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.

November is Prematurity Awareness Month – CHOC Offers Innovative and Life-Saving Neonatal Care

In recognition of National Prematurity Awareness month, we’re highlighting the innovative life-saving treatment provided to some of the tiniest and most fragile babies through our neonatology services.

Premature birth is the leading cause of newborn death in the United States. While California has one of the lowest premature birth rates in the nation, almost 9 percent of infants born in 2013 in the state were premature, according to the March of Dimes. Pre-term newborns often need immediate specialized care not available at birthing centers, and CHOC Children’s is ready to help if the baby needs to be transferred.

CHOC uses the latest in life-saving technology and trained neonatal specialists to provide the best possible outcomes for both pre- and full-term newborns. While many hospitals offer neonatal intensive care units (NICUs), the CHOC NICU is rated by the American Academy of Pediatrics as a Level 4 NICU – the highest rating available – and is among the top 25 in the nation, according to U.S. News & World Report.

“Because of our innovation and advanced protocols, our survival of low-birth-weight babies, and the long term quality of health of such babies, admitted to the CHOC NICU are the best in California according to the California Perinatal Quality Care Collaborative,” said Dr. Vijay Dhar, medical director, CHOC NICU. “Coordinated care across multiple specialties ensures that these fragile newborns receive treatment from a full medical team.”

With access to a full range of CHOC pediatric subspecialists, the NICU offers a number of life-saving technologies and advanced respiratory support such as high-frequency ventilation and inhaled nitric oxide; advanced brain and body cooling; the only extracorporeal membrane oxygenation (ECMO) unit in Orange County; and innovative procedures including mandibular distraction and epidural anesthesia.

For babies born as young as 24 weeks, or who weigh less than 1,000 grams, the CHOC NICU has a Small Baby Unit (SBU) — the only one of its kind — to focus on caring for the unique needs of these newborns. We also have the only Surgical NICU on the West Coast, which cares for babies needing complex surgery; the only Cardiac NICU in Orange County that performs open heart surgery on newborns; and a Neurocritical NICU to treat babies with neurological issues such as seizures, asphyxiation and brain damage. All four areas provide the highly specialized care needed for fragile newborns.

CHOC has three NICUs, serving CHOC Children’s Hospital, St. Joseph Hospital and CHOC Children’s at Mission Hospital. In addition, our neonatologists have privileges at more than a dozen hospitals across Southern California. And, we are currently building 36 private, state-of-the-art rooms at CHOC Children’s Hospital, which will further advance the quality, safety and outcomes of our neonatology program.

Neonatal Intensive Care Unit (NICU) Referrals:

When a baby is born, the CHOC Children’s Transport Team is ready and waiting to transport newborns to CHOC from other hospitals in Southern California. Our neonatologists and surgeons are available for consultations with other hospitals around the clock and can collaborate with referring physicians via phone, telemedicine and secure text messaging.

For any questions, to request a consultation with an on-call neonatologist, or to schedule a transport, referring hospitals may call the CHOC Children’s NICU 24/7 at 714-509-8540.

 

CHOC Small Baby Unit Serves as Model at Conference

VON 1Dozens of representatives from neonatal intensive care units nationwide recently toured CHOC Children’s Small Baby Unit (SBU) and learned how to replicate the facility in their own hospitals as part of a conference held by the Vermont Oxford Network (VON).

About 50 attendees spent two days this month at CHOC, touring and attending workshops and roundtable discussions. Among the sessions was “Creating a Small Baby Program: The CHOC SBU Experience,” presented by Dr. Antoine Soliman, SBU director, and Mindy Morris, DNP, SBU program coordinator and nurse practitioner.

In that session, the pair defined key components and approaches of the program that help develop a team dedicated to the care of micro-preemies; identified strategies for staff engagement in developing tools and processes to standardize the care of babies with extremely low birth weights (ELBW); examined potential challenges and barriers to the development of an ELBW team, and devised possible solutions.

Morris also shared data accumulated by the unit since it opened in 2010, as well as outcome improvements for conditions that are common for this delicate patient population.

“Families as Team Members,” covered patient andSBU_tour_VON family-centered care, including how to enhance the family experience and further staff knowledge. In this session, former SBU parents shared their experience of being a part of the patient care team.

As part of the conference, SBU staff also offered insight into their roles and responsibilities within the unit, as well as the essential tools used by the team in standardizing care for the micro-premature infant.

Conference attendees also had time to devise ways that they could apply information gained from touring the SBU into their own NICU. They also had opportunities to ask questions and seek advice from SBU staff.

The visitors came from nine hospitals – adult and children’s – throughout the country, including Children’s Hospital at Providence (Alaska); Children’s Hospitals and Clinics of Minnesota; Helen DeVos Children’s Hospital (Grand Rapids, Mich.);  Stanford Children’s Health; and C.S. Mott Children’s Hospital (University of Michigan).

Founded in 1989, VON is a nonprofit, voluntary collaboration of health care professionals dedicated to the quality and safety of medical care for newborns and their families. VON comprises more than 900 NICUs worldwide.