In the Spotlight: Irfan Ahmad, M.D.

In addition to treating newborn babies requiring critical care, neonatologist Dr. Irfan Ahmad strives to involve family members in the care of their infant, which he says is essential for providing the best possible care for babies in the CHOC Children’s neonatal intensive care unit.

“I always include parents as part of the care team when treating a baby in the NICU, especially the mother. A mother and her baby were a single unit up until right before the delivery,” Dr. Ahmad says. “Parents are an essential part of the healing team, and building a strong physician-parent relationship is an important aspect of patient- and family-centered care.”

Surgical NICU

An internationally trained neonatologist, Dr. Ahmad also serves as medical director of the surgical neonatal intensive care program at CHOC.

Irfan Ahmad, M.D.
Irfan Ahmad, M.D.

The program will take up residence in CHOC’s recently-opened NICU, which features 36 private rooms with the latest technology and innovations in neonatal care. The 25,000-square-foot unit is nearly triple the size of CHOC’s prior NICU space, and will allow parents to stay overnight with their babies.

“We strongly believe in mother-baby bonding and the value of breast feeding, and our new private NICU rooms are designed to optimize that,” he says.

The recently-opened NICU also features three rooms with surgical lights, allowing minor procedures to be performed at the bedside.

The only Surgical NICU on the West Coast, CHOC’s program is comprised of a multidisciplinary team including neonatologists, pediatric surgeons and anesthesiologists.

“What inspires me the most about care being delivered at CHOC is the combination of passion for helping babies, multidisciplinary interactions, use of modern technology and an atmosphere of teaching,” Dr. Ahmad says. “From dedicated neonatologists present 24 hours a day in the NICU, nurses constantly advocating for best care, nutritionists and pharmacists rounding with the team, physical therapists, wound care teams, lactation specialists and social workers all working together to help a fragile small baby has no parallel.”

Dr. Ahmad’s Surgical NICU team also offers extracorporeal life support (ECLS), also referred to as extracorporeal membrane oxygenation (ECMO) for patients. CHOC is the only facility in Orange County that offers ECLS, which supports the heart and lungs by taking over the heart’s pumping function and the lung’s oxygen exchange until they can recover from injury, surgery or illness.

In addition to neonatologists, the dedicated ECLS team is composed of cardiothoracic and pediatric surgeons, intensive care physicians, nurses, respiratory therapists and cardiopulmonary perfusionists who are experts in their fields and have received additional education to manage the complex equipment and medical needs of the children needing this life-saving technology.

In addition to stewarding the Surgical NICU, Dr. Ahmad’s special clinical interests include caring for babies who require surgery, including those born with structural abnormalities such as diaphragmatic hernia, intestinal obstruction and imperforate anus. His clinical interests also include babies who develop the intestinal infection necrotizing enterocolitis or who have intestinal perforation. His most common diagnoses include intestinal obstruction and trachea-esophageal fistula.

Mandibular Distraction Program

Dr. Ahmad is especially passionate about caring for babies with difficulty breathing due to an undersized or recessed lower jaw, which can be caused by a condition called Pierre Robin Sequence.

In 2008, Dr. Ahmad helped launch a mandibular distraction program at CHOC. Dozens of infants have benefited from mandibular distraction osteogenesis, which involves a plastic surgeon placing a special device in the small lower jaw to expand it, prompting new bone growth over a period of two to three weeks.

Traditionally, babies with this condition have been treated by placing a tracheostomy that remains in place for several years until the child outgrows the condition. Mandibular distraction is a more permanent solution that takes a few months to complete, allowing a baby to go on to have a normal, healthy development.

Constant quality improvement

Passionate about quality improvement, Dr. Ahmad serves as director of quality improvement for NICUs affiliated with CHOC Children’s Specialists. He has participated in several quality improvement initiatives with Vermont Oxford Network and California Perinatal Quality Improvement Collaborative. This includes a project to improve the transition of care for surgical cases from one team to another, decreasing delivery room intubations and preventing premature newborn babies from developing hypothermia.

As the director of quality improvement for CHOC’s network of nine NICUs, he partners with quality improvement teams at each unit in carrying out improvement projects based on local needs. The team currently has nine simultaneous quality improvement projects in the hospitals where CHOC neonatologists round.

