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[Music up and under]
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Host: Hello and welcome to this edition of Doc Talk. Today, we're talking with Dr. Hevil Shaw and Samantha Corkum from our small baby unit in our NICU.
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Hevil Shah: (singing) Small baby
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Host: Caring for tiny, micro preemies and medically fragile newborns means having the ability to provide the highest level of care available for our tiniest patients. The outlook for the littlest of patients has come a long way. For babies born before 28 weeks and those born full term, but with serious complications, the specialized care that's provided in the small baby unit adds an extra level of care that can help boost the outcomes, both short- and long-term, giving these babies a fighting chance for a bright future. We'll find out how in just a moment. But first, a little about our guests.
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Host: Dr. Hevil Shaw is a board certified neonatologist within our division of neonatology. He has been a part of Cook Children's family since 2019. He earned his medical degree from the Medical College of Georgia and completed his pediatrics residency at Arkansas Children's Hospital, followed by a neonatal-perinatal fellowship at Nationwide Children's Hospital. A perpetual student, he also has his master's degree in public health and bioethics. While he enjoys taking care of babies of all ages, he has a special fondness for taking care of and improving the health of our smallest and most premature infants.
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Samantha Corkum is a registered nurse who has worked in the Cook Children's NICU since she graduated from nursing school. She obtained her BSN from University of Texas at Arlington, and her master's degree in nursing leadership and administration from Texas Tech University and joined the neonatology unit in 2010. She currently serves as the neonatal program coordinator, where she oversees all quality and accreditation efforts within our 106 bed level four NICU. A little side note about Samantha, she cannot be trusted alone in a pet store or animal shelter. She left home one day to purchase new school clothes for her daughter and returned with a very expensive, very fluffy, very adorable Bernese Mountain Dog puppy … and no school clothes.
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Both Dr. Shaw and Samantha are heavily involved in improving the quality of care and outcomes for our extremely premature infants through their collaboration with the Children's Hospital Neonatal Consortium and the Vermont Oxford Network. Welcome, and thanks for being here to talk about care for our tiniest patients.
00:02:32
Hevil Shah: Oh, thank you very much for having us.
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Samantha Corkum: Yeah, thank you for having us. We love talking about our small baby unit.
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Host: Many preemies and babies in the NICU are already small or tiny. So why the need for a specialized small baby program inside the NICU?
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Hevil Shah: Like you said earlier, like in the NICU, we can take care of a lot of critically ill babies, but the small baby population just has such unique needs compared to the more term or congenital heart babies, some of the bigger kids we got to look into their development, their skin care, their feeding intolerance versus intolerance. I mean, there's just such specialized nuances that we have to keep in mind, and that's where I think the small baby program kind of helps tailor that where the variations care is not driven by the docs or the nurses. It's really driven by the patient. And we can tweak what we need to … to drive and help the patient out, while standardizing everything else.
00:03:24
Samantha Corkum: So we've always cared for these babies down to 22 weeks gestation. So this isn't something new for us. However, our unit, as previously stated, is very large, and so previously our small babies were kind of scattered throughout our unit, just placed into whatever bed was available. We have five sub-units, so they could really be anywhere. So we figured that cohorting them just kind of brings awareness. As soon as you walk into that corner of our unit, you know that that is small baby land, and it's just kind of a visual indicator of, "I need to bring my voices down. I need to keep the lights low. Lend a helping hand." I have personally witnessed whenever we admit a new small baby, just the teamwork. Everybody knows that this is a very critical, very fragile baby, and so it's just really kind of helped enhance the care of these babies.
00:04:06
Hevil Shah: It really is a great start … will lead to better outcomes. So we're trying to do our best to give these kids a really good start to life, to have them have great outcomes as they keep growing.
00:04:15
Host: What are some of the unique challenges in caring for extremely low birth weight babies?
00:04:20
Samantha Corkum: So these babies, of course, are born at the edge of viability, down to 22 weeks gestation. Their lungs are very underdeveloped. We offer all forms of high frequency ventilatory support. So we have very, very gentle, high frequency ventilators that we offer these babies. Their skin is really like one of their biggest concerns. It's very, very paper thin. Their immune systems just aren't quite ready for the outside world.
