Although giving birth is a natural process, unexpected events can put newborn babies and mothers at risk.
Neonatologists working in coordination with other specialists play a crucial role in caring for newborns.
Bumrungrad International Hospital has established both the Perinatal Center and the Neonatal Service to look after expecting mothers from the early stages of pregnancy all the way to the delivery of their newborn babies.
Prof. Dr. Oradee Chandavasu, Chief of the Neonatal Service Unit, understands the importance of the Perinatal Center and Neonatal Intensive Care Unit (NICU) for expecting mothers and newborns. At the Perinatal Center, obstetricians with sub-specialty qualifications in maternal-fetal medicine work with neonatologists to provide diagnosis and treatment for pregnant women, high-risk fetuses and newborns post-delivery. The hospital provides care for newborns ranging from healthy to critical condition, classified into four levels:
• Level 1 (Well Newborn Nursery): Oversees healthy babies without complications.
• Level 2 (Special Care Nursery): Oversees premature babies; babies without complications weighing 1,500 grams and more, pregnancies of 32 weeks and more; and babies in stable condition after discharging from the NICU.
• Level 3 (NICU): Oversees premature infants with gestational age under 32 weeks and/or babies weighing less than 1,500 grams; those using a respirator and/or nitric oxide; and infants in need of special care by pediatric specialists, such as a pediatric surgeon, pediatric anesthesiologist, or pediatric ophthalmologist.
• Level 4 (Regional NICU): Oversees patients transferred from other hospitals within the country or from overseas. Bumrungrad International Hospital’s NICU is comprised of pediatric surgeons sub-specializing in heart and brain surgery, as well as experts in other disciplines. Its facilities include: ECMO machinery that works in place of a damaged heart and lungs; a micro-technique laboratory for newborns in order to reduce anemia. Most tests results are completed quickly and mobile X-rays machines are readily available.
Differentiated Neonatal Service
• Preparing mothers from the start
The first few minutes after childbirth are known as the “golden minutes” when seconds can make the difference between life and death for both the newborn and the mothers. Bumrungrad International’s NICU and operating theater are located near the delivery room by design. This reduces possible risks during the transfer of babies and enables close supervision. These arrangements increase the chances of survival and minimize the risk of negative symptoms developing.
• Newborn supervision
Newborn babies are different from older babies because they need much closer supervision. As such, personnels who care for newborns must be specially skilled and work in coordination with a multidisciplinary team.
After delivery, newborns must be moved from the operating theater to the nearby NICU.
Normally, immediately after birth, newborns must stay in a newborn room for two to three hours for observation under the close supervision of neonatal nurses. If there are no apparent symptoms or reasons for concern, the newborn will be moved to the nursery nearest the mother’s room within the same zone. If a newborn shows any signs of health problems, the baby will be transferred to a special unit or to the intensive care nursery.
High-tech facilities play an important role in newborn care; these include normal and high frequency respirators, Extracorporeal Membrane Oxygenation (ECMO) machines, and micro-technique blood testing technology, which requires only one or two drops of blood. These tools are mobile so that they can be moved near the infant incubators for quick set-up and results. The operating theater is fully-equipped and capable of performing rigorous treatments such as newborn heart surgery.
• Superior service
Because the full understanding of each situation by the parents is just as crucial as the treatment, Bumrungrad International Hospital offers an extensive team of consultants. The hospital, thereby, never neglects to take full appropriate care of the physical and mental health of both parents and their newborns.
At the NICU, private rooms are available to enable parents to care for their babies under the close supervision of one or two nurses, depending on the baby’s condition. Family rooms enable mothers to stay with their baby overnight, boosting their confidence in caring for their baby prior to taking the baby home. A negative pressure room is also available to provide a safe, secure environment for newborns being treated for certain infections.
Teamwork and professional expertise are the Core of neonatal care
The Perinatal Center and the NICU at Bumrungrad International place utmost importance on teamwork and professional expertise. Working in coordination during treatment planning and preparation, multidisciplinary teams play a crucial role in defining the treatment plan and discussing risks, possible complications, and outcomes with parents.
The medical team comprises of experts with numerous sub-specialties, including obstetricians with a sub-specialty qualification in maternal-fetal medicine; pediatricians with a sub-specialty qualification in neonatal medicine who are specially trained to treat babies during pregnancy and after birth; anesthesiologists to take care of mothers and newborns; genetic disease specialists; as well as specialist pathologists and laboratory technicians. Other specialists include pediatric cardiologists, endocrinologists, hematologists, and specialists in joint and bone disease.
Nurses also play important roles at the Perinatal Center and the NICU. Neonatal nurses must initially undergo extensive training in neonatal nursing and attend neonatal practitioner courses to attain certification. The nursing team must also undergo training in prenatal care for delivery. Coordinating nurses are needed for breastfeeding. As well, there are laboratory staff, pharmacists, and infant physical therapists whose contributions are critical.
Prof. Dr. Oradee Chandavasu’s newborn experiences
I have been through many difficult newborn cases. On recently was a mother from the northeast region of Thailand who had given birth to twins. She had antenatal care at Bumrungrad International Hospital, but because of twin pregnancy, she had premature birth upcountry, with only one baby boy weight 780 grams survived. Due to the baby precarious situation, we had to bring him to our facilities for care as quickly as possible.
As the province does not have an airport, we had to use the nearest airport in a neighboring province.
Two teams were set up; one team travelled overnight by ambulance with the incubator and equipments. The other team consisted of doctor and nurse who travelled by plane in the morning. The ambulance team picked up the doctor and nurse at the airport and continue to that hospital.
The infant was in critical conditions with premature lungs (Respiratory Distress Syndrome or RDS: lung condition which is not fully developed and unable to generate surfactants in the alveoli). He also had congenital chylothorax (accumulation of lymphatic fluid in the pleural cavity in the lungs). Due to the baby’s precarious situation, we had to bring him to our facilities for care as quickly as possible.
Despite these condition we made every effort to ensure he survived and can eventually go home safely.
Life-threatening situations can occur at any moment, but coordination among our multidisciplinary team at Bumrungrad International’s Perinatal Center and NICU, as well as the support of the parents, made all the difference. We have a crucial role looking after newborns, doing everything possible to save infant lives and send them home safely to be with their families.