Passionate about educating the next generation of pediatricians and neonatologists, Dr. Ahmad also serves as NICU education director for UC Irvine’s pediatric residency program and is an associate clinical professor of pediatrics at UC Irvine. He also trains neonatology fellows through CHOC’s partnership with Harbor-UCLA Medical Center’s neonatal-perinatal medicine fellowship program.

His current research efforts include studying the breathing patterns of full-term babies in order to refine inclusion criteria for the mandibular distraction procedure. He is also currently studying the clinical outcomes of CHOC’s surgical NICU program.

Pursuing his calling to care for children

Dr. Ahmad attended medical school at Aga Khan University in Pakistan. He completed a residency in pediatrics at the University of Oklahoma and a fellowship in neonatal-perinatal medicine at UC Irvine. He has been on staff at CHOC for 10 years. He knew from an early age that he wanted to care for children, so pursuing a pediatrics residency after medical school was a natural choice.

“I was exposed to various specialized fields like cardiology and oncology, but I wanted to take care of the whole patient. I also wanted to see when I could have the most impact on the life of a person,” Dr. Ahmad says. “During my residency when I worked in the NICU, I noted that good care in the first few minutes of life was so critical. Effective resuscitation, followed by intensive care in the NICU could make all the difference for the patient, who can then live a long and accomplished life.”

Dr. Ahmad finds inspiration in the strength of his patient’s families, and is continually renewed and humbled by their gratitude.

“I have been impressed by the strength of the families who have a sick little baby in the NICU. It is extremely difficult to have your newborn on a ventilator struggling for life. Yet, we see the moms and dads holding on to hope and being there for their baby,” Dr. Ahmad says. “Neonatology is a very difficult field with long hours taking care of very sick babies. The gratitude you get from parents when the baby is finally well and going home and the amazing photographs and cards that are sent to us makes everything worthwhile.”

In his spare time, Dr. Ahmad enjoys golfing with his children and developing his photography skills.

Learn more about neonatal services at CHOC Children’s.

Baby with Rare Condition Undergoes Expert, Life-Saving Surgery at CHOC

Lizette Lough, experiencing a seemingly normal pregnancy, was making final preparations to welcome her first baby, when her water unexpectedly broke at 33 weeks. She was rushed to San Antonio Regional Hospital in Upland, close to home, where her son Landon was born early on May 3, 2016.

After a few days in the hospital, Lizette and her husband Sean noticed the baby had not made a bowel movement. Tests revealed that Landon had an obstruction in his intestine. His physician recommended Landon be transferred immediately to CHOC for an emergency surgery with Dr. Peter Yu, a pediatric general and thoracic surgeon.

“My husband and I lost it,” Lizette says. “Our baby was only three days old and weighed about 4 pounds. The thought of surgery was beyond frightening.”

Upon arrival at CHOC, the Loughs were immediately made to feel at home by the staff, who helped them find a nearby hotel. Dr. Yu explained every scenario of the complex surgery in a compassionate and confident manner, the Loughs recall.

Dr. Peter Yu, pediatric general and thoracic surgeon at CHOC.

“Landon was in stable condition when he arrived at CHOC, and I’m very pleased that our expert transport team was able to get him here quickly and safely. If there had been a delay in transfer, Landon could have become very sick and it’s very possible that more of his intestine could have died.  If that would’ve happened, he may not have had enough bowel to adequately digest food, which can be incompatible with life,” Dr. Yu says.

Landon was diagnosed with jejunal atresia, a rare condition – approximately 1 in 5,000 births – in which the small intestine is incompletely developed, leading to one or more gaps, or blockages, in the intestinal tract.

Lizette had gone through the required genetic tests prior to Landon’s birth, and jejunal atresia – often diagnosed prenatally – was not detected.

Additionally, Landon had malrotation of his intestines, which failed to coil in the proper position in the abdomen. This led to twisting of his bowel. If surgery had been delayed for longer, Landon could have died.

Landon’s surgery involved making an incision on his abdomen, examining the entire length of his intestine and untwisting it, removing the dead bowel, stitching together his small intestine, and performing a Ladd’s procedure. A Ladd’s procedure places the intestines back into the abdomen in a safe configuration to prevent future twisting of the bowel.

