Chapter Analysis

Caring for Babies in the NICU

Although about 9 percent of all newborn babies require care in a NICU, giving birth to a sick or premature baby can be quite unexpected for any parent. Unfamiliar sights, sounds, and equipment in the NICU can be overwhelming. This information is provided to help you understand some of the problems of sick and premature babies. You will also find out about some of the procedures that may be needed for the care of your baby.

http://www.chop.edu/healthinfo/caring-for-babies-in-the-nicu.html

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About Dr. Thomas Bond & Benjamin Fraklin.

IN THE BEGINNING
	The Story of the Creation of the Nation's First Hospital Pennsylvania Hospital was founded in 1751 by Dr. Thomas Bond and Benjamin Franklin "to care for the sick-poor and insane who were wandering the streets of Philadelphia." At the time, Philadelphia was the fastest growing city in the 13 colonies. In 1730, the population numbered 11,500 and had grown to 15,000 by 1750 (the city continued to grow and by 1776, its 40,000 residents made Philadelphia the second largest English-speaking city in the British Empire). The docks and wharves along the Delaware River teemed with activity as ships bound for foreign ports loaded up with flour, meat and lumber while overseas vessels delivered European-manufactured goods and wines. Foreign visitors noted with envy the city's growing prosperity. Although the majority of the population was neither extremely wealthy nor extremely poor, there was a significant increase in the number of immigrant settlers who were "aged, impotent or diseased." At the time, colonial America's urban centers were far healthier than their European counterparts. Nevertheless, the Philadelphia region, according to city leaders of the day, was "a melting pot for diseases, where Europeans, Africans and Indians engaged in free exchange of their respective infections." Faced with increasing numbers of the poor who were suffering from physical illness and the increasing numbers of people from all classes suffering from mental illness, civic-minded leaders sought a partial solution to the problem by founding a hospital. The idea for the hospital originated with Dr. Thomas Bond. Born in Calvert County, Maryland, Bond, a Quaker, moved to Philadelphia as a young man. In 1738, in order to further his medical education, he went abroad to study medicine in London. While in Europe, Bond spent time at the famous French hospital, the Hotel-Dieu in Paris, and became impressed with the continent's new hospital movement. Bond returned to Philadelphia in 1739 and two years later was appointed Port Inspector for Contagious Diseases. Bond and Benjamin Franklin were long-standing friends. Bond was a member of Franklin's Library Company and helped establish the American Philosophical Society and the Academy of Philadelphia, which evolved into the University of Pennsylvania. Around 1750, Bond "conceived the idea of establishing a hospital in Philadelphia for the reception and cure of poor sick persons." The idea was a novelty on this side of the Atlantic, and when Bond approached Philadelphians for support they asked him what Franklin thought of the idea. Bond hadn't approached his good friend because he thought it was out of Franklin's line of interest, but because of the reaction he received, Bond soon turned to Franklin. After hearing the plan, Franklin became a subscriber and strong supporter. Franklin's backing was enough to convince many others that Bond's projected hospital was worthy of support. Franklin organized a petition, although not signed by him, bearing 33 names and brought it to the Pennsylvania Assembly on January 20, 1751. The petition stated that although the Pennsylvania Assembly had made many compassionate and charitable provisions for the relief of the poor, a small provincial hospital was necessary. After a second reading on January 28, the petitioners were directed to present the Assembly with a bill to create a hospital. Presented a week later, the bill encouraged the Assembly to establish a hospital "to care for the sick poor of the Province and for the reception and care of lunaticks." The hospital bill met with some objections from rural members of the Assembly because they thought the hospital would only be serviceable to the city. At this critical juncture, Franklin saved the day with a clever plan to counter the claim by challenging the Assembly that he could prove the populace supported the hospital bill by agreeing to raise 2000 pounds from private citizens. If he was able to raise the funds, Franklin proposed, the Assembly had to match the funds with an additional 2000 pounds. The Assembly agreed to Franklin's plan, thinking his task was impossible, but they were ready to receive the "credit of being charitable without the expense." Franklin's fundraising effort brought in more than the required amount. The Assembly signed the bill and presented it to Lieutenant Governor James Hamilton for approval. After amending the bill several times, Hamilton signed it into law on May 11, 1751. From early 1752 until the east wing of the Pine Building opened in 1755 Pennsylvania Hospital was housed in the home of recently deceased John Kinsey, a Quaker and Speaker of the Assembly. So pleased was Franklin that he later stated: "I do not remember any of my political manoeuvres, the success of which gave me at the time more pleasure..." To illustrate the purpose of the hospital, the inscription "Take care of him and I will repay thee" was chosen and the image of the Good Samaritan was affixed as the hospital seal. Timeline: May 11, 1751 Charter is granted to establish Pennsylvania Hospital. 1752 Temporary hospital established and Elizabeth Gardner, a Quaker widow, is appointed matron. 1753 First patients admitted on February 11. 1754 Hospital's first plot of land purchased from the Penn family. 1755 Benjamin Franklin writes the cornerstone for the east wing of the Pine Building. 1756 The hospital starts admitting patients in the 8th and Pine Streets facility. 1767 Thomas and Richard Penn donate property to give the hospital the entire square between Spruce and Pine Streets and 8th and 9th Streets. 1796 Construction of the second wing of the hospital, the west wing, is completed. 1804 Construction of the third wing, the center section, is completed and the surgical ampitheatre opens. Related Stories: Benjamin Franklin Dr. Thomas Bond Admission and Regulation of Patients Back to Stories from Pennsylvania Hospital's Past http://www.uphs.upenn.edu/paharc/features/creation.html I realy want to change my project!!!!

