A Paradigm Shift in Caring for Critically Ill Newborns

The Innovation: A path to better neurodevelopmental outcomes

Children’s Health℠ and UT Southwestern created a neonatal neuro-intensive care program in collaboration with Parkland Hospital. It is one of the only programs in the nation that integrates a comprehensive clinical care system, a fellowship program to train the next generation of Neurological Neonatal Intensive Care Unit (NeuroNICU) providers and a robust research platform to further new knowledge in the field.

The program is part of our health care system’s collaborative push to spur a paradigm shift in care for preterm infants and other fragile newborns. The goal is to advance from helping these babies survive to helping them thrive with the best possible neurodevelopmental outcomes.

“This program fills a large gap in services. There are no other NeuroNICUs in the state of Texas,” says Lina Chalak, M.D., the Medical Director who leads the comprehensive program.

She is a neonatologist at Children’s Health and a Professor of Pediatrics and Psychiatry at UT Southwestern who developed and first launched this program with Dr. Thomas at Parkland Hospital in 2018.

“Parkland was very supportive in inaugurating the program. It has one of the largest delivery services in Texas with more than 11,000 births each year and serves a vulnerable population.”

The Neonatal Neurological ICU program expands to Children’s Health in early 2022 and then to other sites in the UT Southwestern system.

The Big Picture: Shifting from survival to quality of life

group of physicians talking around a infantIncreasing numbers of infants born preterm or with acute health issues can now survive. But one-third of them experience significant neurodevelopmental complications that can include cerebral palsy, motor and cognitive impairment, behavioral issues, and visual and auditory deficits.

What’s more, the families of these children bear a heavy emotional burden. According to a report by the Institute of Medicine published in 2006, it is estimated that prematurity results in medical and educational costs, as well as lost productivity of more than $26 billion each year in the U.S.

“Our success shouldn’t be measured only by whether a baby makes it out of the hospital, but by how well we enrich their brain growth, improve their neurodevelopment and give them every chance for a good quality of life,” says Dr. Chalak.

Everyone on the bedside team is trained to deliver evidence-based neuroprotective care that ranges from simple techniques, like how to rotate an infant or move their head, to leading-edge therapies, like hypothermia that limits damage after neonatal brain injury. Team members are also pioneering new techniques, like novel non-invasive heat map biomarkers that recognize at-risk infants in a timely manner.

“Time is brain when caring for newborns facing neurological insults,” says Dr. Chalak.

The Fetal and Neonatal Neurology Fellowship Training is a collaborative program established in 2018 to provide sub-specialty training to pediatric neurologists and neonatologists, along with research expertise focused on the neonatal brain.

“We often meet with families early in their medical journey and maintain the relationship with babies and their families as they grow in our NICU follow-up Neurology Clinic, closely tracking their neurodevelopment and managing their neurological needs,” explains Jennifer Thomas, M.D., Fellowship Director and pediatric neurologist specializing in fetal and neonatal neurology, and Assistant Professor at UT Southwestern.

Key Details: Training the next generation, spearheading research

“There are currently only about 100 specialists in the world currently focused on the intersection of neonatology and neurology and the profound impact this has on fragile newborns,” says Dr. Chalak. “We need to train the next generation to carry the work and the research forward. That’s why we’re establishing a specialty and a pathway for such training.”

The neonatal neurology intensive care program includes:

  • A team of specialized neonatologists, neonatal neurologists, specialized nurses and neuroradiologists integrated into the Level IV NICU at Children’s Health. This team will: 
    • Work with NICU staff during daily rounds to conduct neurological assessments and provide input on each baby’s status, progress and treatment plan.
    • Integrate neuroprotective strategies to minimize each baby’s pain and stress.
    • Provide education and support to parents.
    • Coordinate care and communication among the specialists, parents and community providers.
  • A one-year accredited Fetal and Neonatal Neurology Fellowship Program to train pediatric neurologists and neonatologists about caring for neonates who have been neurologically compromised. The fellowship program will:
    • Build the pipeline of specialized physician-scientists who can serve this vulnerable population and conduct innovative research.
    • Orchestrate day-to-day neurology care in the NICU.
  • A research program that includes a unique research database to capture patient data, treatment and outcomes. The database will:
    • Provide opportunities to make observations.
    • Form the basis for research studies and publications.

Why Children’s Health: A Level IV NICU offering TeleCooling and other innovative care

The Level IV NICU at Children’s Health offers everything from ECMO to surgical suites equipped for children to pediatric anesthesiologists, radiologists and respiratory therapists who understand small infants. Our specialists are available for consultations via our Telehealth and TeleNICU technologies. Babies are referred here from across the region.

We’re also home to an innovative TeleCooling program that begins pre-transport to our NICU. This enables babies outside our immediate area to receive treatment within the crucial six-hour window after a newborn brain insult.

“Time really does matter for these fragile newborns,” says Dr. Chalak. “The more we learn about how to treat them, and the sooner we can reach them, the better their future will be.”

Learn more about our Neonatal Neurology Intensive Care Program

Call 214-456-7871 to refer a complex patient or consult with one of our specialists. You can also email Lina.Chalak@UTSouthwestern.edu for additional information.

Learn more about Neonatal-Perinatal Medicine programs and services at Children's Health.

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