Technology in the Neonatal Ward: Bringing Mortality Rates Down
More pre-term infants are surviving than in decades past – both in the United States and around the world. This is thanks to cutting edge technology and research and also to a form of care that’s as old as humanity. The neonatal ward attempts to simulate the natural environment, using machines to do some of the work of lungs and other vital organs until they’ve matured to the point where they function normally. This is a combined effort of physicians, respiratory therapists and other allied health professionals, and engineers.
Incubators have multiple purposes. They keep babies warm until they have sufficient body fat and mass to maintain a constant temperature. They also prevent infection and house a variety of equipment.
Incubators – and the equipment that goes inside – are designed by engineers. They’ve been around in some form for well over a hundred years. It’s not difficult to design a basic incubator, but it can be difficult to solve some issues. One is portability. Often pre-term babies are not born in large hospitals with neonatal wards. Instead, they’re born in small towns – or even at home. This is a big issue in the United States, but an even larger issue in developing countries. Recent innovations for use in rural or impoverished communities have included an incubator that could be strapped to the back like a giant backpack and one that used automotive parts (and thus could be maintained and repaired more easily).
Biomedical engineers have very specialized training that allows them to solve medical problems, from needs analysis to maintenance. Engineers from other disciplines also sometimes work on medical equipment that is mechanical and not actually attached to or inserted in the body. It’s partly the official curriculum and partly the extras like biomedical internships and senior or graduate projects that help an engineer find a niche.
Repairing and calibrating equipment, meanwhile, is the job of the biomedical technician. Technicians who repair very sensitive high tech equipment usually have bachelor’s degrees.
One of the biggest challenges is immaturity of the respiratory system. Premature babies are prone to apnea. Even babies that are mostly successful at breathing on their own may not be ready to coordinate breathing and feeding at the same time. There are different levels of breathing support from standard ventilators down to nasal cannula; the latter allows a baby to do much of the breathing on her own. Modern ventilators are often computerized and may combine physiologic monitoring with respiration. A separate blood gas machine analyzes blood to make sure the oxygen is right.
Respiratory therapists monitor babies’ breathing – and the equipment that helps them – both in the neonatal ward and in transit from the local hospital to the larger regional medical center. Neonatal respiratory therapists may hold the Neonatal-Pediatric Specialist (NPS) credential as well as the more basic ones. Other staff members who work in the neonatal ward are also trained in neonatal resuscitation.
In most cases, issues are resolved before infants leave the ward. In some cases, though, it’s not possible. Babies must leave with equipment that supports breathing and alerts caregivers when there’s a problem – another challenge for engineers.
Combining High Tech with Quality Care
21st century technology, though seemingly miraculous at times, has its limits. It can’t ensure survival and it can’t accurately recreate the conditions that promote normal emotional and cognitive development. In fact, an overly mechanistic and sterile environment can do more harm than good—when not absolutely necessary. In recent years, the neonatal team has again invited parents in. Many NICUs encourage kangaroo care, or skin to skin contact with a parent, at least after an initial stabilization period. Understanding old-fashioned care and how it works in a medical context is the realm of doctorate trained candidates from a number of fields: medicine, nursing, and the social sciences.