Patient Impact

From Infancy
to Adulthood

How neonatology has grown since this premature baby was born.

a man standing in an art studio

Jesse Blanchard was born at just 24 weeks in 1974. He was one of the first babies in the early neonatal intensive care unit (NICU) at Mary Hitchcock Memorial Hospital in Hanover, N.H. Now, he’s an artist living in New Mexico. Photo courtesy of Jesse Blanchard.

Published: 
By Jeremy Martin
6 min read

In the spring of 1974, Melinda Blanchard went into labor at just 24 weeks. During those first couple hours, she and her husband Bob drove their Volkswagen bus from their home in Vermont’s Northeast Kingdom all the way to Mary Hitchcock Memorial Hospital in Hanover, N.H. Though Saint Johnsbury Hospital was closer, they chose Mary Hitchcock for its budding neonatal care facilities, crucial for such a premature birth.

Upon their arrival, nurses did their best to stop the premature labor—they plied Melinda with alcohol, a standard practice at the time to suppress contractions. Their efforts delayed the birth by 57 hours.

“She was singing ‘Rocky Mountain High,’” Bob recalls with a chuckle.

Giving birth to her son, Jesse, was far more sobering. Even after the alcohol-induced delay, his odds of survival were less than 4%. “And his chances went down after that,” Bob recounts. “He weighed just under two pounds. I could hold him completely in one hand, with his head in my fingers and his legs dangling over my wrist.”

Tucked in the corner of Mary Hitchcock’s adult Intensive Care Unit (ICU), Bob and Melinda watched their son’s life hang in the balance inside an incubator, where he suffered from frequent episodes of apnea.

“I remember flicking his heel when he would stop breathing. He would turn blue and the alarms would start to go off,” Melinda says, her voice still tinged with the fear of those moments.

“It was one hurdle after another,” Bob adds.

During his ten-week stay at Mary Hitchcock, Jesse also struggled to feed, a dire sign for a premature infant. “When you’re just two pounds, you can’t afford to lose much weight,” Bob emphasizes.

These moments of crisis were as frequent as they were terrifying. Back then, success stories for such premature babies were exceedingly rare. Neonatal intensive care was in its infancy and scarcely resembled what it is today.

“We used makeshift endotracheal tubes and mask CPAP,” says Kathy Albright, Jesse’s nurse at the time. “It was all very new and experimental. Every day felt like we were walking a tightrope. We were in the pioneer days—proving there was a need for a neonatal unit at Dartmouth to cover the state of New Hampshire and part of Vermont.”

Incubating a New Era of Neonatal Care

In 1974, neonatal intensive care at Dartmouth was housed within the adult ICU of the former Mary Hitchcock Memorial Hospital in Hanover. In the early 1980s, the neonatal intensive care unit (NICU) was moved to its own space near the obstetrics department and the regular nursery, improving the care environment for newborns.

This arrangement continued until 1991, when the Children’s Hospital at Dartmouth Hitchcock Medical Center (CHaD) opened in Lebanon, featuring a new dedicated space for the Intensive Care Nursery (ICN).

Prior to this dedicated unit, newly minted specialists cared for premature infants like Jesse in an improvised setting. Only two incubators were available, one for Jesse and another for a premature baby girl, Melinda recalls.

Both machines lacked the modern features of today’s more sophisticated devices—integrated monitoring systems; precise oxygen, temperature, and humidity controls; easy access for medical procedures; and noise reduction. Bereft of this last capability, the constant drone of incubator motors produced noise levels far exceeding today’s safety standards. This prolonged exposure, occurring at such a critical stage of development, put premature infants like Jesse at significant risk of noise-induced hearing loss.

Amid the din, hospital staff still made the new parents feel at home. Allowing the Blanchards 24/7 access to their son was a significant departure from typical policies of that era. “We lived far away. The hospital’s flexibility in allowing us to be there around the clock made all the difference. We felt like part of Jesse’s care team,” Bob says.

Some nights, Melinda and Bob would sleep in their Volkswagen bus in the hospital parking lot, just to be nearby. After days spent at the hospital, they would drive back up to the Northeast Kingdom. “Then we would look at each other and say, ‘What the hell are we doing here? We need to be with him,’” Bob recalls.

“And we’d drive back down. Everyone at Dartmouth let us come. There were no hours or rules. They knew how important it was.”

Neonatology’s Journey to Whole-Child Care

More than fifty years later, Melinda and Bob, now in their seventies, still vividly remember the compassion of the nascent neonatal intensive care team at Dartmouth. “They taught us how to care for Jesse and involved us in every aspect of his treatment,” Melinda says.