00:04:43
Hevil Shah: I agree. I mean, it's a lot of it is just the in-utero physiology we got to bring out ex-utero. And so it's a lot of fragility everywhere there. You know, the blood vessels and their brains are fragile. Their gut is fragile. The skin is very fragile. Their lungs are fragile. And so, like, it really is kind of hammering down to what these babies need. At that moment in their physiology, and like Sam is saying, like, we have a lot of the tools available here to help with that.
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Host: What about long term risk for these babies? What role does small baby care play in reducing developmental challenges in the future?
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Hevil Shah: I think it's … it's twofold. One is the understanding on our end of the physiology, like a small baby is not a baby born at 40 weeks. There are a lot of complications and a lot of growing that needs to happen to get them to a term age. For us, really is to kind of mimic the in utero environment as best as we can. You know, we don't have the artificial womb or artificial placenta yet. I think that technology is in the works. Maybe in our lifetime, it'll happen, but right now we have to do our best to mimic the in utero environment. And so I think the biggest challenges is, kind of, how do we do that? So limiting pain, limiting stressors, like, you know, limiting lab draws, doing cares all kind of at the same time, but limiting the care time so it's not, you know, not everyone's going into the bed at various times and interrupting this child's ability to just grow. And I think in really stressing the neurodevelopment by engaging families, you know, having a quiet environment, I think all of that those challenges we have to keep in mind to give them the best outcomes.
00:06:10
Samantha Corkum: One of the unique things about our unit is that we have dedicated respiratory therapists, physical therapists, occupational therapists, speech therapists, they're all dedicated to our NICU. We don't share them with the rest of the hospital. And so the way that we teach our staff is, with these babies that are at the edge of viability, every time you touch them, you're essentially touching their brain. You're leaving fingerprints on their brain. And so our therapy services really kind of drive the care in this small baby unit, and they're really an integral part of our team and how we care for these babies. And so one of the things that we do is what's called four handed care. So every time we go in the isolette, it's actually two providers going in there, and one provider's job is simply just to maintain two hands on the baby, to maintain stability and to keep that baby in a physiologically stable state, while the other provider is actually doing the interventions that have to happen for this baby.
00:07:02
Hevil Shah: And what happens is like, as the nursing staff and the RTs are doing their care, we kind of come in at the same time, so that all care is happening kind of all at once, our daily exams, their care, so that, again, to kind of allow these brains to grow and just limit the interruptions and the stimulus as much as possible.
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Host: Take us through your process of developing the small baby unit within the NICU, and what is the advantage of having it all together?
00:07:27
Hevil Shah: So this is kind of how we met five years ago now, like pre-pandemic, and right after I joined the group, I started talking to Sam about quality work. And one of the things we had talked about was, from my fellowship, we had a small baby unit. And I was like, I've noticed we have a lot of small babies, but we don't have a dedicated unit. And so that kind of really started the talks of, "Hey, how can we make this happen?" Now, the pandemic kind of, it's a pandemic. Everything kind of went wazoo with that. But one of the biggest positive points with especially in our group, now, we're about to have a little more than 45 Neos, a little more than 70 nurse practitioners.
So it's a it's a big group that's been around for more than 40 years within the community, and they've established relationships here, as well as all of our delivery hospitals. And so one of the things that they started when they first formed the group with, like, five or six, six of the NEOs when they originally started, was consistency of care, and that has led to this robust now it's online, but like booklet of guidelines that every all of us follows, again, to limit the variation. And so, because we already had the guidelines in place already, and a lot of our delivery hospitals kind of cohorted these kids into the acute admission areas, then we started talking a little bit more like, well, a lot of these babies end up coming here from West Texas. You know, East Texas further away, maybe we should start cohorting them too into a certain area. So post pandemic, we kind of started talking about this again. And then we got momentum like, "Hey, we're starting to see an increase in the number of especially the 22 to 24 week population."Just every year, we were kind of going up and up and up pretty well. And so that got us the momentum with the leadership, nursing and medical leadership, to be like, "Hey, let's start looking into this." And then Sam kind of drove the boat with a lot of the work.
