Paediatrician Dr. Steven West told Hamilton Rotarians this week that Bermuda was keeping up with the major North American neonatal centres.

"Each year, with aggressive delivery room intervention, improved neonatal stabilisation, and transport and intensive care technology, smaller and more immature babies are surviving,'' Dr. West said.

"We therefore need to ask ourselves, `How small is too small'? "With the major advances that are occurring in the field of neonatology, we are constantly challenging and redefining the limit of viability. For this reason, neonatology has become the most rapidly advancing field of medicine.'' In Bermuda, paediatricians recently put forward a proposal for the establishment of a Neonatal Intensive Care Unit.

"The NICU will be located near to the labour and delivery ward in the newborn nursery,'' Dr. West said.

"At the present time, babies born prematurely, or with some form of critical illness are cared for in the adult ICU. This requires that unstable babies be transported from the labour ward to the second floor ICU, and there they are cared for by ICU nurses trained in looking after adults.'' Dr. West added that though the ICU nurses had done a remarkable job at tending to the needs of premature babies, most of those that worked in the newborn nursery had received level III training which focused on the exclusive care of premature and critically ill infants.

"They recognise the potential complications these infants can develop, and they understand the stresses that are placed on the family unit.

"Since all of the infants' care will occur in one unit, continuity of care will also be enhanced.'' Dr. West said that premature infants were also immunosuppressed, or at risk of significant infection.

"Being nursed in their own unit, with strict infection control policies, should hopefully prevent some of the infections occurring in these at risk infants.'' He added that with the recent renovations on the labour floor and nursery, the appropriate oxygen and air connections had been installed.

"We are in the process of drawing up policies and procedures for the running of the new NICU.

"Clinical practice guidelines are being established, so that a consistent and excellent standard of care can be provided for these babies. Nursing skills are being upgraded, so that eventually they will be able to make adjustments to the ventilators, take blood work, site intravenouses, and institute feeding regimens.'' Dr. West added that along with other guidelines, the hospital had instituted the Neonatal Resuscitation Programme, developed by the American Heart Association and the American Academy of Paediatrics, as a requirement for all staff involved with the delivery and care of newborns.

"This is to ensure that all babies born in Bermuda receive the best level of care possible.'' He noted, however, that the unit would prove expensive. "Several pieces of new equipment will need to be purchased, so that we can continue to keep up with the advances being made in neonatology.

"This will include two new ventilators, various monitoring equipment, and maybe a portable ultrasound machine so that head ultrasounds can be performed on these unstable babies in the NICU.'' Dr. West added that much work had been done in recent years looking at the environment in which infants were nursed, and their eventual developmental outcome.

"It is interesting to note that various simple manoeuvres such as positioning techniques, the amount of excessive stimulation, and parental contact have all been shown to improve these premature babies' development outcome.'' He said that Bermuda was moving in this direction with babies in isolettes with covers, instead of overhead warmers, preventing unnecessary and frequent handling.