Program Improves Outcomes for Region’s Tiniest Babies

The Lehigh Valley’s tiniest newborns require the highest level of intensive care, and they don’t have to travel far to receive it. The Small Baby Program at the Level IV neonatal intensive care unit (NICU) at Lehigh Valley Reilly Children’s Hospital resuscitates and cares for babies born at 23, 24 and 25 weeks gestation.

“Twenty-three through 25 [weeks] is that window where you’re at the limits of viability. The babies are very fragile, and the care required is extremely comprehensive and delicate,” explains Omer Choudry, MD, neonatologist and Director of the Small Baby Program.

The primary goal of treatment is to increase the chance of survival and reduce the likelihood of complications, which may include intraventricular hemorrhage – or brain bleeds – and lung damage.

The Small Baby Program, established in 2020, focuses its care on replicating the uterus’ favorable conditions. This includes keeping the baby in an Isolette® bed that controls temperature and humidity. The care team minimizes stress on the infant by carefully timing disruptions and necessary procedures. Babies are placed on a high-frequency JET ventilator and initially obtain their nutrition using total parenteral nutrition (TPN) through a central intravenous line.

“Their lungs are very immature and fragile. With the newer, gentler jet ventilator, we try to minimize damage,” Dr. Choudry says. “In addition to TPN, we start feeds at a very tiny volume and then slowly increase them, with the intention of stopping IV nutrition between one to two weeks of life.”

The preemies’ treatment also includes “kangaroo care,” where moms are encouraged to have skin-to-skin contact once daily and provide pumped breast milk.

“The smell and touch of and interaction with the mother reduces mortality and the risk for complications, improving outcomes dramatically,” Dr. Choudry explains.

While each baby is cared for on a case-by-case basis, the treatment goal for discharge is typically around the baby’s due date.

“Our goal is to keep the hospital stay as short as possible and minimize complications so that the child can have a healthy, bright future. Our meticulous care of these tiniest humans aims to decrease the need for repeated childhood hospitalizations and rehab care,” he says

The multidisciplinary NICU team at Lehigh Valley Reilly Children’s Hospital is committed to learning about new technology, research, equipment and protocols in the evolving field.

“We’ve been through rigorous training and are always attending conferences to bring back new information,” Dr. Choudry says, adding that the effort to reduce complications in neonates and standardization of care includes participation in the Vermont Oxford Network, a national collaborative.

“We’re continuing to tailor the program to what the most recent literature shows and what major institutions are doing,” he adds. “We’re very excited about the program. It really is a one-of-a-kind program in this region.”