00:09:04
Samantha Corkum: We're very, very fortunate here in that our executive administration, our C-suite, they believe in quality of care and they believe in moving the needle. And so they were actually very supportive in flying us out to some of the leading programs in the country, where we spent four days over the summer touring various facilities and their programs and asking the questions and walking the walk. And then we were able to bring that back to administration here and have conversations and gain buy in.
00:09:28
Hevil Shah: She's not gonna tell you this, but then, afterwards, she kind of led as a leader in quality. Like she really broke down how we're gonna do this in a streamlined fashion that we were able to hit all the major points we needed to at once and not have to worry about, hey, we forgot to do this … when we look back, we forgot to do this. So she helped lead a number of subcommittees, the medical, the nursing and the respiratory, the developmental and within each SubCom … SubCom ... the parent and family advisory committees … within each subcommittee were 10, 20 …
00:09:51
Samantha Corkum: There was about 100 multidisciplinary staff members amongst all of the subcommittees. We had amazing buy in and support and involvement in planning small baby unit. We planned it out over ... it took about 18 months from start to finish, and then about a year of intensive subcommittee meeting. We were very intentional with how we rolled this out and how we planned it.
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Host: Wow. So Cook Children's NICU is already unique in its layout, because babies are placed in individual rooms where the parents are welcome to stay. Does this include these extremely small babies? And if so, what are the advantages for both the babies and the parents?
00:10:32
Hevil Shah: Yes, even the small babies are included in the individual rooms. I think the best part about cohorting them into what we call the C unit is really a sense of community for everyone, nursing staff, families. RTs, it gives an awareness that, hey, these are our most, one of our most fragile groups of babies in the NICU within a certain area. So to limit the noise, limit the stimulus from lighting, and then have families, their neighbors, they'll be able to talk to each other when they're in the family lounge. It's a different sense of community. I feel when you're able to kind of go through the same ups and downs and same walk in having a really, extremely premature baby, versus having a baby that has just jaundice and is there for two days. And as a mom and a dad, you're sitting in the room and you see just families just keep going in and out, going in and out, and your baby's still in the NICU, and that burden of like, wow, we're never gonna go home. I think that really helped to kind of foster that community with within the unit and so no, all babies are in there.
00:11:29
Samantha Corkum: Yeah. Another benefit to our all private rooms is the fact that parents can actually sleep at the bedside. They can stay 24/7 within our rooms. A lot of NICUs are open 24/7 for parents. But sleeping at the bedside is not feasible, as they're in an open bay unit and they may only have a chair next to their baby's isolette. So we actually provide a couch that folds down into a bed and has a privacy curtain. So theoretically, mom, we provide meals for all of our moms that are pumping and providing breast milk for their babies. So theoretically, mom, parents can stay there, 24/7 and engage in cares with their baby and bond with their babies.
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Host: I was just gonna ask that question. So does ... they ... are they also able to, like, learn the skills of caring for their babies long before they go home, because they're gonna require additional ... additional care at home?
00:12:16
Hevil Shah: Yeah, no. I mean, we get the families involved pretty quickly. Once the babies are stable enough within a few days of life. Parents are engaging in kangaroo care. We're getting parents to hold moms get preference first. I you know, they gave birth, so they get preference first. But both mom and dad, we allow them to kangaroo care and then and we inch away, you know, for the first time, it may be just a small amount of time as the baby tolerates it, and then we kind of incrementally increase it as the baby gets older. And so like having, having the rooms helps for these families to do it at two in the morning or at five in the morning or five in the afternoon, and not have to worry that they have to drive in or be at home and miss out the ability to do skin-to-skin if they can't be at the bedside .
00:12:55
Samantha Corkum: And there's room too. These babies, these ones that are at the edge of viability there, they have a lot of equipment. It takes many staff members to move one of these babies onto a parent's chest for kangaroo care, and so being in a private room just allows for that space where you're not worried about, "Am I tripping over another baby's cords? Am I bumping into another mom?" Just the comfort level is paramount.
