ichael Lipka '89 (CLAS) and his wife, Kate '96 M.B.A., were looking forward to the birth of their first child, and the pregnancy was going exactly as planned. That is, until Kate's water broke at her baby shower, eight weeks too soon. The Wethersfield, Conn., couple never had any reason to suspect that their baby would be premature. "I was as unprepared as you could be," says Kate.

Kate delivered their son, Matthew, at the University of Connecticut Health Center's John Dempsey Hospital in a labor and delivery suite adjacent to the Newborn Intensive Care Unit (NICU), a special nursery that would become Matthew's home away from home for the first four weeks of his life. Providing the highest level of care (known as Level III or tertiary care), the NICU combines high-tech equipment, the latest research in the field, and good old-fashioned love and nurturing to help the sickest and tiniest babies survive and flourish.

"Every family goes into a pregnancy with the expectation that at the end of the pregnancy they're going to have a healthy 'Gerber' baby," notes Dr. Ted Rosenkrantz, director of the NICU and professor of pediatrics. Since 1975, the UConn Health Center's NICU has been prepared for the unexpected--even the unimaginable--on behalf of families with pregnancies that are identified as high risk in the early stages, as well as for families such as the Lipkas who are shocked to suddenly find themselves in need of critical care for a newborn.

With a capacity for 48 infants at any one time, the UConn Health Center's NICU is the largest in the Greater Hartford region. Some 500 babies are admitted every year. A basically healthy infant who has trouble transitioning from the womb to the world and experiences a few hours of respiratory distress might stay in the NICU for a few days. The tiniest preemies, who require the most extreme measures modern medicine can provide, may stay for months.

Such was the case for Amanda McTighe, who was born at 24 weeks of gestation, weighing only about one and a half pounds, and who spent five months in the care of UConn's NICU. Her parents, John and Kimberly McTighe of Ellington, Conn., remember feeling overwhelmed at first: Somewhere amid the ventilator, the IVs, all of the tubes and wires and monitoring apparatus was their tiny little girl, no bigger than her dad's hand. Says John, "Kim cried when she saw all the equipment." But the McTighes soon grew accustomed to the beeps and buzzes of the monitors and the machines and also learned that despite the ubiquitous technology, their baby was in an environment designed to be as supportive as possible. The infants' incubators, which are draped in baby blankets and coverlets to block out the light, are double-walled to maintain the temperature and reduce noise and other environmental stimuli. Within the incubators, the babies have nestlike padding that simulates the boundaries and the positioning they experienced in the womb.

John McTighe notes that while their baby's survival relied upon a great deal of technology, he and his wife soon learned to rely heavily on UConn's NICU staff. A variety of highly specialized medical and nursing professionals participate in the care of the babies. At the heart of the medical team is a primary nursing team, which provides the majority of care for each individual child and is incredibly involved in supporting and teaching the parents. "The primary nursing team quickly became part of our family," says McTighe.

Dr. Marilyn Sanders, a neonatalogist and associate professor of pediatrics, notes that the primary nursing team is key because parents--who would under normal circumstances be fully in charge of their baby--can feel disenfranchised by their dependence on equipment and medical experts. Yet scientific research has shown that the relationship built between the family and the sick infant is important for the child's growth and development and can affect such outcomes as the length of the infant's hospital stay and rate of weight gain.

The NICU at UConn's John Dempsey Hospital uses an approach to care that emphasizes both an infant's individuality and the parents' involvement. It's called the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), which involves a systematic method for observing and responding to cues provided by the infant. Parents such as the McTighes are taught how to interact with the baby in ways that will be most beneficial. John McTighe explains: "Early on, for example, touching and talking at the same time is too much stimulation."

McTighe notes that during the long ordeal of nurturing their critically ill daughter, other parents of preemies, as well as friends and acquaintances with premature nieces or nephews or grandchildren, shared their stories. "After a while," he says, "we realized that their experiences at other hospitals were not the same as our experiences." Specifically, he says, what stands out about the UConn Health Center NICU is the manner and degree to which staff encourage parents to actively participate in the care of their child. The Lipkas also credit the staff for their positive hospitalization experience. On the day before Matthew's discharge, Kate remarked, "The people here are so supportive and caring. We certainly never wanted to be here, but it's been fantastic."

