In celebration of our Neonatologists
As we conclude the last week of prematurity month we felt it appropriate to celebrate the leaders of the NICU team. The specialized doctors who ultimately carry the huge burden of responsibility for these little lives and are at the forefront of some of the most difficult decision making moments. Our Neonatologists.
Deciding to pursue a medical career as a Neonatologist is a very serious decision, as this specialty works with the most complex and critical care situations dealing with paediatrics.
The educational path to becoming a Neonatologist involves rigorous curriculum and intense training in paediatrics and additional training in neonatology prior to practicing.
Babies born prematurely, who may have developmental risks as a result, are placed into the care of a Neonatologist.
Having a baby is a life-changing event, and for most new parents, it’s a happy event. However, for some families, this moment is life changing because of unforeseen complications during labour and delivery, from preterm birth to congenital malformations. Families may suddenly find themselves working with a team of neonatal specialists caring for their newborn in a neonatal intensive care unit, or NICU. NICU teams work with infants born anywhere from 23 week’s gestation (micro- preemies) who are born more than 4 months ahead of schedule) to full-term babies born with complications that need immediate, short or long-term attention.
We spoke with some of Cape Town’s top Neonatologists, Dr. Alida Nel & Dr. Quanitah Keraan from Netcare’s Chris Barnard Memorial Hospital. Dr. Ricky Dippenaar from Netcare Blaawberg & N1 City hospital and Dr. Gertijie Rossouw from Cape Gate Mediclinic.
They gave us an overview of the life of a Neonatologist and what goes on in a NICU.
Babies who are below 1 kg (micro preemies), make up 0.5 percent of all births, per year in the
NICU. The highest risk for developmental delays and complications can occur in this group of premature infants. Babies who are born with acute illness, respiratory problems, babies with total lung or total heart failure, cardiac surgery cases, abdominal surgery cases, neurosurgery, orthopaedic surgery these are other examples of the types of complications they face.
According to Dr. Nel, the goal is to provide intact care resulting in lower risk of morbidity (disabilities and long term illness) and mortality (death). There is a lot of worldwide research, conducted in Neonatal units with a qualified Neonatologist, looking at best practice and care for babies born prematurely. One common aspect across all the top NICU units is continuity of care under specialized Neonatologists who are present and ‘on the floor’. This allows you to get to ‘know’ and understand your prems, giving them space to grow and develop at their own pace. According to the Neonatologists we interviewed, intervention should be minimal and should follow the babies lead.
According to Dr. Nel, nutrition should allow the baby to grow slow and steady and the baby should not be rushed to discharge. A recent study at a large American Neonatal unit, showed that longer hospital stays in preterm infants allowing proper establishment of feeds and adequate growth resulted in better long term outcomes and less medical intervention post discharge.
Ninety-five percent of the time labour and delivery goes well but there is always potential for something to go wrong. The rare and unusual becomes common for these Neonatologists.
In the Delivery Room
As neonatal specialists they need to think about how to speak to families. It’s complex. It can be overwhelming. They need to convey complex information to people who may or may not have a biology background, parents have no idea what these specialists are talking about, and they’re scared. To be in this field, you need to be comfortable with high-risk situations. Its tension / release, tension / release. They are doing something that changes the course of a life. It’s that dramatic. Those few minutes, those few moments set the tone for that tiny person’s entire life.
In the delivery room, it’s a combination of all the wonderful things about having a child, a family is growing, and there’s a lot of blood and people crying and it’s totally unpredictable until it’s done. It’s concentrated excitement. The decisions the Neonatologist makes, what needs to happen now, in the next five hours, in the next five weeks all need to happen quickly and be communicated to the family. If the family understand how and why things are happening, they’re better involved and less panicked.
These doctors can do so much to alter the course of a life in such a short time. That whole concept is so fascinating. Most preemie deliveries are perfectly fine it’s just that they’re just here too soon. A preemie is a splendid example of human biology. They get to hold a whole person in the palm of their hands. With good nutrition and care, 450g babies grow, and at 2-3 kg’s are sent home. It’s exciting, and they have impacted that life. A wonderful feeling of accomplishment.
So what is a typical day like for our Neonatologists? According to Dr. Rossouw – He would say there is not a typical day! Each day is filled with multiple challenges and opportunities including very high ups and really low downs.
