Julia’s Story: NICU Care And Its Cool Babies

Julia's Story

Julia Shipley, who turned 3 on May 21, 2012, is a happy, huggable, and healthy child. She’s one cool kid. And the reason she’s a cool kid today is because she was one of the first “cool babies” treated at Miami Valley Hospital’s Level IIIB Neonatal Intensive Care Unit (NICU)

A Precarious Birth

When Julia was born at a Dayton-area hospital in 2009, she was at risk for brain damage due to oxygen deprivation, a condition called hypoxic-ischemic encephalopathy (HIE). “Hypoxic” refers to the lack of oxygen; “ischemic” refers to the lack of blood and the nutrients it provides; “encephalopathy” refers to injury, disease, or malfunction of the brain.

Prior to giving birth, Julia’s mother, Katy, experienced a placental abruption – the separation of the placenta (which supplies oxygen and nutrients to the fetus) from the uterine lining. When Julia was delivered by emergency C-section, she was not breathing. But, seconds later, the 6 pound, 11 ounce full-term baby was breathing on her own and showed no signs of distress.

However, that night, she suffered a seizure, a sign of possible HIE, and was transported by ambulance to Miami Valley Hospital, where she was admitted to the NICU.

Assessment And Treatment

At the Neonatal Intensive Care Unit, Julia underwent a series of tests to assess her condition, including an EEG, a brain wave test; and a follow-up MRI, which offers a better image of suspected brain injury. Tests confirmed HIE.

As Marc Belcastro, DO, then medical director of NICU, explains, “Some babies with HIE can get better without any long-term or lasting problems. However, if severe, HIE can lead to seizures (convulsions), mental retardation, blindness, hearing defects, and/or physical (muscular) disabilities. In the worst cases, HIE can cause death.”

Traditionally, there had been no effective treatment for HIE infants other than supportive care, such as the use of respirators to facilitate breathing, medicine to control seizures, and antibiotics to prevent infection. There was no way to minimize or slow down the brain damage process.

But, Julia’s timing was impeccable. She arrived at the NICU just as the unit’s neonatologists (physicians specializing in newborn intensive care) were starting to use a new treatment for babies suffering from HIE: therapeutic hypothermic (cooling) treatment.

In 2009, the cooling treatment used at the NICU was the Food and Drug Administration-approved Cool-Cap system, a medical device that keeps the head cool. The system consists of a cooling unit, a control unit, temperature probes, and a water-filled cap.

Cool water is piped through the cap, which is placed over the baby’s head. The lowered temperature (92° F) slows the brain’s metabolism, thereby preventing brain cells from dying and reducing swelling that can cause further damage.

More recently, a whole-body cooling system was designed and is now used by the NICU. With this treatment, often called a cooling blanket, the baby is placed on a mattress filled with cool water so the entire body is cooled. While there is no difference in outcome between using the cap or the blanket, the NICU nurses prefer the blanket because it’s easier to keep a baby comfortable and provide care. 

Cooling treatment for HIE babies is most effective when it is started within six hours after birth. After 72 hours of treatment, the baby’s head or body temperature is gradually warmed over a four-hour span.

A cooling system, by itself, is non-invasive – it requires no medication, no needles, and no incisions. However, babies being cooled are constantly monitored for changes in blood pressure, heart rate, and other bodily functions that might require procedures involving tubes and catheters. (In Julia’s case, a catheter was used to facilitate urination.) Babies being cooled are also fed intravenously.

A Significant Breakthrough

When the FDA first approved the cooling cap for the treatment of HIE in infants, Dr. Daniel Schultz, director of FDA’s Center for Devices and Radiological Health, said, “This approval brings new hope to parents of the approximately 5,000 to 9,000 babies each year who are born in the United States with moderate to severe hypoxic-ischemic encephalopathy. Until now, there has been no effective treatment for these infants other than supportive care. Up to 20 percent of them died, and 25 percent suffered permanent disability because of neurological deficits.”

At that time, the FDA reported the cooling cap was found safe and effective in a study with 234 babies with HIE. The results showed fewer deaths and fewer severe cases of neural development disability in the cooled group compared with the control group. Subsequent studies have supported these results. 

“I’m proud that Miami Valley Hospital chose to make a major investment in a technology that has proved so effective in treating HIE babies,” says Dr. Belcastro. “Therapeutic hypothermic treatment is one example of how the NICU continues to offer leading technology to the Dayton region. Our long-standing ECMO program  was also enhanced because infants who require ECMO often require therapeutic hypothermic treatment as well.” 

A Happy Place 

At the NICU, parents are able to stay with their babies in a private room. 

For the first four days that Julia was in the NICU, Katy was still recovering from Julia’s birth at an area hospital; but dad, Ian, stayed at his daughter’s side. On the fifth day, Katy arrived to bond with her baby girl.

And that was not the only bonding going on. The NICU nurses have a habit of developing close relationships with “their” babies and their families.

Case in point is Tracy Morrison, RN, one of the nurses who cared for Julia. Tracy recalls being summoned to the NICU in the middle of the night to set up the Cool-Cap System for Julia. “She was only the second baby to be treated with the system at our hospital,” explains Tracy. “I had cared for the first baby, who had been discharged the day before, and thus was well versed in the technology.”

“Tracy was the first person my husband met when he arrived at the Neonatal Intensive Care Unit,” says Katy. “She answered all his questions and calmed his fears. She represents all that was great about our family’s NICU experience. I also must acknowledge Stephanie Gronlund, another NICU nurse, who treated all of us like family during the eight days Julia was there.”

Tracy proudly brings up a progression of digital photos of the little girl she cared for. “Julia came back to Miami Valley Hospital for her one-year evaluation on my day off, but I made a point of coming in to see her,” says Tracy.

Such a loving atmosphere is one reason Julie Scanlan, RN, nurse manager of the NICU, says, “Despite the serious conditions of many of our little patients, we don’t have a lot of sadness here. The NICU is a happy place with many happy outcomes.”

Julia Shipley is one such happy outcome. While she left the NICU, still taking seizure-prevention medication, today she is off all medication. Her annual check-ups have shown no signs of mental or physical abnormalities.

“Someday, when she’s old enough to understand, we’ll tell her about her first days of life when she was one cool baby,” Katy says.

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