The Big Picture
Although upward of 7,000 babies have benefited from the individualized care they've received in UConn's NICU, this special nursery's work is just one thread in the tapestry--or perhaps safety net--that represents the University of Connecticut Health Center's broader commitment to ensuring that all newborns in Connecticut receive the medical care they need. The UConn NICU is the Greater Hartford regional referral center for high-risk pregnancies and births. UConn's NICU also takes responsibility for transporting critically ill newborns from one facility to another in vehicles that are equipped to be mobile NICUs. Says Dr. Sanders, "If a critically ill baby is born in the state of Connecticut and the community hospital can't meet the child's needs, then we'll transport the baby to a Level III facility."

UConn Health Center's experienced high-risk obstetric physicians and neonatal physicians act as resources to physicians at other hospitals, often providing consultative services to doctors who are treating sick newborns or assessing whether mothers need to move up to a Level III facility in anticipation of a high-risk birth. The McTighes are one family who appreciated the long reach of the UConn experts. Their local doctor's consultation with UConn specialists resulted in a surgical procedure at their community hospital that prevented the loss of Kim's pregnancy at 19 weeks.

Tiffany Johnson of Bloomfield, Conn., spends time with her son, Quincey, who was born 15 weeks premature, weighing 1 pound, 14 ounces.

Given the responsibilities and expectations of excellence that go along with being a teaching and research institution, the University of Connecticut NICU doctors are also professors. The faculty help train not only future neonatologists but also pediatric residents, medical students, nurses, nurse practitioners, physician assistants, and others. The Health Center has recently become the first in the state with the credentials to train other professionals in the NIDCAP approach to care.

As part of an academic research institution, the Health Center is also a place where new knowledge in the field of neonatology is derived. UConn doctors and researchers have conducted basic research in such areas as the utilization of glucose in the blood and the mineral metabolism for premature babies. Says Dr. Sanders, "We did a lot of the research that helped to develop the formulas that are used to feed premature babies today." Dr. Rosenkrantz points out that the UConn Health Center was one of only 25 institutions across the country to participate in clinical trials that proved that a new kind of device, a high-frequency oscillation ventilator, was far superior to the traditional ventilators being used. The use of the new ventilator is now widespread.

Also part of the larger context at the University of Connecticut Health Center are the prenatal, labor and delivery services for healthy moms and babies. Each year, hundreds of healthy babies are born into the hospital's Well-Baby Program.

"If you're going to have a baby here at the UConn Health Center, we're probably not the doctors you'll see," notes Dr. Sanders. "But the NICUwill be here if you need it."

If having a premature baby is one of the most frightening and overwhelming situations a parent can experience, imagine what it's like having four premature babies--all at once.

So it was for David and Marie Zipadelli in 1984, when they were expecting quadruplets. At that time there were only three facilities in Connecticut equipped to handle such a high-risk situation, and none of them had successfully delivered quadruplets who all survived. "I talked with the doctors at all the facilities to see where we felt most comfortable," David says. That turned out to be the UConn Health Center, where doctors recommended that Marie be admitted for bed rest and medical care to delay labor.

Four months later and still three months premature, Kristin, Mark, James and Daniel were born. They ranged from just under one and a half pounds to just over two pounds. David recalls how quickly everything happened in the delivery/operating suite, which was packed with dozens of people divided into four teams--one for each baby. Says David, "It was all planned and rehearsed." Dr. Ted Rosenkrantz, who is now the director of UConn's Newborn Intensive Care Unit, recalls, "It went like clockwork."

Once their immediate resuscitation needs were met, the children were ushered into the adjacent NICU. It was "touch and go" for weeks. But five months later, the last of the siblings, James, was discharged.

Returning to the Health Center for medical care over the years, the Zipadelli kids have maintained a bond with UConn's Health Center. Now UConn the University will play a central role. Kristin, Mark, James and Daniel, who all graduated from high school with honors, are freshmen at Storrs this year.

"It's been my kids' dream to attend the University of Connecticut," says David. "It's a wonderful completion to a great story that started at the Health Center. They came into the world together. They wanted to go to college together."