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Steps Towards Future In Neonatal Care At The “M. S. Curie” Hospital

carstoveanuCirstoveanu Catalin MD PhD

Assistant Professor in Neonatology

Carol Davila University of Medicine and Pharmacy,

MS Curie Emergency  Clinical Pediatric Hospital

Chief of NICU

Bucharest, Romania

Undoubtedly, at the “Maria Sklodowska Curie” Children’s Emergency Hospital, important steps have been made regarding care of the critical neonatal patient.

The years 2000 have been marked by the desire to identify and individualize neonatal care given in our facility.

In 2004, after an ERS grant and a 3 months visit in the United Kingdom, as well as an Academy of Medical Sciences grant, new medical equipment and nitric oxide were brought for the very first time in a Romanian pediatric hospital and more precisely in a mixt newborn intensive care unit. Outstanding progress followed with reduction of neonatal mortality rate in pulmonary hypertensive patients with meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN), etc.

After Prof. Litarcek’s first attempts to create a flow interrupter in the 80’s followed by Dr. Teianu’s et al. initiative at “MS Curie” Hospital in the Pediatric Intensive Care Unit, an HFOV mechanical ventilator was brought for the first time in Romania. It was the very first use, in our country, of a non-conventional ventilation system, with a new functional oscillator. Apart from impressive success especially in treating SDR, but also MAS, pneumothorax, etc, HFOV implied a better understanding of pulmonary physiopathology.

Even so, it was not the technological development which brought the most significant changes in neonatal care. In his work, Dr. Radu Tabacaru emphasized that parenteral nutrition is an essential aspect in treating the newborn patient with severe surgical or medical conditions. After 2003-2004, all such patients benefited from central venous lines, peripherally inserted central catheters (PICC) or seldinger technique, even at a weight as low as 600g. The price of a quality perfusion was high: for 3 hours, 2 nurses had to work continuously, day by day, with a laminar flow cabinet, in stressful conditions. As a consequence, significant reductions in nosocomial infections were achieved. Previously untreatable patients emerged with better prognosis: e.g. those with 30-40cm small bowel length, some of whom against all odds survived after months, years of parental nutrition given the lack of intestine transplant option.

The year 2007 brought a new and long desired, state-of-the-art infrastructure with a 180 square meters surface where, annually, 160-200 severe cases would be treated. Promising results soon emerged: less than 40% mortality rate in diaphragmatic hernia, lower mortality rate in duodenal stenosis, 75% survival in pulmonary hypertension, etc. All of these are due to dedicated and highly efficient medical personnel.

Years 2012 and 2013 brought a new challenge for us as all of the ECMO cases, namely 3, didn’t survive. A new training program soon followed with both physicians and nurses traveling for specialization in the UK, after previous courses in USA and The Netherlands. It is our hope that experimental animal models will soon be available in order to exercise and improve current procedures.

November 2013 delivered an exceptional change for our children. Each and every patient benefits from individual medical care areas, dedicated facilities for mothers, possibility of mothers’ presence in the recovery period and decent conditions for the medical personnel.

The most thrilling step towards future is the implemented infrastructure for the “Tele- NICU”, where, at the moment, a pilot project is under development. Using this modern concept, similar to other foreign facilities, a bigger reduction in mortality and morbidity rates is hoped to be achieved, with better internal medical collaboration and an efficient interaction with other university centers.

The teaching activity provided in our NICU, pediatrics, pediatric surgery and ENT departments is a tremendous opportunity for dedicated students and residents, who have the desire to supra-specialize in those fields where, currently, Romania is still deficient.