Neonatal Response team


NICU_2K16-0174_PVK_4669 Dr. Karen Johnson - photo by Paul Vincent Kuntz

The Neonatal Response team has been a part of Texas Children’s long before I started here. We use to respond to St Luke’s for deliveries. After the Pavilion for Women opened in 2012, we began to respond to our own deliveries.

The team is made up of numerous professionals, including neonatologists, specially trained neonatal intensive care unit (NICU) registered nurses (RNs), respiratory therapists and often others. Our team is paged to all preterm deliveries (babies born before 36 weeks). Additionally, the Neonatal Response team is present at all deliveries of babies who have birth defects that require the baby to be admitted to the NICU, as well as for unexpected emergencies that occur just prior to delivery. Our team does everything to stabilize the baby, including assigning Apgar scores after delivery. This could include supporting the baby with a variety of tools for oxygen delivery, IV access and medications. We then transport many of these babies to the NICU or cardiovascular intensive care unit (CVICU).

One of our team’s general duties is to follow the labor and delivery “grease board” to see who is currently in labor. The board shows advancement of labor, as well as gestation, so we immediately know which deliveries are premature, and therefore which babies will need to be admitted to the NICU. We also track and attend deliveries of babies with known birth defects who will need to be cared for in the NICU. Additionally, we monitor babies diagnosed with heart defects who will need special care in either the NICU or CVICU, as well as those who need to go directly to the cardiac cath lab for a procedure. We are also called to about half of deliveries for healthy laboring mothers due to emergencies that occur close to delivery. In addition, we attend a huddle two times per day with the leadership team of women’s services where pending deliveries are discussed. We have timely communication between labor and delivery and triage when emergencies show up unexpectedly. When we are paged the team is positioned around the bed. We work so well together as a team crossing traditional role designations to get the work done. The goal is rapid stabilization. The RN on the team gives added support to the neonatologist and respiratory therapist. We are an advanced care team that helps the baby with whatever he/she needs. Oftentimes, when we are present during the birth of a baby who had an emergency prior to delivery, the baby does very well and can stay with their mother. Most of the time we are there simply as a precaution. However, in some situations, these babies don't transition well and need escalation of care to the NICU. Our team works very closely with the Fetal Center team as many of the babies they follow are diagnosed with conditions that need NICU care. Some examples include congenital diaphragmatic hernia, gastroschesis, omphalocele, spina bifida, renal anomalies, neurological anomalies, respiratory emergencies and a variety of heart conditions. Many hospitals do not have Neonatal Response teams available 24/7, and may only have a neonatologist on call. Unfortunately, circumstances during a delivery can change so quickly and seconds count! I am proud I work in a place that can get a baby delivered so fast in an emergency and our Neonatal Response team can stabilize the baby. I am most excited when we can place a baby back into their mom’s arms because he/she is fine. Someone once told me a family's feelings about Texas Children’s begins the minute they walk into the lobby, and these early interactions set the tone for their entire stay. Our team helps to set that tone for a family’s NICU stay and it starts the minute our team walks into their delivery room. We talk to the families as we go through the resuscitation so they understand what is happening. Not only does our team do the technical stabilization of a baby, we also try hard to make the personal experience special to the family as well. We go out of our way to make sure mothers and fathers hold their infant prior to departure to the NICU or CVICU, and we take their first family photos so their delivery experience is as normal as possible. Many families are surprised when we provide this service. These photos, and the experience of holding their baby, helps to make families happy in what can be an otherwise scary and intimidating situation. We give the mothers a "first moments" card which has their baby's birth details (date, time, weight, length), name, first foot prints, rounding information, bed space and phone numbers to the ICU their baby is going to. This card stays with mom so she has something to hold on to as we leave to take her precious baby to the place where they will receive the care and treatment they need. Fathers or significant others always travel with us to take the baby to their destination. This is special work and it takes special people to do it. I am so honored to be a part of this highly specialized team.