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Releases Packard
Children's News
Children's Fund
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The Birth of Neonatology:
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A Half-Century of Innovation: Timeline of Technologies and Treatments Pioneered at Packard and Stanford |
When Allison was born in 1981, she contracted a serious bacterial infection that caused her to go into respiratory failure. "Back then, the mortality rate for those kids was virtually 100 percent," recalled Benitz, who was a resident in Stanford's Neonatal Intensive Care Unit (NICU) that year. Despite the grim statistics, he and his colleagues treated Allison with antibiotics and intensive care that pushed the available technologies to the edge. Two weeks later, she surprised everyone in the NICU and made a full recovery. "I remember Dr. Benitz saying that she was the sickest patient he ever had who lived," said Joanna Hunter, Allison's mother.
"It was great to meet him," said Allison. "I've grown up hearing so much about him and the other doctors."
Benitz was equally thrilled to see his patient for the first time since she left the NICU. "Seeing what a fine person Allison turned out to be is the kind of thing that makes this job special," he said.
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A Reunion: William Benitz, M.D., and former patient, Allison Hunter, look at pictures of Allison's stay in the NICU nearly 23 years ago. |
Today, the survival rate for babies like Allison has risen to nearly 80 percent, thanks to advances in treatment pioneered by Benitz and other neonatologists. In fact, Stanford has been leader in neonatal research for more than four decades, and the staff at Packard has carried on that tradition by continuing to develop new technologies, novel therapies, and synergistic approaches to care – like the Charles B. and Ann L. Johnson Center for Pregnancy and Newborn Services, which opened in 1997.
Approximately 5,000 babies are born at Packard's Johnson Center each year. Many arrive prematurely and require long periods of intensive care to prevent serious infections and reduce injuries that could result in learning disabilities and other developmental problems. Packard also treats many full-term babies who experience complications at birth, including blood loss, trauma, asphyxia, and – like Allison – bacterial infection.
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Emily and Nicholas Andreas, 6-year-old twins from Redwood City, were born at Packard 16 weeks early. Since their birth, a team of specialists at the Mary L. Johnson Development and Behavior Unit has tracked the twins' development. Though both twins have been diagnosed with a mild form of cerebral palsy, they are enjoying a full and happy childhood. |
According to David Stevenson, M.D., chief of Stanford's Division of Neonatology and Developmental Medicine, neonatology was literally invented as a sub-specialty at Stanford and at a few other schools in the 1960s. "Doctors no longer assumed that the medicines and the dosages they used in adults were safe for babies. All of the things that we now take for granted – like the miniaturization of medical technologies and the development of minimally invasive technologies – didn't exist and had to be invented. They're all part of the history of neonatology, and part of that history has unfolded here," said Stevenson.
Many of the innovations that have emerged from Stanford and Packard represent major milestones in neonatology, including the development of the first mechanical respirators and apnea monitors for infants in the 1960s.
"Before 1960, doctors took a passive approach to newborns," said Philip Sunshine, M.D., emeritus professor of pediatrics at Stanford. "If they made it, they made it. If they didn't, that was it.What changed was this aggressive approach, which showed that, if you provided intensive care to premature infants, you'd improve survival without increasing the number of damaged kids."
Sunshine began his residency at Stanford in 1957 – two years before the term "neonatology" first appeared in a medical textbook. He eventually served two stints as director of neonatology at Stanford, from 1967 to 1976 and 1979 to 1989.
When Sunshine started practicing medicine, babies younger than 28 weeks gestation had a 90 percent chance of dying. "Now babies born at just 26 weeks have an 80 percent chance of survival," he noted, "and only a minority of those babies end up with any kind of learning disabilities or other developmental damage."
During Sunshine's tenure as division director, the faculty began to explore new areas of research, including infant hearing loss and pulmonary hypertension – a disease in which high blood pressure in the pulmonary arteries reduces the heart's ability to pump blood to the lungs.
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| Fathers of Neonatology: Doctors David Stevenson and Philip Sunshine hold a model of the first apnea monitor used to track newborn breathing. The monitor, developed at Stanford in the 1960s, is one of the many contributions to the field of natology that Stevenson and Sunshine helped shape. |
"We were one of the first centers to recognize the importance of pulmonary hypertension," Sunshine observed, noting that Benitz, Stevenson, and other Stanford researchers were instrumental in developing therapies that eventually cut the mortality rate in half.