00:13:18
Host: Is there an urgency to refer these tiny babies to the small baby unit, and if so, what and why is this so critical? And are there risks for waiting too long?
00:13:29
Hevil Shah: Time is definitely critical. The literature and even our practice model is, if it's possible for the OBs and the high-risk docs to transport babies and moms antenatally, like the mother baby died, that's preference first, to get them to a high risk delivery center. The beauty of Fort Worth, as we were saying, like our group is so large that we and all the other delivery hospitals have such a great relationship. So the care provided from the guidelines standpoint, is the same, whether you're at the delivery hospital attached to us, delivery hospital across the street. The guidelines allows us to be similar care. But for those families that can't come to the high risk delivery centers, or there's an imminent delivery that's about to happen, then that's where I think if you can't transfer the mother baby diet, then get teddy bear transport involved.
A lot of times, if the teddy bear transport knows early on that a baby's about to imminently deliver, they can start their process of getting over there at or either before, right at delivery, and start, kind of again, using our guidelines and our protocols, start their first hours of care, and then bring the baby back. Especially in these ... in this population, you know, you'll hear terms called Golden Hour, which ends up being a few hours, but the term Golden Hour is key. It's kind of the same in emergency room physiology, or it's kind of like in adult medicine, when you look at men and women that have heart attacks or strokes like that, first couple of minutes are key. Couple of hours are key to provide the best treatment. It's the same way in this population where the whatever we do in the first few minutes to hours of life is key, and so to standardize it and really stabilize those babies are instrumental. And, and hat's why a lot you know, teddy bear transfers is able to help bring these kids over here. That'll be great, because they'll help maintain their temperature, minimize their oxygen needs. Again, kind of our goal is to optimize short-term outcomes, but also long-term outcomes.
00:15:14
Host: You mentioned teddy bear transport. How far away can we typically transport a baby and still stay within that golden hour?
00:15:21
Samantha Corkum: Unless the baby is coming from directly across the street, it is impossible to get the baby to us within an hour of life. However, if our teddy bear transport team is contacted in a timely manner and they are there at delivery, they can actually ... they can place lines, they can intubate, they can maintain normal thermia, they can follow all of our guidelines and get the baby packaged and settled within an hour, hour and a half, two hours, and then be on the way. So as long as the baby has had interventions done and is packed up in a nice little bow and then sent on their way, that's really ideal. We have seen ... when we look at our morbidity and mortality for this population, and we break it down by when the baby comes to our NICU, there is a stark difference in stats when it comes to overall mortality and then various morbidities. The babies that come to us sooner do better, and it's just all across the board.
00:16:13
Host: What specialized training is required for the team prior to caring for these babies?
00:16:18
Samantha Corkum: So like we were saying before, we had multiple subcommittees, and each subcommittee kind of developed what they thought were topics of interest and main teaching points. So prior to small baby unit opening, we did mandatory staff trainings, and then we also did flash trainings. We did a lot of hands on pop up trainings, where we would take an available room in our NICU and set up an isolette with a doll and a ventilator, and then allow staff to practice certain skills on these babies, with the ability to receive feedback and be in a low pressure environment. And then we would leave that open for a couple of days, so staff could kind of come and go and practice it on their own will. So small baby unit opened in October, so we're less than a year out. We've been providing a lot of feedback with staff of, hey, we've had this many cases. Here's what the outcomes look like. Here's lessons learned. So we've been constantly tweaking our guidelines, constantly rounding in the unit, taking feedback from staff of what works, what doesn't work. We do not have a dedicated small baby team. Every single nurse in our unit that is able to take high frequency ventilators, has been trained on small baby care and has taken a small baby class.
00:17:25
Hevil Shah: And it's similar to the physicians or the nurse practitioners as well. I mean, we give constant feedback of kind of the outcomes that is already happening since the small baby unit rolled out in October of 24, and we come about a year's time, like, so later this winter, we're going to do, like, a massive review of the outcomes and what works, what doesn't work, and kind of improve on what we need to improve on, to keep improving outcomes, and kind of continuously, kind of review our data and the processes of what we need, what we don't need, and kind of go from there.