“I had never held a child,” she admits, adding that she was just 21 years old, a college senior. “Somebody at Dartmouth taught me how to cut a diaper in half—actually, in quarters—because there were no preemie diapers.”

This family-centered approach was quite novel for the times. In the 1970s, neonatal care focused primarily on medical interventions and survival, rather than broader aspects of infant development and parental involvement. One of Jesse’s doctors, Carol Little, MD, says most physicians “took care of organs and didn’t focus on the whole child or family. That wasn’t part of medical consciousness then. Neonatology led much of that change.”

George Little, MD—Carol’s husband and then-assistant professor of pediatrics at Dartmouth Medical School—was a major reason for this big leap forward and is now heralded as one of the forefathers of neonatology. In 1973, he developed a patient-centered system of care for newborns, establishing the earliest iteration of the Intensive Care Nursery at Dartmouth, which he says “quickly became a model” for integrating families into the care team.

I knew that a system of care for newborn babies was needed. ... My goal was to establish an advanced critical care unit for babies.

George Little, MD, Founder of the Intensive Care Nursery, the first chair of pediatrics at the Children’s Hospital at Dartmouth Hitchcock Medical Center, and active emeritus professor of pediatrics and obstetrics and gynecology at the Geisel School of Medicine at Dartmouth

Over the past five decades, Dartmouth’s facility has evolved from a modest two-bed addition to the adult ICU to a state-of-the-art 30-bed Level 3 NICU. It now stands as the premier critical care center for newborns in New Hampshire and surrounding regions, treating approximately 450 babies annually. This growth reflects the broader evolution of neonatology from a pioneering field to a comprehensive specialty.

Now, family-centered practices actively encourage parental involvement, recognizing the crucial role families play in infant development. Tammy Lambert, MSN, RNC-NIC, the current nurse manager of the Intensive Care Nursery at CHaD, takes pride in even the smallest details of this approach. “The word ‘visitor’ is almost forbidden on the unit—the families are our partners,” she says. “We want families to feel like parents in the unit.”

Neonatology now also places a much stronger emphasis on creating healthy environments. The ICN pays close attention to noise reduction, appropriate lighting cycles, and minimizing stress-inducing stimuli. These advancements, along with comprehensive support services, have significantly improved both survival rates and long-term outcomes for vulnerable newborns.

The Blanchard family. Photo courtesy of Jesse Blanchard.

Carol Little adds that parents played a major role in neonatology’s evolution. “Part of that movement was led by families demanding more,” she reflects. “The Blanchards and families like them set the standard for family-centered care. They taught us how to collaborate with families by teaching us, leading us, and in doing so, they helped bring neonatology from infancy to adulthood. It’s part of the collaboration—the trust—that benefited us all.”

“Jesse was my teacher,” Albright, his nurse, agrees. “We all learned so much about the power of observation. Watching Jesse’s skin tone or how his body changed. He communicated to us in ways we hadn’t realized were important. They’re still important today: just looking at the baby and asking, ‘What are they telling us?’”

Steven Ringer, MD, PhD, Section Chief in Neonatology at Dartmouth Hitchcock Medical Center, says that while advances in neonatology have been remarkable, like any art or science worth mastering, he still sees room for improvement. “The environment, the structure, and their impact on babies and families remain critically important issues—sometimes glaringly—in the Dartmouth unit. We’re all learning together. The Blanchards have taught us where we’ve come from and where we need to go.”

Hope in the Hallway

Today, Jesse is 50 years old and a thriving artist living in New Mexico, married with two children. Wearing hearing aids since early childhood, possibly due to the incubator noise, he has found his calling in visual art. “I try to make happy art,” Jesse says. “Silly as that sounds, maybe there’s something innate in that.”

Several of his pieces now hang on display in CHaD, gifts of gratitude that serve as visual reminders of the progress in neonatal care and symbols of hope for families navigating their own NICU journeys.

To learn more about the Intensive Care Nursery at CHaD, contact Polly Antol at 603-646-5316 or at Polly.Antol@hitchcock.org.

Joanna Celenza, ICN family support specialist, recalls seeing Jesse’s art during her own experience giving birth to premature twins 25 years ago. “The hallway parents walk down to get to the ICN is a long one,” she says, “and when you have a baby in critical care, you don’t always know what you will walk into at the end.” But every day, she would gaze at Jesse’s “bright, cheery, abstract piece”—a canvas of comfort, of inspiration, in which she “saw something different [every day], just like my experience as a parent in the ICN.”

This article first appeared on November 14, 2024 at DHGeiselGiving.org.

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