This article was written by Neonatologist Dr. Shawn Ahlfeld. He sees patients at Cincinnati Children’s Hospital Medical Center and the Level III NICU at St. Elizabeth Edgewood.
Q: What does a neonatologist do? When should people seek help from a neonatology specialist?
A: A neonatologist specializes in infant lung injury and ventilatory management, a process where we use a mechanical ventilator to ensure patients receive the right level of oxygen and ventilation support. We focus on preventing and managing bronchopulmonary dysplasia, a lung disease that develops in preterm infants.
Neonatologists are trained to provide specialized care for infants, and our work with these babies is very rewarding. The fact that such a tiny, fragile, vulnerable infant can survive and thrive remains amazing.
Typically, our care is focused on the first 28 days of age. However, we care for premature babies as young as 22 weeks gestational age — that’s 18 weeks premature — and 400-500 grams. That’s sometimes less than a pound or roughly the weight of a loaf of bread. Amazingly, most of our babies, even when they are born 10-15 weeks early, do very well. I am often bewildered by their resilience.
Our patients usually come to us immediately or soon after birth. Sometimes, we suspect the patient may have problems based on prenatal imaging or care. Other times, babies are born with unexpected complications. Thus, some families know we will be caring for their babies before they are born, while it’s unexpected for others. Regardless, we are here to help.
Most of our expertise lies in caring for complications related to prematurity. However, we also care for many full-term infants who are ill with congenital abnormalities, infections and breathing difficulties. I was drawn to neonatology because the care we provide requires a large breadth of expertise. We provide care for every organ system, but we focus primarily on breathing support and fluid/nutrition supplementation and growth, including the development of oral feeding. We also concentrate on the prevention and recognition of infectious complications, as well as neurological and developmental support.
Q: What’s something surprising about neonatology that people might not know?
A: The babies do most of the work! A lot of my job is focused on supporting a baby’s natural development, and I only intervene when necessary. Importantly, we learn to be on constant alert for subtle signs of complications, such as poor growth, infections and unknown congenital malformations that become apparent soon after birth. If we see those things, we intervene as quickly as possible.
However, much of what we do is monitoring to ensure that natural development continues as expected. Whenever we do have to intervene, we try to do so in the gentlest and least invasive way possible to continue to preserve development.
Q: What is St. Elizabeth doing in neonatology that is innovative, unique, or leading edge?
A: Babies born extremely preterm (before 30 weeks or more than 10 weeks early) are at risk of developing chronic lung problems associated with a condition known as bronchopulmonary dysplasia. Once a baby is born prematurely, their lungs are forced to begin supporting the body at a time when they are still very underdeveloped.
Life outside the womb exposes babies to conditions that could injure their still-developing lungs. Those conditions include higher oxygen concentration, a need for ventilators, breathing air instead of fluid and susceptibility to bacterial infections. The lung can repair itself after injury, but it never seems to fully recover. Much research has been focused on trying to avoid lung injury and optimally support normal lung development.
The Level III Neonatal Intensive Care Unit (NICU) at St. Elizabeth has partnered with Cincinnati Children’s Hospital Medical Center to provide the very best in respiratory care. A special team of doctors, practitioners, nurses, respiratory therapists, pharmacists, and even parents from around Cincinnati has been assembled to develop a bundle of care strategies to best support preterm babies as their vulnerable lungs grow.
When possible, we avoid placing babies on ventilators to protect their lungs. Babies may need surfactant, a natural substance made by the lungs to keep them open and full of air. Preterm babies don’t make enough surfactant. In these cases, we use a thin tube to deliver it to the lung without needing a ventilator. When ventilators are necessary, we use the gentlest possible settings and minimize the time on the ventilator.
Most importantly, studies have shown that supporting the growing lung with continuous positive pressure via a CPAP mask on the nose can help the lung grow in size and function. We are constantly working as a team to implement cutting-edge strategies that will continue to improve our babies’ outcomes, and St. Elizabeth has enjoyed a very low rate of chronic lung disease. Similar programs are in place to prevent intestinal and brain injury related to prematurity.
St. Elizabeth’s is the only hospital in the region that has invested in a Women’s Health Institute that brings together doctors from all specialties in women’s healthcare, including obstetricians and neonatologists. The goal is to develop collaborations and care strategies that will optimize the quality of care.
Infants cared for at St. Elizabeth benefit from the loving care our hospital provides, coupled with the expertise of world-renowned experts in neonatal medicine from Cincinnati Children’s and the support of the Women’s Health Institute. Together, we strive to ensure that babies and their families receive the highest quality care.
Q: What is currently on the horizon for neonatology? What changes might we expect in the next few years?
A: Neonatal care is entering an exciting phase of developmentally protective care. As advances have made survival possible at the limits of viability (down to 22 weeks gestation), it has become ever-important to ensure that we protect infants’ developing organs, especially the developing brain.
Infants have an amazing capacity for plasticity and resilience, and ongoing work has been focused on harnessing natural developmental paths to optimize outcomes. Meticulously refining and improving care, mimicking the intrauterine environment as much as possible, and avoiding injurious complications will be the hallmarks of future neonatal care.
Our work with Cincinnati Children’s and the Women’s Health Institute will be instrumental in providing the highest quality care and achieving the best outcomes for infants and their families.
Q: Does St. Elizabeth offer screenings for early detection of illness in neonatology?
A: All babies are screened by the State of Kentucky for rare metabolism disorders, congenital hearing loss and congenital heart disease. St. Elizabeth also screens many premature babies for eye and brain development problems.
Q: From your perspective as a neonatologist, what should people be aware of to prevent disease or catch it early?
A: Prematurity is still a major cause of mortality and long-term health problems. It is important that women are as healthy as possible before, during and after pregnancy. Smoking, obesity and high blood pressure are some of the more preventable health problems that can impact preterm birth. Finally, waiting the appropriate amount of time to get pregnant again after delivery (at least 12 to 18 months) can help prevent pregnancy complications.