Huge Strides in 25 Years : Medical Center to Honor Pioneer in Neonatology
It was 25 years ago this month that Dr. Louis Gluck, director of neonatal and perinatal medicine at UCI Medical Center, opened the world’s first intensive care unit for newborns at Yale University.
Today at the Medical Center he will be honored for 25 years of service to critically ill newborns, and his latest achievement--the newly remodeled Infant Special Care Unit at UCI Medical Center--will be dedicated.
In what is billed as “an enhancement” of the old Neonatal Intensive Care Unit, the unit is being renovated, and sophisticated new technology--including double-walled incubators with water-bed mattresses--is being installed.
But if the 61-year-old physician and professor of pediatrics, obstetrics and gynecology allows himself to reflect back today, he may remember that his Yale project was initially dismissed as “crazy” by most other doctors. In fact, though generally considered the father of modern neonatology, Gluck notes that when he proposed many of his ideas, “many of my (medical) colleagues . . . challenged them as being ridiculous.”
Rudimentary Care
During a recent interview he recounted the rudimentary care ill newborns received just a quarter-century ago when those infants were placed in so-called “premature nurseries.” If such babies were lucky, Gluck said, they were treated by the relatively few doctors who specialized in treating premature and other high-risk infants.
Still, mortality rates were as high as 90%. There weren’t many pieces of equipment to help keep premature babies alive, Gluck explained, and about the only therapy was to place them on oxygen and hope for the best.
Doctors in those days were particularly perplexed by infections, which could spread like wildfire through pediatric wards, and severe lung diseases--such as hyaline membrane disease--that took countless lives.
“In the ‘50s--and most of the ‘60s--there was this hysteria over ‘staph’ (staphylococcus) and other infections spreading among newborns,” Gluck remembers. “What had happened was that antibiotics--which then were still relatively new--had been overused in treating newborn infections and respiratory ailments; the result was that strains of organisms resistant to antibiotics--and just about anything else--could develop and spread almost overnight on pediatric wards.
“To prevent these outbreaks, hospitals came up with really bizarre rules: Some hospitals said you couldn’t have more than one baby in a room, so their pediatric wards were cut up into these mazes of cubicles; other hospitals only allowed babies who were born on the same day to be in the same room--and they all had to be sent home at the same time because they where all considered ‘cohorts.’ ”
Doctors’ Misunderstanding
These extraordinary steps were taken, Gluck said, because doctors misunderstood how diseases spread. “Most of the medical profession believed that staph and other bacteria flew through the air and landed on babies--causing the spread of infection.
“This concept didn’t make any sense to me; germs spread whether or not you took steps to isolate babies.”
And even though he conducted studies while on Stanford University’s medical staff in the late ‘50s clearly showing that bacteria and infectious diseases were spread among newborns because doctors and nurses failed to wash and sterilize their hands after handling each baby, Gluck still was unable to set up an “open” intensive care unit where babies weren’t isolated.
“Stanford felt that despite the evidence, setting up an intensive care unit where the infants weren’t isolated from each other would be flying in the face of public health laws.”
Laws Stood in Way
California was not alone in this belief, Gluck remembers. The public health laws of most states, reflecting prevailing medical opinion, effectively forbade the establishment of newborn intensive care units.
The only way he finally succeeded in 1960 in setting up the world’s first neonatal intensive care unit was by making it a precondition for his joining the faculty of Yale University, which had failed in previous attempts to recruit him.
“A lot of people believed I was doing nothing more than spreading infection by mixing together on the same ward all kinds of babies,” Gluck said.
“We had all kinds of babies on the ward: full terms, prematures, those who’d undergone surgery and those who hadn’t. We even committed the unpardonable sin of admitting babies who’d been born outside the hospital to our unit.
“At Yale we found that if you cleaned the bacteria off infants when they were born and washed your hands between handling babies, you never saw infections,” Gluck said in explaining how the now common “open” neonatal intensive care unit came to displace the isolated cubicles of two decades ago.
Joined UCI Last Year
For taking what Gluck calls “this obvious and simple step” at Yale--and for innumerable other contributions to the care of sickly newborns, Gluck earlier this month was honored on National Child Health Day at the National Institute of Child Health and Human Development in Washington.
After 15 years at the UC San Diego Medical Center, Gluck last year joined the UCI medical faculty as professor of pediatrics and director of the division of neonatal- perinatal medicine. Since then he has shepherded the transformation of UCI Medical Center into a nationally recognized center that, according to Gluck, treats 600 critically ill infants annually.
Eleven doctors and 60 nurses staff the unit, which has 15 beds for critically ill babies, 10 for intermediate care babies and another 10 for so-called “growing” babies who are undergoing final treatment before release from the hospital.
(Today’s dedication is for the first phase of the remodeling, which cost $210,000. The second renovation phase will begin shortly and cost a similar sum, according to a hospital spokeswoman.)
When the new unit opens its doors today one of the new additions will be a one-of-a-kind incubator that Gluck and his colleagues worked on perfecting for more than two years while he was in San Diego. Gone are the 90 decibels--the equivalent of industrial noise--emitted by the incubators now in use. Gluck’s incubator will put out no more than 25 decibels--the equivalent of background noise.
Incubator Advances
Babies placed in incubators now in use tend to lose heat because body heat radiates towards the incubator’s cooler surface, requiring constant monitoring and temperature adjustment. To prevent this, Gluck’s incubator has a double wall that radiates heat, resulting in a warmer, constant heat layer around the baby.
His eyes gleaming with quiet satisfaction, Gluck pushes up the incubator’s unique sliding door, which opens only partially to keep heat from escaping, places his right hand through the opening and pats the bed that begins to gently sway.
“It’s a water bed,” he gleefully announces. “This is the first incubator with one. I’ve wanted an incubator with a water bed for a long time.
“The baby can breath better--preventing sudden infant death syndrome--and it’s just a better bed because it re-creates the atmosphere of the womb--the kind of weightless, moving and stimulating environment babies would be in if they hadn’t been born prematurely.”
Gluck’s incubator is a far cry from the one he keeps tucked between a set of bookshelves in his nearby office. This so-called “Hessbed,” which Gluck says was used from the early ‘30s until 1950, is a foreboding looking stainless-steel cradle. Notwithstanding its massive, cumbersome appearance, Gluck said that when the Hessbed’s hollow wall was filled with hot water, it kept premature infants as warm and comfortable as anything of its era.
“With the advances that are being made in neonatology every day, it probably won’t be too long until my incubator becomes as much a museum piece as the Hessbed,” he said with a chuckle.