CHOP Newborn Care at Pennsylvania Hospital

Pennsylvania Hospital

Pennsylvania Hospital, the nation's first, was founded in 1751 by Benjamin Franklin and Dr. Thomas Bond. Today, the hospital is known for services including Obstetrics, high-risk maternal and fetal services, and Neonatology. The hospital has 45 licensed and staffed Neonatal Intensive Care Unit beds.

The unit's capabilities include a full-service, Level 3 NICU designed for the care of extremely low birthweight premature infants up to full-term infants with respiratory failure, sepsis, genetic syndromes and other neonatal conditions. The unit provides conventional ventilation, and high-frequency oscillation, jet ventilation and nitric oxide are available for the sickest of infants. CPAP and high-flow nasal cannula are offered for milder forms of respiratory failure. Both apnea diagnostic and neonatal follow-up programs are also on-site to provide comprehensive care after discharge. Neonatal transport services from the CHOP Transport Team are available for outside referrals such as RDS, laser ROP surgery and PDA litigation.

The team includes 24-hour neonatologists, neonatal nurse practitioners and physician assistants, and respiratory therapists. Pediatric and pediatric surgical subspecialists from CHOP are available for consultation in the NICU. Social workers, occupational and physical therapy teams, speech and feeding specialists, developmental specialists and lactation consultants work with both babies and families.

http://www.chop.edu/locations/inpatient-at-pennsylvania-hospital/inpatient-at-pennsylvania-hospital.html

I want to ask Mr. Brasof if i could change from chldren's hospiatal to pennsylvania hospital. I think i would make our project easier.

Visit the Pennsylvania Hospital Web site »

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Call CHOP Newborn Care at Pennsylvania Hospital

• 215-829-5069

Our Address

8th and Spruce Streets

Philadelphia PA ,19107

NICU during 1960

FOREWORD

In 1960, the idea of having a special intensive care unit for newborns—a neonatal intensive care unit

(NICU)—represented a developmental milestone for the field of neonatology. With the increased

sophistication developed since then, doctors now are able to save the lives of many premature or

desperately ill newborns who in the past would have died soon after birth. The result is that the U.S. infant

mortality rate has shown a steady decrease since the NICU first came into widespread use a quarter of a

century ago and, concomitantly, survivors have fewer sequelae.

The widespread access to NICUs based on the existence of regionalization has allowed the establishment

of a national network of technologically advanced NICUs. Under regionalization, centrally situated

hospitals maintain one or more NICUs available to all babies of high-risk mothers and to critically ill

newborns referred from other hospitals located within a certain area. Babies born at hospitals not equipped

with state-of-the-art facilities or without experts in perinatal medicine on their staffs are thus ensured

access to the best possible neonatal care if needed. Regionalization represents nationwide access to health

care in the true sense of the term.