00:17:55
Host: Do you see this ever like being used in sim lab as well for training?
00:18:00
Hevil Shah: Yeah, for sure. I mean, even for us, for designation purposes, like we, all of us, have to be involved with some sort of simulation training. And, so some of the simulations are related to small babies.
00:18:10
Host: According to the NIH, caring for extremely low birth weight babies comes with many challenges, not least of which are periviability, perinatal monitoring, resuscitation, developing and following care guidelines, plans of care, and parental wishes. So how is your team putting all this together?
00:18:31
Hevil Shah: For us, everything is very family centered and a collaborative approach. These families didn't get pregnant thinking, hey, we're going to have a 22- or 23-weeker and be like, hey, we want to be NICU parents. Guarantee you 99.9% of the people out there, this is not what they were dreaming about. And so ideally, if the time is available and our group is involved, we try to meet with them prenatally to kind of tell them kind of what to expect, not only in the delivery room, but also short term and long term. So they're well informed of like, this isn't going to be an easy road. And if they want to do a trial of life and see how the … how their children respond, there's a lot of complications to keep in mind and offer all the you know, be upfront and offer that information to the families.
And then it's just, really, antenatally. Working with the OBs and the MFMs and with us and the nursing staff to just make sure it's the right environment for these moms to be able to deliver in the right time.
And like I said, if we are far away at a delivery center that really doesn't deal with these high-risk deliveries, and they're gonna deliver, then it's best to call Teddy Bear Transport, get the Cook Children's transport team out there to kind of help with the resuscitation and stabilization. And then, as you mentioned, it's the protocols. I mean, I think for us, we've had such good outcomes with our protocols that followed really evidence-based guidelines. And this is such a hot topic right now in the entire country, as more and more institutions and big level-four hospitals are trying to get towards having 22-weakers, especially the 22 week 23 week population, that's been a game changer within the field of neonatology, because those families didn't have that option, even 10, 15, years ago.
And so for those families to be able to have a family, we have to be mindful of what the data is showing and what the research is showing. And so our outcomes are improving as we're starting to really utilize a lot of the evidence that's out there, and being like, "Oh, this works. High frequency ventilatory strategies works," and that's what we have the jet ventilator here to help with that, and that's what we do, starting feeds and helping them grow works. And so once they're stable, we start feeds right away. Have provide proper nutrition. So I think that antenatally, knowing the risks going into it for these families, and then really engaging them once the baby's born, I think, has been the game changer.
00:20:34
Host: Because they're at risk of all kinds of complications, what happens if a baby has a sudden urgent need for care, who responds and how quickly?
00:20:43
Samantha Corkum: So one of the things that we're fortunate about here at Cook Children's is our staffing is … is amazing. These small babies frequently are staffed one to one, so that nurse generally just has that baby as a patient. So here, she is able to devote all of their attention to this baby. If there does happen to be a medical emergency, if it's during the daylight hours, we are full of physicians and nurse practitioners that are all over the unit. If it's after hours, we actually have two neonatologists and two neonatal nurse practitioners that are on site. So we're actually very privileged to have four licensed providers that are available, so two upstairs and two downstairs, and they get to the bedside within minutes.
00:21:22
Hevil Shah: I think that's the beauty, is there's so many people involved, and there are dedicated NICU staff involved. And so if an unfortunate event happens and they need emergency care, like people are there within seconds to minutes at the bedside.
00:21:34
Samantha Corkum: And then again, talking about our all private rooms and the space that is available if, heaven forbid, there is a medical emergency, and we have to bring in the crash cart. We have to bring in all kinds of equipment. Radiology has to come in and shoot films or echo has to come in and do a stat echo on a baby. There's room to do that without disturbing the other babies around them.
00:21:55
Host: So how long is a typical stay in the small baby unit, and do they transition to the main NICU as they progress?
