By Elizabeth Fernandez
The San Francisco Chronicle
SAN FRANCISCO — The pregnancy was normal. And for a dozen hours, the delivery at a South Bay hospital seemed to be going smoothly, too.
Then, in the span of 10 minutes, everything went horribly awry.
Nelya Hochleutner’s uterus ruptured, and the birth of baby Nolan — whose heart rate and oxygen levels had plunged — suddenly became a critical emergency.
When he was born, his skin was blue and he needed resuscitation. Within an hour, he was having seizures.
“It felt like we had wakened to a nightmare,” said the infant’s father, Mike Hochleutner. “We had no idea what the future held for our son.”
The doctors told him there was little they could do other than to continue to give Nolan anti-seizure medication. But, they said, UCSF had a special new treatment that might help.
With Hochleutner’s consent, Nolan was rushed by ambulance to UCSF, and in a special intensive care unit there, was placed onto a cooling blanket that lowered his tiny body’s core temperature in an effort to prevent or minimize the possibility of brain damage. And there, connected to a battery of monitors, Nolan would lie for three days.
The hypothermia treatment is part of a groundbreaking infant-care unit that recently opened at UCSF’s Children’s Hospital. The nation’s first neuro-intensive care nursery, it offers specialized treatment for infants who show indications of brain damage at birth, which puts them at risk of developing cerebral palsy, mental retardation or other cognitive disorders.
The unit represents a new concept — to identify brain issues in newborns at a time when their medical conditions might still be reversed.
“It’s really a baby brain ICU,” said Dr. David Rowitch, chief of neonatology at the children’s hospital who helped launch the unit. “The technical details of looking carefully at these babies turns out to be very complicated. You need very intensive monitoring and a lot of specialists.”
Later problems
Some of the infants in the unit had undergone a difficult delivery, suffering birth asphyxia. This condition can result in a range of hardships as the child grows, from mild learning problems to an inability to feed or breathe on one’s own.
Other babies in the unit were born prematurely. As survival rates among preemies have increased, so has the rate of infants with cerebral palsy.
Rowitch says there’s a direct link.
“The younger we go, the more vulnerable the brain is,” he said.
The specialized unit is also focusing on babies who have suffered strokes — before, during delivery or immediately after delivery.
Approximately 1 in 2,300 babies experience a stroke, said Dr. Donna Ferriero, chief of pediatric neurology at the UCSF Children’s Hospital and director of the Neonatal Brain Disorders Center. The causes include malformations of blood vessels, infection, or problems with blood clotting.
“That is equivalent to the number of strokes in the elderly,” she said.
While several medical centers offer hypothermia therapy, UCSF’s neuronursery is the only one of its kind, combining such components as research, neuroradiology, infant care and therapy. So far, about 40 babies have undergone the treatment at UCSF. The babies are referred from hospitals throughout Northern California.
The hypothermia treatment was suggested from animal studies, said Rowitch.
“If you expose the animals to lack of oxygen, then cool their body a few degrees, they have better outcomes,” he said. “We think it is only effective among babies within six hours of birth.”
The babies lie on a special pad, much like a tiny raft. Circulating through the pad are coils containing water. The coils can be heated or cooled depending on medical need.
For three days, the baby’s temperature is dropped to 92.3 Fahrenheit — normal temperature is 98.6. Then the baby is gradually warmed.
While on the blanket, the babies are put on a morphine-sulfate drip, which sedates them to minimize movement. They are fed through an IV. A urinary catheter is inserted as well as a rectal probe to monitor the baby’s temperature. Three tiny probes are placed just under the babies’ scalps connecting them to a monitor that records brain activity.
“Cooling is so counter-intuitive to the way we think — you always want to keep a baby warm,” said Susan Peloquin, the clinical coordinator of the neonatal ICU who wears a fleece vest adorned with a penguin to symbolize the treatment. “But once it’s explained that it will help the brain, the fears of parents are allayed.”
Mike Hochleutner said his little son went into hibernation.
‘A little rocket ship’
“When I first saw Nolan in the incubator, it looked like he was in a little rocket ship,” he said. “He looked so damaged. The doctors told me that a year ago they wouldn’t have had any treatment for him. They would have just had to let it run its course.”
During the week Nolan was hospitalized, Mike Hochleutner hung a UCSF pennant near his son’s incubator and bought himself a UCSF sweatshirt — a considerable gesture for a man who works as an administrator at Stanford University.
“I’m so proud of my son — at a week old, he graduated from an incredibly prestigious institution,” said Hochleutner.
Nolan, who is regularly being monitored as part of ongoing UCSF research, is now 4 months old, weighs 14 pounds, and has just started teething. Big sister, Sofia, 5, loves to fetch things for him and to read him books.
The Hochleutners hope that the cooling treatment at UCSF will prevent any ongoing developmental issues for him.
“There’s no way to know at this point,” Mike Hochleutner said. “Most problems you can see within a year. Some conditions don’t manifest themselves until age 6 or beyond. But we are very hopeful. We haven’t seen anything that causes us great concern.”
“He seems completely normal,” says Nelya Hochleutner, a stay-at-home mother. “He’s a joyous little boy, he smiles all the time. We’re so lucky that this treatment was around.”