himself.

“He also loves smiling and laughing, especially at his big brother,” Danielle says.

“We’re moving in the right direction,” she says. “We are so grateful to all the wonderful nurses and doctors who cared for Ryan. I know he is doing so well because of the amazing care he received while in the SBU. We love our little fighter. He’s such a good baby. He is truly a miracle and we are blessed to be able to witness this little guy’s journey.”

In the Spotlight: Kushal Bhakta, M.D.

In recognition of prematurity awareness month, we’re highlighting Dr. Kushal Bhakta, medical director of CHOC Children’s Small Baby Unit (SBU).

CHOC Children's Small Baby Unit

The Small Baby Unit – the first of its kind – opened in 2010. The special 12-bed unit within our neonatal intensive care unit (NICU) is designed for babies born at less than 28 weeks gestation or who weigh less than 1,000 grams. The space is designed to aid in babies’ development with dim lighting and low noise levels, mimicking the womb’s environment as closely as possible. The unit is also nurturing for patients’ families. Since they are going through many of the same experiences, families are able to bond and support one another.

“It’s an amazing blessing to be part of these families’ lives. So many parents write to us and send pictures long after they’ve left the hospital. There is a mutual respect, and they become part of our extended family,” Dr. Bhakta says.

Dr. Bhakta received his medical degree from Baylor College of Medicine and completed his pediatric residency and neonatal-perinatal fellowship training at Baylor College of Medicine and Texas Children’s Hospital, in Houston, Texas.

Subsequently, he joined the faculty at Baylor College of Medicine/Texas Children’s Hospital as assistant professor of pediatrics, where he also obtained an advanced certificate in teaching through the Educational Scholars Fellowship Program. He enjoys teaching medical students, pediatrics residents, neonatal fellows, nurses and nurse practitioners.

Dr. Bhakta has received several awards throughout his career, including “Super Doctors Southern California Rising Stars” in 2014 and 2015.

He has published in many publications and given countless presentations throughout the country. He is also member of the American Academy of Pediatrics and the Orange County Medical Association.

Board certified in pediatrics and neonatal-perinatal medicine, Dr. Bhakta is part of a specialized, highly trained team at CHOC. He owes the success of the unit to his team, he says.

“It’s inspiring to see the team’s passion for the lives of these babies,” Dr. Bhakta says. “From nurses to respiratory therapists, and all other disciplines, everyone on the team takes care of our patients like they were their own children.”

The highly committed team is improving quality and outcomes in extremely low birth weight infants.  Impressive outcomes from the two years before and four years after the SBU’s opening in March 2010 include:

  • Significant reduction in chronic lung disease of prematurity. A common condition for premature babies, chronic lung disease can have long-lasting ramifications including re-hospitalization and poor neurodevelopment.
  • Significant reduction in the rate of hospital-acquired infections.
  • Significant reduction in infants being discharged with growth restriction (combined weight and head circumference, < 10th percentile). These factors are linked to cognitive and physical disabilities.
  • Reduction in the average number of laboratory tests (from 224 to 82) and X-rays (from 45 to 22) per patient.

Dr. Bhakta’s vision for the SBU is to be recognized nationally and beyond as the premier destination for the care of extremely preterm infants. Dr. Bhakta and his team have hosted many hospitals interested in modeling their units after CHOC’s SBU. As leaders in their field, the team hopes to continue to improve patient outcomes.

“We’ve come so far in how we treat this patient population, he says. “We don’t want to only adapt knowledge, but create the knowledge and help set standards of care for these patients.”

In his spare time, this dedicated physician enjoys spending time with his wife and two daughters.

To contact Dr. Bhakta, please call 714-509-4373.

CHOC Leads the Way to Safer Breast Milk Handling with New Tracking Process

Breastmilk TrackingCHOC Children’s is gaining recognition for a new breast milk handling process that is proving to be safer for patients and more efficient for physicians and staff.

With very few government regulations in place, hospitals across the country struggle to establish best practices in handling breast milk, and CHOC is no different. Busy nurses are often tasked with collecting, labeling, inventorying and distributing dozens of bottles during a shift, amid other critical responsibilities.