When Stevenson was named division director in 1989, he expanded on Sunshine's legacy of good medicine and solid research. "We built on the same philosophical base that Phil Sunshine established," Stevenson said. "We are fundamentally a group that has its origins in research. Our underpinnings are in the laboratory.We're translational in our focus, and ultimately we look for applications in clinical investigation."
Neurodevelopment medicine is one of several important areas of neonatal research at Packard. Susan Hintz, M.D., working with fellow neonatologists Ronald Ariagno, M.D., and others, focuses on brain development in premature infants, using novel technologies such as diffusion tensor imaging – an advanced form of MRI that analyzes the movement of water molecules through the brain.
"Eventually we hope to be able to take the information we gain from these studies and see things that will help us identify infants who are at higher risk for cerebral palsy and other problems," Hintz explained. "If so, we'll be able to intervene early and try to give them the best possible outcomes. That's our longterm goal."
Several Stanford researchers are engaged in clinical trials to study the benefits and risks of relatively new therapies, such as inhaled nitric oxide gas, which is used to treat pulmonary hypertension in premature babies. To broaden the scope of such trials, Stanford became an affiliate of the Neonatal Research Network of the National Institute of Child Health in 1991, joining forces with 16 other academic centers in the United States.
"The network gives us the opportunity to continually test new technologies, diagnostic approaches, and therapies in coordination with other universities," Stevenson said. "There are a number of trials where we have been the spearhead institution."
Research is only one facet of neonatology at Stanford. "Phil insisted from the very beginning that every one of us had to be a good doctor," Stevenson said. "We had to practice our discipline and take care of babies. So everybody is expected to participate in the research enterprise, but also practice the discipline as well as it can be practiced."
According to Sunshine, a team approach was especially important in caring for such fragile babies. "The nurses in the NICU would come up with really clever ideas to improve care," he said. "What developed was an unbelievable camaraderie with the nursing staff – probably better than anywhere else in the hospital."
Neonatology services made a giant leap forward with the opening of Packard Children's Hospital in 1991. Sunshine maintains that the NICU and other nurseries would have remained in the adult hospital had it not been for the vision and generosity of Lucile Packard, who understood that a close collaboration between obstetrics and neonatology would enhance the care of mothers and babies.
Today, the nurseries at Packard Hospital are at their maximum capacity. To ease the demand for additional neonatal beds, Stevenson created a regional network of Northern California hospitals – all staffed by doctors who report directly to Packard.
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Satellite Centers: The special care nursery at Sequoia Hospital in Redwood City is one of seven centers developed by Packard at community hospitals. |
"Our faculty are out there in the field at seven hospitals – from Pleasanton to Salinas – bringing the Packard philosophy and standard of care into these outlying communities," he said. "So it's not just 5,000 live births at Packard but actually 25,000 over which we have influence. Now our neonatologists can take care of babies closer to their homes, and if they need something that can’t be provided in their community, the patient is moved seamlessly to Packard, then seamlessly back to their community."
The regional hospital network is coordinated through the Charles B. and Ann L. Johnson Center for Pregnancy and Newborn Services. The Center is designed to streamline all obstetric and neonatal services at Packard into a single clinical program that provides a continuum of care to pregnant mothers and their babies. Among the services offered by the center is the Mary L. Johnson Development and Behavior Unit – a special clinic that helps infants and young children who are at high risk for developmental problems.
"We have a team of people engaged in evaluating those kids and getting them seen by the appropriate specialist," Stevenson said. "The clinic takes care of kids through the first three to five years of life and through the early school years, so we can understand what their problems are and get help for them. It's really the only clinic that's focused on an integrated approach to development and behavior, engaging expertise from other specialists, such as neurologists and psychologists."
Long-term evaluation is especially crucial for babies prematurely born at 24 weeks. "About 60 percent of kids born at that age survive," Stevenson noted, "but about half of them are going to have some developmental problem – usually a learning problem. They need follow-up so they can get early intervention that maximizes their learning abilities."
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