00:22:02
Hevil Shah: Twenty-two to less than 28 weeks, is what we consider a small baby population. And so if a child is born at 26 weeks, and now they're 27 weeks and they're coming into Cook Children's to be admitted here, they get admitted to the small baby unit. Once you're 30 weeks post menstrual age, by that point, you're a little bit more stable to where you can transition into the main NICU. And so then we'll transition them out of the small baby unit into one of our other rooms within the entire NICU. Now, if we're at a point where we you know, there's no urgency to move them, then we're not going to move them. But if we're getting an influx of small babies coming in, we're going to transfer these babies into a different room in the unit.
00:22:37
Samantha Corkum: However, we do have our small babies that do end up having complications that keep them in the acute phase longer, and so those babies we're not going to be quick to transition into the main unit. They may still be 35, 36, 37 weeks, even term. And if they're still having complications and they're still critical, then if we don't need to have that bed space for another small baby, we may keep them there for a little bit longer.
00:23:01
Hevil Shah: The phases of care is like they'll be in the small baby unit at the most critical and once they're stabilized and they're not as critically ill and above 30 weeks post menstrual, then we can transition them into the unit with the hopes of trying to get out of the NICU and home by around due date.
00:23:17
Host: Prior to discharge home, what metrics are used to measure their readiness, and are they sent home with monitors and other additional care.
00:23:27
Hevil Shah: So if, if there are parents listening, and they've heard me say this that my spiel is usually, there's six things babies need to do to get out of the NICU. They need to pee, urinate, they need a poop or stool, they need to breathe, they need to be able to eat or be able to get nutrition in some, some sort of way. They need to be able to maintain their temperature, and they need to be able to sleep and be able to sleep comfortably. I think combining all of those six things and if they're able, if parents are able, to check that off, you're on your way to getting out of the NICU. You mean to dive in a little bit more? Yeah, I can talk about it more. Yeah.
00:23:59
Host: So once they get home …
00:24:00
Hevil Shah: Our goal would be, they go home as parent and child, and there's nothing else attached to the baby. That's, that's our ultimate goal is the baby goes home as a baby without any need for home equipment. But, if it comes around that we know their lungs are so immature and it's taking them longer to get off of respiratory equipment. You know, at Cook Children's, we have a variety of different modalities that a child can go home on. Whether that's something as simple as a nasal cannula to a tracheostomy and a ventilator to go home on. Same thing with feeding. Ideally, we want children to be able to eat everything or with a bottle or breastfeeding. But if they if they still struggle and need more time, then we can send them home with a home nasogastric tube or a G button, depending on the criteria that they meet, to help them get nutrition, and then kind of further their development at home. Because the key for all of this is, how do we improve development? How do we continue to improve development? There's things that we do in the NICU that's great, but a lot of it can also be done at home, and the home environment is even better. And so whatever we need to do to get them home safely, we're going to do that, keeping in mind the six things that they all babies need to do to get out of here.
00:25:07
Host: Is there specialized care training for the parents to continue certain types of care once they go home.
00:25:13
Samantha Corkum: We do a lot of discharge teaching with our parents, especially if they're going to go home with equipment. These babies that Dr. Shaw was just speaking about it, especially if they end up with a trach and a feeding tube, they end up transitioning out to our transitional care unit, which is a very intense, almost a boot camp. They actually have a boot camp experience for these parents, where they get them involved very, very early, and they have them practicing changing out the baby's trachs, changing out the baby's feeding responding to medical emergencies. They put them through a lot of situations, and so these parents are very well trained, and then they also end up checking off an additional caregiver as a backup. So it's a very extensive checklist process that these families go through prior to going home with their babies. If they have a lot of medical equipment at baseline, all of our families get a baby basics boot camp and then CPR training prior to going home.
00:26:03
Host: So, for both NICU and SBU babies, there may be short and long term developmental needs. What kinds of continued care will some of these little ones need in order to achieve their best life? And how is that care managed between specialists, pediatricians and of course, the parents?
