The neonatal intensive care unit (NICU) is home to the hospitals tiniest patients, many weighing less than a kilogram (2.2 pounds). This is where I spend my Wednesday afternoons, learning about the care of neonates and wondering if they even appreciate the new dress shirts my girlfriend picked out for me. After several weeks of visiting the unit I could not help but notice that there seemed to be new babies every week. Always a curious and eager learner I asked my preceptor where babies come from. Rather than answer me right away she suggested that over the Christmas break I spend a night with the neonatal resuscitation team. This she (correctly) assumed would provide me with the knowledge I sought.

I arrived at 4pm on a cold afternoon and was paired with the pediatric resident on call for the night. I changed into scrubs (so much for those dress shirts) and got my own pager. The resuscitation team is comprised of nurses and residents who are called to any birth deemed to be high risk (the threshold of high risk is quite low, so their resuscitation skills are most often not needed).

We started the shift with the neonatology rounds. This was cut short with our first page to the C-section of a term baby whose umbilical cord had gotten wrapped around her neck. This proved of little challenge to the obstetrician who pulled her out with relative ease. She was transferred to the resuscitation team, positioned around an incubator in the back of the delivery room. They evaluated her breathing and heart rate (normal), suctioned the goop out of her mouth, cleaned her off (this birth stuff is a messy affair), and then turned her over to her mother. We returned to the NICU to find that we had missed the rest of rounds. This gave us some down time sample from the numerous boxes of chocolates grateful patients (or more likely their parents) had given to the staff for Christmas.

Our detour into chocolaty goodness did not last long as the resident was paged to admit a newborn from the regular nursery into the NICU. We arrived to find a highly jaundiced baby who had not been able to feed for most of the day. Blood tests suggested sepsis (high band cell count) and she was started on broad-spectrum antibiotics and IV nutrition.

Next came the birth of twins by C-section. They left no question as to the functionality of their lungs, screaming the second the hit the air. The next baby born would not have such an easy time.

Shortly after the twins came a 27 weeker (normal gestation is 38-42 weeks) by vaginal delivery. Weighing barely more than a kilogram his delivery was relatively easy. However after initially making some noise he rapidly deteriorated and his maximum effort was required to take even the smallest, inadequate breath. He was intubated and given artificial respiration was well as surfactant to help open his lungs. He was rushed to the NICU where he was placed on a respirator and had central lines run in his umbilical artery and vein. These are used to monitor his blood pressure, blood gas levels etc, as well as to administer nutrition and medications (as needed) and take blood for tests.

The final birth I attended was the uneventful C-section of a term baby. I left the hospital around 2:30 am with a solid idea of where babies come from. Next I am going to figure out how they are made.