The Newborn Center: Looking back

In the summer of 1974, Texas Children’s Hospital was a small subsidiary of St. Luke’s/Texas Heart Institute – home of Dr. Denton Cooley’s renowned cardiovascular surgery program. However, a pediatric giant was about to stir. Specialists in the (then) small Baylor Department of Pediatrics were exploring new frontiers in the care of infants and children.

The growth of pediatric cardiac services under Dr. Dan McNamara, in conjunction with the surgical expertise of Dr. Cooley, produced a new program in Houston offering diagnosis and treatment of severe congenital cardiac malformations. At this same time, Drs. Arnold J. Rudolph and Murdina Desmond, Baylor faculty members and research pioneers in newborn physiology, relocated their activities to Texas Children’s.   

These new programs created a need for specialized facilities to care for critically ill babies and infants. At that time, Houston’s only neonatal intensive care unit (NICU)  was at the Harris County Jefferson Davis Hospital. In 1974, as a postdoctoral fellow in the emerging field of neonatology, I came to Texas Children’s and worked with Dr. Rudolph to establish the first four NICU beds in the original Abercrombie building. I subsequently joined the Baylor faculty and became medical director of the NICU. Serving in that role for more than 30 years, I had a ringside seat to the remarkable growth of the Newborn Center – from humble beginnings to 170 beds in three campus buildings.

Each phase of new construction added increasingly sophisticated techniques for neonatal critical care. Some advancements include the addition of individual control of noise and light networked monitoring systems, remote transmission of electroencephalogram (EEG) and ultrasound studies for immediate review. Of critical importance was the inclusion of family support facilities such as the on-site Ronald McDonald House adjacent to the NICU and the single patient NICU rooms in the new Pavilion for Women.

New clinical programs developed rapidly. In 1978, the Neonatal Transport Team was inaugurated, followed in 1980 by the first Baylor/Texas Children’s Neonatal Nurse Practitioner class – one of the first of its kind in the United States. Specialized two bed stabilization rooms were built in the adjacent St. Luke’s delivery suite to provide immediate NICU care to a growing population of inborn premature infants. A multidisciplinary program was developed to perform certain emergency surgical procedures at the bedside in the NICU. This provided comparable pain management, intraoperative care and postoperative recovery procedures to those used in traditional operating rooms. The Neonatal extracorporeal membrane oxygenation (ECMO) program was added in 1990. Outcomes analysis of clinical care began with manual collection of patient data in 1976 and progressed to increasingly sophisticated program support, such as membership in the Vermont-Oxford network.

Growth of these facilities and programs was accompanied by cutting-edge research. Baylor faculty members in the Newborn Center were primary investigators in the original controlled clinical trials of surfactant replacement therapy and inhaled nitric oxide. Both became mainstays in treatment of newborn respiratory disorders. Basic research into mechanisms of lung injury continues in the pulmonary biology laboratory today. Newborn Center studies of the use and supplementation of human milk and neonatal calcium metabolism have led to important advances in nutritional management of premature infants. This clinical research led to the establishment of the human milk bank.

Education has always played an integral component of Newborn Center operations. Since 1973, more than 200 postdoctoral fellows have been trained in the Newborn Center. These graduates have had major impacts on perinatal care internationally. Since 1980, the Baylor neonatology section has provided an annual introductory summer program for new faculty, fellows, nurse practitioners and other nursery personnel. This is combined with a defined educational curriculum presented throughout the year as weekly conferences. Evidence-based support for clinical care is provided by a book of guidelines for management of common neonatal disorders, which is updated and published annually.

The Newborn Center has been recognized throughout its history as one of the nation’s top ranked facilities for delivery of family friendly, evidence-based patient care. Thanks to the planning, skill and hard work Texas Children’s swill continue on the cutting edge of international perinatal medicine.