By Cherrie Welch, MD, Medical Director, Neonatal Intensive Care Unit at Brenner Children's
I have the incredible honor of serving as one of the attending neonatologists in the Brenner Children’s Neonatal Intensive Care Unit (NICU). I work with a talented team that cares for babies who are born prematurely or who are born with malformations or medical challenges. I have cared for babies delivered at only 22 weeks of gestation (40 is full term) and as small as 12 ounces. Our team cares for some babies in the hospital for only a few days or weeks, and others for nearly the entire first year of their life. It is a rewarding job filled with both miracles and challenges, and I wouldn’t trade it for anything. Here is a day in my life:
On a typical day, I arrive at the hospital around 8:30 am. I never know what the day will hold. It could include happy events (like discharging a baby after a long hospitalization), sad ones (like helping a baby pass on), or anything in between. So the first thing I do each morning is take the temperature of the NICU. This lets me get a sense of whether things are off to an active or peaceful start—although in our unit, that can change in a minute.
Shortly after arriving, I start making rounds with my team, which includes, neonatal nurse practitioners, physician residents, medical students, a pharmacist, a nutritionist, a respiratory therapist, physical therapist, occupational therapist, speech therapist and NICU nurses—all are experts at taking care of tiny human beings. As the attending neonatologist, I lead this team. Over the course of two to three hours, we round the unit, discussing each of the babies and planning their care for the next 24 hours. We encourage parents to be available during our rounds, because they are a part of our team too. While we are experts in our specialties, they are experts on their babies.
When I’ve finished my rounds—around 11-11:30 am—I start meeting with families. Each discussion is different. Sometimes I have a new test result or finding I need to discuss with them; other times I go over the baby’s progress and what needs to happen before he or she can go home.
The babies in our unit have a range of challenges, and each one progresses at a different rate. We are able to help many of our babies grow and heal, but unfortunately, not every baby responds to medical care. In those cases, we discuss palliative care with the family, so that we can make the remaining life of the baby as comfortable as possible.
As my workday comes to a close, I meet with the team that will be taking over the next shift. We discuss the overnight care plan for each baby, and I make the team aware of any concerns or potential problems. Those meetings typically end my day at around 5-5:30 pm—unless I’m on call overnight, which occurs about every 10 days.
Of course, in a hospital environment, things rarely go exactly as scheduled. At any point during my day, we might receive a baby in acute condition who has been transferred from another regional hospital. During those times, I stop everything I’m doing to go care for that baby. Our transport team is amazingly prepared to get sick babies to us in a short amount of time. If a doctor at a community hospital calls us to let us know a premature baby is getting ready to be delivered, our team will travel to that destination so that they can take over as soon as the baby is born.
Rewards of the Job
Each workday as a NICU neonatologist is a day filled with emotional exertion. In our department we see a lot of highs and lows. Fortunately the highs outweigh the lows, and we are frequently able to give sick babies amazing outcomes. One of my favorite parts of my job is that I get to see some of those babies again a couple of years later. When these children are at Brenner for appointments in other departments, their parents often bring them by to see us. Patients I once treated when they were tiny newborns are now running up the hallway to hug me! That’s one of my favorite feelings, and one I get to experience around here frequently. It’s a reminder that the work we do here has a lasting impact.