Landon, recovering in CHOC’s surgical NICU.

Sean, who works as a law enforcement officer, recalls how traumatic this was for his family. “I’m used to working in stressful situations, but this was a different kind of stress,” he says. “We were so happy that our baby had a successful surgery and that he was better. However, we were still waiting for him to have his first bowel movement. We were trying to stay positive.”

After his first bowel movement indicated that his intestines were recovering well, and spending about a month in CHOC’s surgical NICU, Landon was finally able to go home with his family.

“It takes a team to successfully care for sick babies and complex patients,” Dr. Yu explains. “Landon would not have had the excellent outcome that he had without our wonderful neonatologists, experienced and skilled pediatric anesthesiologists, Melissa Powell, our dedicated surgical neonatal nurse practitioner, and the outstanding NICU nurses who have dedicated their lives to taking care of newborn babies such as Landon and countless others.  Together, we have the only dedicated surgical NICU in the area, with a special focus on taking care of newborns with surgical problems.”

Landon today at 11 months.

Thanks to the expert multidisciplinary care provided at CHOC, today Landon is a happy baby, meeting all his milestones. The Loughs are enjoying their brave little boy, and look forward to his first birthday next month.

“Dr. Yu, as well as the nurses in the NICU, were so empathetic and amazing. They saw us through so much throughout our stay and we will forever be thankful,” Lizette says.

Learn more about surgical services at CHOC.

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 Surgical NICU Reduces Post-Op Hypothermia in Infants

Consistent, standardized efforts across several disciplines helped CHOC Children’s reduce rates of post-operative hypothermia in neonates by nearly 88 percent, results of a quality improvement project show.

Staff decreased the number of babies who returned to the Surgical Neonatal Intensive Care Unit with body temperatures below 36 degrees Celsius from 10.7 percent to 1.3 percent following surgeries between September 2014 and August 2015.

Due to high body surface area, infants undergoing surgery are at risk for hypothermia, especially premature infants with decreased subcutaneous and brown fat. Hypothermia-induced vasoconstriction can lead to impaired wound healing, surgical site infections, impaired coagulation and decreased drug metabolisms, which can collectively increase perioperative morbidity, said Dr. Irfan Ahmad, co-director of the unit.

Though CHOC’s baseline figure was well below the national average rate of 15.6 percent, reducing post-operative hypothermia rates wasmock-surgery-1 identified as an area for quality improvement for the Surgical NICU and staff set out to reduce rates by half, Dr. Ahmad said.

Involving a cross-disciplinary team including nurses, neonatologists, surgeons and anesthesiologists, the project tracked 76 patients. Because infants can be at risk for hypothermia before surgery, intra-operatively and post-operatively, their temperatures were tracked during each operative stage. Staff were then able to identify problem areas and make improvements over each quarter.

Dr. Ahmad attributed the success to consistently implementing measures such as ensuring patients wore hats and blankets while headed to the operating room; pre-warming transport isolettes before placing babies inside; and using intra-operative heating devices during procedures.

Dr. Ahmad presented this data earlier this month to a quality congress held by the Vermont Oxford Network, a nonprofit, voluntary collaboration of health care professionals dedicated to the quality and safety of medical care for newborns and their families.

CHOC established its Surgical NICU in October 2013, and remains one of a handful of hospitals nationwide to cohort infants needing and recovering from surgery in a dedicated space.

Surgical NICU patients receive care from a multidisciplimock-surgery-4nary team that includes neonatologists, surgeons and many other clinicians. The surgical NICU team cares for patients jointly, discussing the cases as a group and forming a treatment plan that often calls for the expertise of other specialties.

Patients and families are a key component of the surgical NICU care team, collaborating and partnering with clinicians on every stage of the patient’s care.

The Surgical NICU rounds out CHOC’s expansive suite of services for neonates, including a main NICU; the Small Baby Unit, where infants with extremely low birth weights receive coordinated care; the Neurocritical NICU, where babies with neurological problems are cohorted; and the Cardiac NICU, which provides comprehensive care for neonates with congenital heart defects.

Learn more about CHOC’s neonatal services.