At any given time our Neonatologists may be caring for between 5 and 20 intensive care patients and their families. There are babies who may have been 450g at birth, who are very sick, requiring lots of medications, respiratory support and procedures and those who are now older and maturing to develop their suck and swallow reflex to eat successfully so that they can go home. There are other babies who may have only been 1 or 2 months early and are 1,5-2kg’s who have not been very sick but still remain in the NICU waiting to get “big” enough to eat and to go home. And sadly, there are also babies who are so sick that nothing you do is going to work and they force you to realize that ultimately we are not in control.
In the delivery room, according to Dr. Rossouw, the Neonatologist will be assessing breathing, color, heart rate, tone and making sure the baby is warm. They may be placing a breathing tube if they need to and with the assistance of their neonatal sisters making sure the baby has adequate oxygen. In the midst of the delivery and the resuscitation, they may also be trying to make sure that Father’s and Mother’s questions and concerns are addressed…particularly because in this moment nothing that they are doing was part of the birth plan or the wish for this pregnancy.
Dr. Nel from Netcare’s Chris Barnard Memorial hospital sums up the concept behind Neonatology:
New-born babies are not just small children. A medical problem can mean a special challenge. Sometimes babies are born before their bodies are ready to leave the womb. Important organs such as the heart, lungs, stomach, and skin may not be mature enough to function without special help.
Neonatologists have the special training required to evaluate and treat new-borns’ medical problems. In addition, Neonatologists use equipment that is designed specifically for the tiniest patients.
If your Paediatrician suggests that your baby needs to be evaluated by a Neonatologist, you can be assured that your child will receive the best possible medical care.
And to conclude, Dr. Keraan and Dr. Dippenaar gave us some very real and insightful answers to some personal questions.
Why did you choose to become a Neonatologist?
Dr. Keraan from Netcare’s Chris Barnard Memorial Hospital responds:
“I was fortunate enough to work with amazing, passionate Neonatologists when I was a junior doctor. I realized that with the proper care, these vulnerable new-borns could do extremely well, often in a very short period of time. This inspired me, as I felt that I could make a real difference, even in a tiny life.”
Dr. Ricky Dippenaar from Netcare Blaawberg and N1 City Hospital said:
“I see neonatology as a Hands on speciality – hands on with parents and hands on with the baby.” says Dr. Dippenaar. He draws a parallel between a conductor of an orchestra and a Neonatologist. The Neonatologist ‘conducts’ the neonatal team this includes other doctors and specialists, the parents, the tiny patient to the NICU nurses and even the cleaning staff. It’s a delicate balance daily to create an environment that closely mimics the womb to give these tiny patients the best chance to grow and thrive. “And when they grow …” He says “….it is the result of a beautiful symphony”!
Dr. Dippenaar loves the idea that neonatology is one of the few (if not only) specialities that allows you to be involved at a micro and macro level in every “body system” of the child. It involves the lungs, heart, brain, digestive system, bones etc. and everything you do impacts all aspects forever. He goes so far as to say he sees prematurity fundamentally as a ‘ nutritional emergency’.
What are the least and most rewarding aspects of your work?
“The least rewarding I suppose are the long, unpredictable hours. Also the grief that comes with the loss of a neonate in your care and breaking the news to parents. It doesn’t get easier with time.”
“The highlight for me is the day the infant is discharged. I just love that. One of the best parts are seeing the joy on parents faces when they are able to touch or hold their little ones.”
For Dr. Dippenaar the Low lights are often the highlights… He explains further:
“Sitting with a premmie that is so complicated with a poor prognosis you quickly realize that you are only as good as your most complicated patient. This is both humbling and daunting but when a really sick baby pulls through there is a great sense of accomplishment and feeling of ‘together we can all do this!”
What are the most important skills and abilities required (in your opinion)?
Dr. Keraan responds to this question by highlighting that “All Neonatologists have to have strong technical skills to perform procedures required to treat sick or premature infants.” She felt very strongly that “Attention to detail is also very important- small things make a big difference in sick infants.” She also believes that the ability to work within a team and good communication skills are also required, “as nurses, ophthalmologists, dieticians and allied health professionals all play a vital role in optimal care. And lastly to remain empathetic to parents who have never envisaged having an ill or prem infant.”
Being a mom to three beautiful children herself, Dr. Keraan understands the importance of empathy when communicating with a parent of a sick baby.
Dr. Dippenaar agrees and added that he feels a Neonatologist needs to border on ‘Obsessive Compulsive’ and be an absolute perfectionist. He says it is a profession where you dedicate your entire life to your speciality and it’s all consuming.
We celebrate all these amazing doctors and the ongoing tireless work they do for the tiniest patients on the planet.
Thank you x