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Making a Difference

Neuro-NICU at Phoenix Children's Hospital treats neonates with conditions affecting the brain and spinal cord.

When Kimberlee Allred, RN, NNP-BC, saw one of her former patients running, talking and playing, it confirmed what she already knew in her heart; the Neuro-Neonatal Intensive Care Unit (neuro-NICU) at Phoenix Children's Hospital (PCH) was making a difference. PCH is one of only two such NICUs in the country - the other is at the University of California, San Francisco (UCSF) - that treat the most complex conditions of the brain and spinal cord.

COOL CARE: Macie Cloe Reynolds was the first newborn to be treated with the first-of-its-kind cooling therapy at Phoenix Children's Hospital. courtesy Phoenix Children's Hospital

Hypothermia Therapy

Nurses in the neuro-NICU use hypothermia therapies to treat newborns who experience a lack of oxygen before or during birth, a condition known as hypoxic ischemic encephalopathy (HIE). According to Allred, who serves as the hospital's NICU coordinator, 41 recipients of the first-of-a-kind therapy recently had a reunion. "We are now up to 41 babies who have been cooled in the approximately 20 months since we've been doing this," Allred said. "To see these children - the oldest at 18 months was walking, talking and running around - was highly gratifying. Under other circumstances, where these babies would not be treated with the cooling therapy, there could be devastating results such as cerebral palsy - and they would maybe not be walking or talking."

In addition to cerebral palsy, HIE can result in other disabilities such as dyslexia or even death. The therapy system works by cooling the infant's brain, while the rest of the body remains 3 degrees below normal body temperature. It includes a helmet-like shell that is placed over the baby's head and tubes that circulate cold water though the cap. Whole-body cooling has the same effect as the cap therapy, but allows physicians to conduct brain studies such as MRIs and EEGs while cooling is taking place. "Research is another important piece of a neuro-NICU," added Cristina Carballo, MD, medical director of the new unit. "We'll be looking into issues specifically related to babies who are neurologically affected such as with swallowing difficulties, MRI perfusion studies of babies while being cooled and after cooling, neonatal seizure protocols and neonatal meningitis."

'A Virtual Unit'

Instead of a physical space apart from the other neonates, Allred explained the babies with neurological problems are among the population of other babies. "We have formed a virtual unit that is the neuro-NICU," Allred said. "We don't assign bed spaces, and we still have an open NICU. Neuro beds could be any of the beds here at the facility, so it is all contained within the NICU."

Christine Bure, RN, clinical supervisor at PCH, added there is no specific cadre of nurses referred to as the neuro-NICU group. Instead, each nurse is thoroughly trained within his or her core group, and receives annual updates along with all appropriate educational sessions.

Both Bure and Allred acknowledge the neurological status of infants is still relatively unknown territory, and these unknowns contribute to the challenges for nurses and physicians. "There have been many things tried, but I think what we have here is state-of-the-art and up-and-coming," Allred said. "I would not be surprised to see more facilities incorporating neuro-NICUs, but it is definitely on the new side, and at the forefront of neonatology."

Fortunately, the hypothermic therapy equipment is now out there for NICU officials to purchase. However, Allred believes that any such program should start with a holistic and/or "big-team" approach. "Other facilities don't always have neuro radiologists - pediatric neuro radiologists, EEG capabilities and the dedicated medical team and a nursing team," Allred added. "Before the babies go home, we establish a follow-up program, so they are followed up as outpatients and get physical therapy, occupational therapy and speech therapy. Any place can buy this equipment and do the cooling, but it's the whole program that really makes a neuro-NICU."

Making a Difference

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