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Respiratory Care
The neonatal intensive care unit at The Morgan Stanley Childrens Hospital of New York Presbyterian (MSCHONYP, formerly Babies and Childrens Hospital of NY) admits neonates with a wide variety of respiratory pathologies. Cutting edge, state of the art technologies are practiced in an exciting educational environment. In addition to the neonatology faculty and respiratory support staff, there is a full time neonatal anesthesiologist, Jen Wung, MD, internationally recognized as an expert in neonatal respiratory management and who assists with the day to day, minute to minute care of infants requiring all varieties of respiratory support. Our neonatal intensive care unit has been recognized regionally, nationally, internationally and by the National Institute of Health for the extremely low incidence of chronic lung disease in preterm babies hospitalized here.
ECMO
Extra Corporeal Membrane Oxygenation (ECMO) employs highly trained personnel and a number of biomedical devices working in synergy to temporarily reproduce the physiologic functions of the heart and lungs in children with reversible diseases causing cardiorespiratory failure. The technology provides sustained life support for carefully selected newborn and pediatric patients; these children, who are likely to succumb without ECMO, are suffering from reversible yet overwhelming respiratory or cardiac failure refractory to conventional treatments. For newborns, ECMO therapy physiologically may be thought of as returning the infant to his mother's placenta to allow for adequate respiratory gas exchange. When needed, a form of hemodialysis can also be accomplished using the ECMO circuit.
Since 1982, the Center for Extracorporeal Life Support at MSCHONYP has been directed by Dr. Charles Stolar, Director of the Division of Pediatric Surgery and Surgeon-in-Chief at the Hospital. Thousands of infants have been referred as potential ECMO patients from institutions throughout the Tri-State and Mid-Atlantic regions. To date, approximately 400 infants and a smaller number of older children have been treated with ECMO; 84% are at home with their parents. ECMO therapy is part of the therapeutic armamentarium used in our NICU in neonates with sepsis, meconium aspiration syndrome, diseases producing reversible neonatal pulmonary hypertension, as a bridge to cardiac transplant and in neonates with congenital diaphragmatic hernia (CDH). By designing a protocol focused on gentle ventilatory support and permissive hypercarbia in these babies, we have been able to turn a mortality rate of 50% into a survival rate of 92% for patients with CDH, frequently avoiding the use of ECMO in this subpopulation of neonates who frequently are treated with ECMO at other centers.
Neonatal
Nutrition Support
For decades Babies and Children's Hospital of New York (MSCHONYP) has been in the forefront of pediatric and neonatal nutritional rehabilitation. Major contributions have been made by our staff in the field of neonatal parenteral and enteral nutrition with many seminal investigative papers originating from data collected on neonates hospitalized in our unit. The director of the team is Sudha Kashyap, MD with 2 nutritionists, Inga Gukhman, RD (inpatient) and Joanne Carroll, RD (outpatient followup) providing support to her, the primary care teams and the babies.
In our Neonatal Unit, the Nutrition Support Service is represented on a daily basis by registered dieticians. A neonatal nutritionist and a neonatologist who specializes in neonatal nutritional research are readily available as well. Caloric requirements of each child and the diets administered to each child are reviewed daily, and the process frequently raises many teaching points during the rounding process.
The nutritionist is an integral part of the neonatal teams. She rounds daily with the attendings, nurse practitioners, and residents and offers recommendations to optimize the nutritional care of critically ill neonates. The nutritionists also provide educational in-services to the house staff and all other health care professionals on theory and rationale of nutrition principles.
Nutrition assessments, goals and plans are evaluated on a regular basis for neonates receiving parenteral and/or enteral nutrition.
Congenital Heart Disease
Our NICU has a huge population from which we attract patients. Although this is true for all specialties and subspecialties of pediatrics, our pediatric cardiology and pediatric cardiothoracic surgery services are especially active and care for a large volume of critically ill neonates. Our survival and intact survival statistics in these patients are outstanding and the best in New York State by an overwhelming margin. The volume of patients and procedures as well as the camaraderie amongst physicians are the reasons for the successes of the patients. Our 3 pediatric cardiothoracic surgeons perform about 175 neonatal open heart cases each year, excluding PDA ligations in preterm neonates. These babies are cared for by the same NICU nursing, physician and physician-extender staffs in both the pre and postoperative periods. There is extremely close collaboration and respect between our neonatal, pediatric cardiology, pediatric CT surgery and pediatric anesthesia colleagues. Add to the mix exceptionally knowledgeable and capable nursing and respiratory care staffs and the basis exists for best possible outcomes in these very special children. A team of well trained and very experienced neonatologists lead and orchestrate the minute to minute care these neonates need and deserve.
Maternal and Fetal Medicine (MFM)
Because the delivery service for the College of Physicians and Surgeons of the Columbia University Medical Center is physically within MSCHONYP we have a very close collaboration and daily interactions with our MFM colleagues. Respect is mutual and opportunities for teaching extensive. Each Wednesday morning, every new low risk pregnant woman carrying a high risk fetus(es) and many high risk pregnant women carrying high risk fetuses are discussed by faculty within the following pediatric disciplines including but not limited to: neurology, genetics, cardiology, general surgery, neurosurgery, cardiothoracic surgery, urology, radiology, neonatology and of course MFM, after presentation by our MFM colleagues. Our MFM service is extremely active with both community and referral patients which yields more than a handful of new cases for discussion each week. Diagnoses and outcomes are discussed and delivery plans are established to anticipate and offer the best care for babies. Plans are made for neonates who may need immediate interventions after birth, such as balloon atrial septostomies, ECMO therapy, or delivery via EXIT procedure as in the fetus with a benign cervical teratoma which could be life threatening with out delivery via EXIT because of postnatal airway compromise. There is no doubt that the collaboration amongst services and health care professionals helps make the transition from the intrauterine to extrauterine environments safer for babies delivered here. Additionally, the successes of our MFM group, just as ECMO therapy, helps maintain and insure a constant flow of gravely ill neonates into our NICU.
Other Programs
Because MSCHONYP is on the campus of the College of Physicians and Surgeons of the Columbia University Medical Center, vast numbers of faculty in every pediatric medical and surgical specialty/subspecialty are available to help care for neonates admitted to our NICU and to educate trainees in all fields of pediatrics. Depth in numbers and abilities of the clinical and research faculty is extensive and produces wonderful opportunities for post graduate trainees both in the clinical and research arenas.
Our pediatric general surgery colleagues have a huge neonatal component to their program and have faculty with a vast degree of experience and expertise. Care of these children is collaborative in nature, with the neonatal faculty in conjunction with our surgical colleagues responsible for and leading the patients daily care and management. There is an accredited pediatric surgery training program which insures a high volume of index surgical cases as well as an ECMO training program for fellows.
Our nursing staff is very stable with decades of experience caring for critically ill neonates. They are the most integral part of the management care team
Experienced respiratory therapists are dedicated to the unit and play a very important role in helping manage care and producing the excellent outcomes for which we are known.
Research opportunities exist across divisions and departments with exciting collaboration ongoing between physicians and physician scientists.
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