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CON77NUED "The transfer between hospitals should be as quidc as possible since complete intensive care is not possible until the baby is at Stanford," says Dr. Phillip Sunshine, program director of the university's Premature Research Center. "The ideal traveling time between hospitals is less than one hour." Since infants lack the ability to ward off cold and maintain a stable body temperature, they must be transported in a neutral thermal environment. The Stanford transporter provides a comfortable temperature through use of radiant heat warmers, a principle adapted from the Apollo space program. Safety devices The transporter also has an oxygen ventilation system with a two-to-three- hour oxygen supply, battery-powered monitors for heart rate, fluid intake, blood pressure and temperature; portable rechargeable battery units for the system; and a stabilizing unit to prevent injury to the minipassenger during sudden changes in speed or altitude. But rapid efficient transportation from outlying hospitals to better equipped and staffed regional centers is only part of the story. For one thing, infants require more precise diagnosis than adults. They obviously cannot explain anything about their condition; even more importantly, though, they are often so weak that their lives can be threatened by merely subjecting them to too many tests. "We make a special point of limiting diagnostic studies on these babies," says Dr. Redo. "We only do whatever is necessary to-verify that the patient is in need of surgery." Intensive care for the newborn includes careful monitoring of all their responses. Babies are extremely susceptible to bacterial invasion. Since fever, the standard adult trouble signal, is often absent, they can run deceptively normal temperatures with serious infections. Because babies are physiologically very different from adults, they react differently--sometimes unpredictably --to drugs. Therefore, special infant- drug doses must be based on super- precise calculations. Anesthesia progress The same holds true for anesthesia, and much of the progress in minisur- gery can be traced to advances in this area. Special masks about the size of telephone mouthpieces have been created to administer anesthesia to babies. Other surgical tools have also been S cut down to meet infant needs. Trie jjj minisurgeon's scalpel, for instance, has Â£ a normal handle, but a blade less than 5 a half-inch long; and some test tubes u used for newborns are no larger than | drinking straws. CL 1C M/n/surgeons use microscopes to view body structures barely visible to the naked eye. The liver of a newborn baby, for instance, is 1/20th the size of a 5-year-o/d's. Some*minisurgeons wear special eyeglasses--and even use microscopes-to magnify baby body structures that are barely visible to the naked eye. Even structures that can be seen are incredibly small. The liver of a newborn infant, for instance, is just l/20th as ,big as that of a 5-year-old. But while minisurgery calls for scaled-down instruments, it requires giant-sized surgical skill. "The miriisur- geon needs, special training and understanding," says Dr. Redo. "He has to be careful, yet quick. He has to handle tissues with extreme delicacy; and he has to be ready for a variety of problems, because no two cases are exactly alike. In. minisurgery, as with surgery on adults, there are standardized approaches, but the actual steps in each operation can be very different Above all, the minisurgeon has to be thoroughly prepared for surgery that is always of an emergency nature." Probably the most dramatic and revolutionary minisurgery technique is the use in open-heart surgery of a kind of suspended animation called deep hypo- thermia. Using icebags and a refrigerated bed, doctors drastically lower the patient's temperature, then stop the heart with an injection of potassium solution. At this point, the patient is legally dead--with no heartbeat, circulation or reflexes, and no electrical signals coming from the brain. While the patient's body functions are temporarily frozen, the surgeon is free to operate without the risk of heavy bleeding or the obstacle of a pulsating heart muscle. No damaged blood cells Another great advantage of deep hypothermia is that it eliminates the need for the heart-lung machine, which has made open-heart surgery possible by keeping blood circulating during surgery. In infants, however, the machine, if used throughout an operation, can damage blood cells that no critically ill baby can afford to lose; it also requires several clamps, tubes and connections that further limit the tiny area in which the surgeon works. The new "icebox" surgery is saving many of the thousands of babies whose lives are in imminent danger each year because of defective hearts. "We now do complete corrections I would have thought not possible five years ago," says Dr. Robert L Replogle of the University of Chicago's Wyter Children's Hospital. A heart stops One of the leading specialists in deep hypothermia, Dr. Replogle recently operated on a 5-month-old boy who was bom with one lung artery connected to the aorta--the main artery to the body--instead of the heart. The infant's heart was stopped for an hour while Dr. Replogle repositioned the artery. After the correction was completed, the patient was hooked up to the heart-lung machine" for the first time. It pumped warm blood through his body, and immediately his heart came back to life. At least one new diagnostic technique is also reducing the risk in infant heart surgery. Until 'now, heart disease in babies, as in adults, was diagnosed by catheterization--inserting a flexible tube through the blood vessels and into the chambers of the heart. The tube's progress is monitored by an X-ray as the pressure and oxygen content in the heart's chambers are both monitored. But cardiac catheterization can be a demanding ; and dangerous procedure with fragile infants on the verge of death. So doctors are now using a much safer method called echoeardiography, which uses high-energy sound waves that are transmitted through the pa- tienfs chest and bounced back from the heart, creating an echo picture oh a special scope. Echoeardiography is expected to be a valuable tool in pinpointing the problems of an estimated 50,000 babies bom each year with heart disease, as well as 30,000 babies who are bom "blue" because their blood is not getting enough oxygen. Early diagnosis "The diagnosis must be done as early as possible," says Dr. Aldo Castaneda of Boston Children's Hospital. "Eventually, we hope to perfect intrauterine diagnosis." Recognizing a birth defect in an infant that has yet to be bom is only one future goal in minisurgery. "There's no . question that once the rejection phenomenon is licked even transplantation will someday be possible," says Dr. Redo. "Despite the great strides in this field, many problems still lack total solutions and a good deal of research is needed in several different areas. "In many ways, minisurgery is still in the pioneering stage. As such, it's an exciting, challenging and gratifying field. You see, we give a baby a whole new life--only hours after its life began."