Neonatal Surgical Team

Neonatal Surgical team performing surgery If your baby is born with a condition that will require surgery or complex care immediately or soon after birth, it is important that they have highly specialized care from the very start.

At Children’s Hospital of Philadelphia (CHOP), our unique Neonatal Surgical Team is made up of a dedicated group of clinicians devoted to the care of babies who will need surgery, complex procedures by interventional radiology and/or oncology services during their time in the Newborn/Infant Intensive Care Unit (N/IICU). The multidisciplinary team provides comprehensive care in the crucial perioperative time period and throughout their hospitalization.

The Neonatal Surgical Team was the first of its kind in the world, created in 2004 under the leadership of N. Scott Adzick, MD, Surgeon-in-Chief at Children’s Hospital of Philadelphia. Over the years, we have trained numerous surgeons and neonatologists from all over the world in the detailed care required of challenging and complex surgical neonates. On a daily basis, we are caring for 35 or more babies.

Our team approach to care is special, unique and extremely important to promote optimal outcomes for each and every one of our babies. In addition, we value family-centered care and have parents and caregivers by our side every step of the way.

Who will be involved in my baby’s care?

The Neonatal Surgical Team functions like a unit within a unit. The team runs under the guidance of Natalie E. Rintoul, MD (Medical Director), Holly L. Hedrick, MD (Surgical Director), Renee P. Ebbert, MSN, CRNP (Surgical Advanced Practice Nurse Manager), and Melissa Duran, MSN, CRNP (Lead Surgical Advanced Practice Nurse).

The Neonatal Surgical Team includes a core group of:

  • Neonatologists
  • Pediatric surgeons
  • Surgical advanced practice nurses
  • Specialized neonatal surgical nurses
  • Pediatric anesthesiologists
  • Surgical fellows
  • Neonatal-perinatal medicine fellows

Additionally, specialists in neonatal breathing and long-term mechanical ventilation (pulmonologists and respiratory therapists), heart-lung bypass (ECMO specialists), pulmonary hypertension (cardiologists), intestinal rehabilitation (gastroenterologists), neonatal nutrition (including lactation specialists and a milk bank), fetal and neonatal pharmacists, wound care and neonatal pain management help to take care of the unique medical details for your baby. Specialists in physical and occupational therapy, social work, child life and development round out your care team and provide continuous input.

This team structure ensures that all the necessary support is in place, with an unmatched depth of experience at your baby’s bedside. Every member of our Neonatal Surgical Team provides unparalleled expertise in managing these complex cases.

Every team member practices with an unrelenting passion for perfection.  Every patient is treated as though they are family. There is an intense commitment to excellence and attention to detail: The same people are following these children, noticing trends and asking questions so we can do everything possible for these babies and continuously improve care. - Natalie E. Rintoul, MD

What does the Neonatal Surgical Team do?

Our specialists and facilities allow us to provide the most comprehensive, safe and high-quality care.

What this means for your baby:

The team has established detailed processes and guidelines for care based on the individual needs of newborns with surgical needs. Each year, we update and refine these guidelines to ensure that we are providing evidence based, safe and state-of-the-art care. Specific diagnoses that we care for include, but are not limited to:

  • Congenital diaphragmatic hernia (CDH)
  • Lung lesions
  • Neck masses (lymphatic malformation or cervical teratoma) and mediastinal masses
  • Esophageal atresia/tracheoesophageal fistula
  • Intestinal atresia
  • Abdominal wall defects (omphalocele and gastroschisis)
  • Sacrococcygeal teratoma (SCT)
  • Bladder exstrophy
  • Cloacal exstrophy
  • Hyperinsulinism
  • Conjoined twins
  • Neural tube defects (e.g. myelomeningocele, the most severe form of spina bifida)
  • Lymphangioma
  • Chylothorax
  • Tumors
  • Diagnoses requiring immunotherapy or gene therapy

The same team that meets your baby in the delivery room will continue to care for them in the N/IICU. Whether your baby is delivered vaginally, by cesarean section or by EXIT (ex utero intrapartum treatment), we will ensure your baby is comfortable and safe and can meet you as soon as possible. Some babies are able to breastfeed in the delivery room.

If your child has life-threatening circulatory or respiratory failure, they may require longer-term breathing and heart support while doctors treat their underlying illness. Extracorporeal membrane oxygenation (ECMO) is a machine that oxygenates blood and clears blood of carbon dioxide, bypassing the lungs and heart. If needed, your baby can be placed on this life-saving machine. CHOP’s ECMO Center is designated as a Center of Excellence and is recognized with the Platinum Level ELSO Award for Excellence in Life Support, the highest awarded honor.

For certain extremely fragile babies, transport to the operating room (OR) can be extremely stressful. To reduce potential risks, we are able to turn your baby’s bedside into an operating room. We have the OR personnel, including pediatric anesthesiologists, and equipment come directly to your baby. Our team is experienced at performing operations after birth while your baby remains on their own bed in the N/IICU.

Experts in neonatal pain management work together with neonatal pharmacists to develop an individualized plan to help alleviate your baby’s pain, using the lowest doses possible to keep your baby comfortable while protecting them from harmful side effects.

How else can my baby benefit from the care provided by this dedicated team?

Around-the-clock attention

Every day, 365 days a year, our team rounds with a surgical attending and neonatology attending physician. Our neonatal attendings are in house 24 hours a day to provide expert level care at all times. We also partner with the teams who will be involved in your child’s care after discharge.

Continuity of care

A commitment to continuity means your child’s core care team follows them from the time they are born, throughout their N/IICU stay and as they transition to other specialized units throughout the hospital who will care for them well into childhood. We know the intricate details of your child’s medical history and will work with your family to refine their treatment plan as they grow.

Experience matters

No matter what condition your child has been diagnosed with, they will benefit from standardized care practices developed from years of experience.

Volume matters: We perform one of the highest volumes of neonatal surgery in the country. Complex cases, seen once in a career by some, are something we see every day. This familiarity allows us to continuously refine and improve our treatment approaches. We meet weekly to review all cases and identify ways to improve. We also perform frequent multidisciplinary simulations to practice so that we are always ready.

To sum it up – we specialize in small patients and rare diagnoses.

What to expect after your hospital stay

As soon as you are ready to learn, bedside teaching begins with the nurses. If your child will need speech therapy, occupational therapy, physical therapy or respiratory therapy, specialists will equip you with the necessary tools to be successful at home. The Connelly Center provides additional resources to complement the bedside teaching.

When your child is ready to be discharged from the hospital, we make sure that you are ready and feel equipped to care for your baby and make the transition to home as smooth as possible.

We aim to make your follow-up needs as easy as possible. Whether you live locally, across the country, or internationally, we will work with you to ensure you have access to our follow up programs and local resources.

For babies with small lungs, the Pulmonary Hypoplasia Program specialty outpatient clinic will provide ongoing follow up and developmental assessments into the critical school years.

We also offer a telemedicine program after discharge, allowing you to stay in touch with the team that you knew and trusted during your N/IICU stay.

From the time of your prenatal diagnosis through delivery, surgery and time in the N/IICU to home and as your child grows, we’re here to support you every step of the way.