In 1855, Children's Hospital of Philadelphia (CHOP) became the first children's hospital in North America, starting with just 12 beds. CHOP established the nation's first surgical neonatal intensive care unit in 1962 under the leadership of C. Everett Koop, MD, then surgeon-in-chief at the hospital and later Surgeon General of the United States. 

In 2004, CHOP pioneered the first dedicated Neonatal Surgical Team, also with 12 beds. This team was founded on a collaborative model integrating surgery and neonatology to unify care goals for patients, families and clinicians. Our expertise in prenatal and postnatal care for surgical neonates has become a benchmark for multidisciplinary collaboration, with growing patient volume. 

CHOP's Harriet and Ronald Lassin Newborn/Infant Intensive Care Unit (N/IICU) is a Level IV, 100-bed unit. The Neonatal Surgical Service manages an average of 25-40 neonates daily, primarily with surgical diagnoses. Most of these patients come through the Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment (CFDT), which connects to the Garbose Family Special Delivery Unit (SDU). The SDU opened in 2008 and delivers more than 500 babies annually with congenital anomalies. In 2020, a 10-bed Infant Transitional Care Unit (ITCU) was opened to serve as a step-down from the ICU to focus on transition to home. The Neonatal Surgical Team cares for the surgical neonate through each step of their journey; or, as the late CFDT co-founder, Lori J. Howell, DNP, MS, RN, used to say, “from gestation to graduation.” 

While the Neonatal Surgical Team’s focus is primarily general surgery, the needs of complex patients have led to significant collaboration with other surgical specialties. The team’s breadth of knowledge and support has extended to other surgical disciplines, most notably neurosurgery, urology, otolaryngology and plastic surgery. Specific care plans have been created for many diagnoses such as bladder exstrophy, conjoined twins, congenital diaphragmatic hernia (CDH), mediastinal teratomas, airway reconstruction, and fetal and postnatal myelomeningoceles. 

The Neonatal Surgical Team is led by attending pediatric and fetal surgeon Holly Hedrick MD, FACS, attending neonatologist Natalie Rintoul, MD, and surgical advanced practice nurse Missy Duran, RN, MSN, CRNP. The team’s unique and highly successful care model for neonatal surgical patients was the visionary design of Dr. Howell and CFDT co-founder N. Scott Adzick, MD, MMM. 

An extraordinary ECMO partnership

The Neonatal Surgical Team has an extraordinary partnership with CHOP’s ECMO Center, which has been led by Jim Connelly, BS, RRT-NPS, FELSO, since it opened in May 1990. The ECMO Center has been designated at the Platinum Level by the Extracorporeal Life Support Organization (ELSO). The first award was for 2017-2020, and it has been renewed for 2020-2023. This is the highest honor awarded by ELSO; it is rarely achieved by ELSO member institutions, especially pediatric centers. The ECMO Center has completed more than 1,500 ECMO runs, including a significant number in the N/IICU (a third of the center’s overall volume).   

Neonatal Surgery

Each bed space in the N/IICU is capable of transforming into an operating room. Specialized personnel and equipment for surgery and ECMO are all brought to the baby’s bedside. This avoids the stress and risk of travel to and from the operating room and reduces transitions in care and hand-offs. Care is seamless. Approximately 10% of the team’s surgical cases are done at bedside. 

The CHOP N/IICU cares for 80 to 90 neonates undergoing surgical procedures per month. This large, concentrated volume of neonatal surgical patients has also allowed the team to focus on improving the perioperative experience and refining care by working closely with pediatric anesthesia colleagues.  

“Every team member practices with an unrelenting passion for perfection,” says Dr. Rintoul. “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.”