Name: Dr. Edward Ogata
Background: Ogata, a Chicago-born physician, heads the Division of Neonatology at Children’s Memorial Medical Center and Prentice Women’s Hospital. He graduated from Harvard University and Northwestern University Medical School and was an intern and resident in pediatrics and a fellow in neonatal-perinatal medicine at the University of California in San Francisco. He chairs the committee on the fetus and newborn for the Illinois chapter of the American Academy of Pediatrics and directs neonatal research at Northwestern Memorial Hospital. He lives in Winnetka with his wife, a pediatric physician, and their three daughters.
Years as a neonatologist: 17
Years ago my mother drew blank looks when she told acquaintances, “My son is a neonatologist.” Our medical sub-specialty is less than 40 years old and wasn’t well-known. But recent documentaries about babies born with critical health problems have given people some idea of what we do.
For the record, a neonatologist is a pediatrician trained extensively to provide care to seriously sick newborns. Our education includes a one-year internship and two-year residency in pediatrics and a three-year fellowship in neonatology. During our fellowship we study fetal and newborn physiology, research an area of fetal development and get hands-on experience with babies admitted to an intensive-care setting.
Our tiny patients, some as light as 24 ounces, account for 5 percent of all pregnancy outcomes in the United States. They’re born with structural or functional disorders of many body organs, the lungs, the brain, the intestine. Causes include injuries sustained during a difficult birth, low birth weight, streptococcus B or other bacterial infection transmitted from the mother, Rh factor complications and heredity, the passage of disease from parent to offspring. Infants of diabetic mothers, for example, often require special attention.
At Children’s Memorial we see babies with congenital malformations of just about any body part. Some are born with the kind of hernia that pushes the stomach and intestines into the chest near the developing lungs. This impairs breathing, and the intestines won’t work if they remain there.
Nationwide, obtunded babies, those born with symptoms related to heroin or cocaine abuse, have become more prevalent; one out of 10 newborns at risk shows signs of drug withdrawal or responds slower than normal to stimuli. Sometimes the mother’s addiction induces early labor and compounds the infant’s problems.
My classic patient is the premature infant who, in terms of development, is still a fetus. Born as early as 15 weeks before term, his vital organs are too immature to support life outside the womb, and he can neither eat nor breathe on his own.
To get nourishment, he relies on the food tube we put down into his stomach to start a feeding, and he has to learn how to suck. His ability to suck is disorganized because it develops later in a pregnancy. A very premature baby can’t suck at all.
For breath he depends on a ventilator designed to breathe for babies. The machine outweighs him severalfold, but the breathing tube we apply is specifically scaled to an infant’s proportions.
Other machines allow us to watch the amount of oxygen going into his blood without taking blood samples. This painless, bloodless method permits ongoing monitoring and is one of the beauties of medical technology.
Our area of medicine, even with the efficiency of technology, remains labor-intensive. Every hospital with extensive obstetrical services, for example, keeps a neonatologist on staff. It’s one of the better developments over the years. Being on site makes us readily available to deliver emergency care to the newborn during a premature labor.
By no means do we attend each birth. Our presence isn’t requested beforehand unless the obstetrician anticipates a problem. If there’s a chance of a severe blood incompatibility or signs of a premature labor, for example, everyone feels better with a neonatologist in the delivery room. Whatever happens, I’m part of a team that stays on call and works a good number of nights, taking turns at service.
We all do clinical work-that is, check on the babies, take care of moms, make sure the plans we set up for our patients are being implemented. That’s part of being a real doctor.
As chief of the neonatology division I lead my team on morning rounds. We go from isolette to isolette looking for changes in the babies, both good and bad. We discuss treatment. We ask the pharmacist, “Should we use this drug or that?” We adjust the oxygen, the tracheal tube, the intravenous flow.
We expect interruptions in an intensive-care setting filled with sick babies. Their conditions can change acutely, and we stop and handle the problem then and there.
Everyone on my team does research, both clinical and basic. We want to know how the fetus grows, how it uses certain substances that allow it to grow and how certain growth factors in a fetus’ metabolism affect all of this. These areas have been my major interest since fellowship days.
Many findings come from our laboratory work and clinical studies. But we work on actual babies to learn how to best provide nutrition to tiny beings. A premature baby’s gut is as underdeveloped as his lungs, and we always look for techniques to enhance feedings.
Writing, lecturing and formal teaching are also among my duties. In addition to bedside instruction, I use a conference room to sit down with residents and fellows and thoroughly review a topic. When I work alongside a young doctor, I employ the apprenticeship method of earlier days. I’ll say, “Let me show you how to do this,” and do it for his enlightenment.
Helping parents cope with the fact that their most precious person is in danger is the important part of my profession. The most difficult part is the ethical issues: How long shall we continue heroic treatment? What will the child’s quality of life be down the road? I sometimes come to a juncture with a sick baby that makes me ask, “Maybe we shouldn’t be doing all this.” But I also see a tangible answer to why maybe we should.
A young mother I didn’t recognize hailed me as I came through the front doors of the hospital’s main entrance yesterday. “Don’t you remember me?” she asked, hanging on to a lively 3-year-old. After she refreshed my memory, I remembered the severe problems with which her son had been born . . . and recalled why I went into this profession.