“Our nurses are doing a multitude of highly important things, often being pulled in many directions at once,” said Caroline Steele, director of CHOC’s Clinical Nutrition & Lactation Services. “Without good support and a better system in place, there was potential for interruptions and errors.”

In June 2011, CHOC’s Joint Leadership Committee formed a process improvement team, including physician co-chair Dr. Christine Bixby and representatives from each inpatient nursing unit, Clinical Nutrition and Lactation, Quality and Transport. The team reviewed data from the previous 12 months and identified 282 potential points where the existing process could fail, and 85 of those were named as top priorities to be addressed in a complete redesign of the system.

A New Method

In January 2013, the team moved milk preparation to a centralized location. The existing formula room was repurposed to accommodate both formula and breast milk preparation. Now referred to as the Nutrition Lab, it houses a breast milk freezer and a commercial dishwasher, and is staffed with registered dietetic technicians. CHOC also operates a satellite nutrition lab in the NICU at St. Joseph Hospital.

CHOC then secured a $190,000 grant from UniHealth to purchase the Timeless™ Breast Milk Tracking system. The software uses unique barcode identifiers to ensure babies are matched with the correct milk, and that the milk has not expired. The system launched in November 2013 in the NICU, medical and surgical units, neuroscience unit, oncology unit, PICU and CVICU at the hospital’s Orange campus.

Nurses previously fortified and prepared milk themselves at the bedside – a contamination risk – and then had to ask a second nurse to verify the accuracy of it at every step. That accuracy check is now done automatically.

“It used to take at least an hour to make your shift’s worth of milk,” NICU nurse Jenn Landman said. “That’s an hour you can spend with a baby’s family or do extra things, like bath time or a ‘spa day’ with a baby. It’s much more meaningful work.”

Now, when a mother checks in with her baby, a nurse prints labels for the breast milk expressed during their stay and scans the baby’s armband to verify the labels are correct. The mother attaches a label to a filled bottle, which is transferred to the Nutrition Lab for inventorying and storage. The lab’s technicians fortify the milk per doctor’s orders and deliver 12 hours worth of feedings back to the units twice a day. All information about the milk is documented in the baby’s medical record and synced with their Cerner medical record.

The process is also easier for physicians, who now only write one feeding order for a patient, rather than multiple orders to cover variations in a baby’s feeding needs.

Dr. Bixby credits Steele for implementing the new process over a long period of time, making sure staff had input and any kinks were ironed out.

“Rolling it out in stages was really smart. It allowed for real-time adjustment and response to every issue that came up,” Dr. Bixby said. “From the bedside, concerns were brought forward, and immediately we were modifying the system.”

In the first three months of the barcode program, 19,989 breast milk feedings were prepared by the Nutrition Lab, with 100 percent compliance to scanning in the lab and 99 percent compliance on the units. The software identified 35 near misses when milk would have been given to the wrong patient, and 78 near misses when expired breast milk would have been given.

Next Steps

CHOC’s efforts have been noticed. The California Department of Public Health has commended the program and has asked Steele to train registered dietitian surveyors across the state on proper breast milk handling. Dr. Bixby has received calls from other physicians across the state, inquiring about the process and asking to tour the Nutrition Lab.

Plans are being made to implement the barcode system at CHOC Children’s at Mission Hospital, and the team hopes to purchase software to track formula, as well. They are seeking additional grant funding.

Meanwhile, two new studies are also looking closely at breast milk production in the NICU. One study uses an analyzer to identify the components of a mother’s milk, rather than assuming it contains generalized amounts of nutrients. That will make the fortification process more accurate, making sure babies get exactly what they need. The second study will track milk production in moms who wear a hands-free bustier pump and use their hands to help express milk, along with a traditional breast pump.

“We are always looking at ways that we can make our hospital safer and ultimately a better experience for the patient and family,” Steele said.

CHOC neonatologists are overseeing a number of other quality initiatives, including efforts to:

Learn more about breast milk health here.