Although the ability to sustain premature or sick infants is a significant medical advance, the ultimate goal

is to eliminate the need for NICUs altogether. As with most, if not all, medical technologies, the benefits

of neonatal intensive care are not achieved without certain risks. These risks run the gamut from

inconsequential to deadly. Some premature babies born too small to survive on their own may have no

apparent problems at first. Some, however, may survive only to suffer severe mental and/or physical

handicaps later in life. Others, despite the best of neonatal intensive care, may not survive at all. In light of

these critical risks, it is clear that, as always, prevention is far better than any cure.

http://www.nichd.nih.gov/publications/pubs/neonatal/nic.htm (3 of 40) [03/17/2001 12:28:58 AM]

Superficially, eliminating the need for NICUs appears to be relatively easy: simply reduce the number of

low-birth-weight infants. But as any neonatologist or obstetrician knows, that is not a simple task. From

steadily increasing numbers of births to teenage girls who receive little or no prenatal care, to smoking and

other forms of substance abuse during pregnancy, the odds against successfully eliminating low birth

weight are seemingly momentous. The rate of low birth weight births has remained virtually constant over

the past 20 years.

A mere 30 years ago, a description of today’s highly advanced state of neonatal care would have been met

with disbelief. Yet we now know what is possible. Perhaps the next 30 years will bring about an equally

miraculous decline in the incidence of low birth weight and its attendant problems. With education and

superb prenatal care for all pregnant women, the goal is attainable.

The following essays present the history and development of the neonatal intensive care unit. Written by

pioneers in the design and implementation of neonatal intensive care who shared their experience and

expertise at the National Institute of Child Health and Human Development’s Child Health Day

symposium, they not only document the past, but give one hope for the potential of the future.

Sumner Yaffe, M.D.

Back to Contents

Neonatal Intensive Care

http://www.neonatology.org/classics/nic.nih1985.pdf

this is the web site i researched today.

Research : Early agressive nutrition;

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Patti Thureen, MD

C.H.O.P.

The argument for delivering early aggressive nutrition to the high-risk, very preterm newborn is based on the observation that nationally, we are producing postnatal growth retardation that is not reversed by the time of hospital discharge. High protein requirements, fluid losses, and energy expenditure combined with small energy reserves and poor gastrointestinal motility in these infants constitute a nutritional emergency. On the other hand, concerns about intolerance and toxicity (especially necrotizing enterocolitis) remain, and clear evidence about long-term benefit is lacking.

The standard of the American Academy of Pediatrics for postnatal nutrition in preterm infants is to duplicate normal in utero fetal growth rates, but no detailed guidelines for reaching this goal have been published. Dr. Thureen explained that normal fetal growth rate is difficult to achieve in extremely low birth weight infants and that weight gain alone does not guarantee “good growth.” She advocates the following steps in early aggressive nutritional support:

• Start total parenteral nutrition on the first day of life
• Give amino acids to prevent catabolism and in amounts that, hopefully, produce growth
• Advance glucose and lipids as rapidly as tolerated
• Give minimal enteral feedings (MEF) on days 1 and 2
• Aim for a “good” weight gain of 15 to 20 g/kg/day by days 10 to 12

Dr. Thureen stated that protein growth may be the best indicator of “real” growth, and evidence suggests that the amount of protein intake early in life correlates with developmental outcome. She and her colleagues compared the results of low and high intravenous amino acid intake in extremely low birth weight infants in the first 48 hours of life. Significantly greater rates of protein accretion occurred in neonates who received high amino acid intake (3 g/kg/day) compared with those who received the lower amount (1 g/kg/day); no evidence of toxicity was found .

Finally, Dr. Thureen discussed the role of MEF, also called “priming” or “trophic feedings,” in which formula or breast milk is given enterally in amounts from <1>

http://www.ncbi.nlm.nih.gov:80/pmc/articles/PMC1200660/ (i researched this site today)

Annotation 4;;

I read an article on about.com; http://adam.about.com/encyclopedia/Poor-feeding-in-infants.htm. I learned that some infants are not treated the right way when their parents have no idea what to do with the baby. Thats why we have day cares and children devolpment centers for less fortunate children. These are some of the facts i was reading about.

Poor feeding in infants

Definition

Poor feeding is when an infant has a lack of interest in feeding or a problem receiving the proper amount of nutrition.