00:26:17
Hevil Shah: Once these babies are discharged, the pediatrician is going to be key, as they are going to be handling with a lot of consultants just to help manage their care. So having a good pediatrician on hand that is comfortable taking care of extremely premature babies is key. After that, for us, we're fortunate that at Cook Children's we have the NEST clinic, which is the NICU follow up clinic. It's also known as the NICU graduate early supporting care transition center led by one of my partners, Dr. Johnson. She and her group have been instrumental in making sure these children are followed up closely and doing different developmental metrics to make sure that these children are on the right developmental pathway. In addition, a lot of these children will be followed up outpatient with speech therapy, occupational therapy, physical therapy, early childhood intervention gets involved, and so it's not only just a the support that Cook Children's provides, but there's a lot of hands that help to make sure that the developmental pathway that we've been able to launch them on, it continues to progress, to give them the best outcomes.
00:27:04
Host: As neonatology continues to advance, what do you think the future looks like in terms of care, from pre-birth through infancy and beyond.
00:27:23
Hevil Shah: I think there's gonna be a lot of exciting things that hopefully I'll be able to see in my career, if not in the next generation of neonatologists. You know, you mentioned previously, the artificial womb and the artificial placenta, and then there's a lot still in the works to even make that possible. But I think as technology gets better, and as the research outcomes and the research improves, I wouldn't be surprised if that's the next phase of neonatology, where we, you know, a lot of these babies that are pre-viable, peri-viable, that they are able to be placed in this artificial womb and to give them a chance to still kind of incubate before the true delivery. In the meantime, though, I think a lot of it is a lot of the care that's going to be driven is gonna be with artificial intelligence. The AI sector is booming within health care. It's already really integrated in adult medicine, already in the outpatient setting. It's starting coming into the inpatient settings. I wouldn't be surprised if AI driven, personalized care starts to come into play for these small babies, where you know, they'll look at the vital signs and their electrolytes and be able to provide nuanced care based on, hey, this is we noticed that this is going up. This is what we need to tweak. And then we know this is going down in six hours, we need to tweak this. And so I think it's gonna be more targeted in that approach. The genomics and a lot of epigenetic work is it's also being researched in this population to kind of identify kids that will develop chronic lung disease early on and see if we can mitigate it, or kids that will have feeding intolerance early on and to mitigate it. And so I think a lot of it's gonna be technology driven right now it's been more physiology driven care. I think the next phase of neonatology is gonna be more technology driven care. As more and more research is done within these technological advances.
00:29:04
Samantha Corkum: There are companies out there that have specifically developed AI programs for the field of neonatology that we at Cook Children's have actually taken a look at, and it's something that we follow peripherally as the technology advances. So more to come on that it's definitely a very, very exciting time to be in this field.
00:29:22
Host: So as we wrap up, is there anything else you'd like to add, or anything we haven't asked you that you'd like to share?
00:29:28
Samantha Corkum: Honestly, our biggest takeaway is, if you cannot transport the mother baby dyad, the next best situation for a high risk delivery, for a periviable infant, is to get in contact with a level four children's hospital transport team immediately. Have them present for delivery, simply because they can resuscitate these babies, just like one of our neonatologists or NMPs would here at Cook Children's and get them to a high functioning. NICU that has a dedicated small baby unit.
00:30:02
Hevil Shah: We're fortunate enough for the North Texas population, the West Texas population that we have Cook Children's and the small baby unit to be able to handle that influx of these babies that need this high level of care.
00:30:14
Host: Thank you both so much for being here and taking time out of what I know is a really busy schedule, and also thank you for what you do.
00:30:20
Hevil Shah: No, I mean, thank you for having us. So we love small babies, so it's great to talk about them.
00:30:25
Samantha Corkum: Yes, we really appreciate this opportunity. We can talk about small baby unit all day.
00:30:29
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00:30:29
Host: For our listeners, if you'd like to make a referral, visit the neonatology
[email protected]. You can also access clinical pathways on the health professionals section of the website. And while you're there, sign up for our Doc Talk newsletter. Want more Doc Talk get our latest episodes delivered directly to your inbox when you subscribe to our Cook Children's Doc Talk podcast from your favorite podcast provider. And thank you for listening.
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