Posted: 1/5/2015
High-risk delivery team at Parkland ready for any problems
The sound of their newborn baby’s first cry is magical for parents.
“It was a miracle,” said Deisy Ramos, whose son Isaiah was born on Dec. 11, 2014 at Parkland Memorial Hospital. Deisy’s husband Carlos Diaz was with her when Isaiah entered the world with a strong, healthy cry. “It will be in our hearts forever,” Deisy said. “He sounded like a little angel.”
The baby’s first cry is also eagerly awaited by medical providers in the labor and delivery room because it signals the newborn’s ability to breathe on its own.
“It’s music to our ears,” said Myra Wyckoff, MD, director of Newborn Resuscitation Services at Parkland Health & Hospital System and Associate Professor of Pediatrics at The University of Texas Southwestern Medical Center. “There’s a big sigh of relief in the delivery room. It’s absolutely vital for the infant to take that first breath. Crying is synonymous with breathing.”
The first minute of life has been called one of the most dangerous, because in those 60 seconds an infant must inhale for the first time, causing millions of tiny air sacs to open and fill with air. Most newborns do it naturally and quickly and the baby’s cry, like little Isaiah’s, marks a healthy start of respiration.
“The first cry is critical to initiate successful transition from fetal circulation, where the baby is completely dependent on the mother and placenta for gas exchange, to life outside the womb where the baby must use its own lungs to sustain life,” Dr. Wyckoff stated.
Nearly one-half of newborn deaths occur during the first 24 hours after birth. Many of these are associated with extremely premature infants. Respiratory depression or asphyxia (a lack of gas exchange that prevents removal of carbon dioxide and entry of oxygen into the body) can also be a factor.
At Parkland, every newborn delivery is attended by a pediatrician or pediatric nurse practitioner who is completely focused on the baby’s first cry or breath. If the newborn doesn’t cry, the medical staff immediately takes action, because there is a very short window of time in which to save the baby.
The old technique of holding babies upside down and slapping their back is not done anymore, said Dr. Wyckoff. “There were lots of old practices that were thought to be helpful that in fact were not evidence based,” she said. “We stimulate the baby to get them to cry by rubbing their back with a warm towel.”
If the baby still isn’t breathing, respiration is artificially initiated with a positive pressure bag and face mask. Parkland’s Neonatal Resuscitation team is summoned if the baby does not respond to the first few artificial breaths and lifesaving treatments are rapidly initiated. The Neonatal Resuscitation Team is present from the very beginning in certain high-risk situations like a baby who is being born preterm or who has a high risk of needing assistance breathing.
According to the American Heart Association, approximately 10 percent of all deliveries require resuscitation at the time of birth. Parkland’s Level III Neonatal Intensive Care Unit (NNICU) offers highly specialized services for infants with significant health issues at the time of birth. The NNICU staff cares for more than 1,300 newborns each year. On average, 28 babies are born daily at Parkland and 53 babies are cared for in Parkland’s Level III Neonatal Intensive Care Unit every day.
Dr. Wyckoff maintains one of the most comprehensive neonatal resuscitation databases in the U.S. to continually improve neonatal resuscitation processes locally and nationally. She has served on the American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee and assumes the chair position of the Neonatal Task Force of the International Liaison Committee on Resuscitation in 2016.
Parents and family members often wonder if the newborn’s cry indicates the sex of the newborn or anything about its personality. According to Dr. Wyckoff, “There’s no evidence of that, even if one baby’s cry sounds frail and another is feisty.” Premature babies with weaker lungs do tend to have weaker cries, she said, and twins have their own unique voice even when ‘identical.’
“We can’t predict much about a baby’s personality from their cry,” Dr. Wyckoff stated, “but it does tell me a lot about how much to worry about them in terms of their ability to breathe. To me, hearing that first cry is a mysterious, almost spiritual experience. I never tire of it.”
For more information about neonatal services at Parkland Health & Hospital System, please visit www.parklandhospital.com/after-delivery.