Alternative Names

Feeding - infant's lack of interest; Infant - lack of interest in feeding

Considerations

Poor feeding is a nonspecific symptom seen in newborn and young infants. It can result from many conditions, including infection, metabolic disorders, genetic disorders, structural problems, and neurological disorders. Poor feeding is not a sign of the severity of the disease, but it requires close watching of the infant.

Poor feeding is not the same as "picky" eating. Many children between ages 2 and 4 are picky eaters. Parents only need to give children what they like to eat at this age. However, children must continue to drink milk or an appropriate milk substitute.

Causes

• Any disorder that causes damage to the nervous system or causes muscle weakness
• Beckwith-Wiedemann syndrome
• Birth-acquired herpes
• Congenital hypothyroidism
• Galactosemia
• Group B streptococcal septicemia of the newborn (late)
• Hypoplastic left heart
• Infant botulism
• Infection of the tissue covering the brain and spinal cord (meningitis)
• Newborn jaundice
• Patent ductus arteriosus
• Premature infant
• Tetralogy of Fallot
• Total anomalous pulmonary venous return
• Tracheoesophageal fistula, a birth defect in which there is a connection between the trachea and the esophagus
• Transposition of the great vessels
• Truncus arteriosus
• Viral gastroenteritis

Home Care

Watch closely for the development of other signs and symptoms of illness, such as dehydration.

Also watch the child's height, weight, and general development closely for signs of malnutrition or failure to thrive.

When to Contact a Medical Professional

Contact your pediatrician if your child does not seem to be eating enough, is consistently losing weight, or if poor feeding is accompanied by other signs or symptoms.

What to Expect at Your Office Visit

A child who is feeding poorly will often have other symptoms and signs that, when taken together, define a specific syndrome or condition. Diagnosis of that condition is based on a family history, medical history, and a complete physical exam.

Questions your health care provider will ask may include:

• How does the baby (child) eat normally?
• Has the diet been changed recently?
• Has the baby (child) always been a fussy eater?
• Is the feeding getting harder?
• Has the baby been vomiting?
• Does the baby have diarrhea?
• Is there an abnormal stool color?
• Is there gagging or choking?
• Is there coughing?
• Are there other symptoms?

DIAGNOSTIC TESTS

Laboratory studies such as x-rays, gastrointestinal (GI) studies, and blood tests may be ordered to confirm the presence of a suspected disorder.

AFTER THE OFFICE VISIT

Although the health care provider maintains records on your baby, it is a good idea to maintain your own records of office visit findings, test results, and your own observations of your baby's health. You should add measurements that you do at home, such as height and weight.

Bring your records to the health care health care provider's attention if you notice any problems, or if you have questions about your baby's development.

This article was created on november 9th 2007 by Reviewed By: Deirdre OReilly, M.D., M.P.H., Neonatologist, Division of Newborn Medicine, Childrens Hospital Boston and Instructor in Pediatrics, Harvard Medical School, Boston, Massachusetts.

This article helped me alot because why certain buildings are very impotrant to our children in the world. If we didnt hace accesor certain opportunties, where would the less fortunate children go to survive through medical assitance.

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Annotation 3;

Citation added: Http://www.chop.edu/service/neonatology/home.html. The Childrens Hospital Of Philadelphia. Web. 2 Nov. 2009. .

This article was very helpful to me. Its explained evolution on neonatal care at the Childrens Hospital of Philadelhpia. I learned that the Division of Neonatology provides comprehensive care for critically ill newborns and infants, including consultation, transport, and inpatient intensive care in our Newborn/Infant Intensive Care Unit. n addition to board-certified attending neonatologists, the newborn care team consists of fellows, residents, physician assistants, staff nurses, neonatal nurse practitioners, clinical nurse specialists, ECMO specialists, clinical staff, charge nurses, respiratory care practitioners, social workers, dietitians, case managers, physical therapists, occupational therapists, speech therapists and lactation specialists in the unit to provide round-the-clock care. And also, The Division of Neonatology, under the leadership of Phyllis A. Dennery, MD, is involved in numerous laboratory and clinical research activities focused on development, lung disease, the fetal origins of disease, molecular mechanisms and use of nitric oxide, biomarkers of neonatal conditions, pharmacology and more. There was no particular aurthor, just under the name of Childrens Hospital of Philadelhpia. 1996-2009!!!

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