Extra care and attention is always given to babies, but the tiniest and most fragile get their best chance for normal development thanks to a special unit at King Edward VII Memorial Hospital.A part of the maternity ward, the Special Care Baby Unit fondly called SCBU, is where all premature, c-section and other babies in need of medical attention are housed until they are deemed strong enough to carry out some necessary body functions on their own.Breathing is typically the most important of these. “One of the concerns with premature babies is that they are predisposed to develop respiratory distress syndrome (RDS),” said KEMH Chief of Pediatrics, Dr Eugene Outerbridge.Surfactant, a slippery substance which helps the lungs inflate with air and keeps the air sacs within the lungs from collapsing, is often not produced in premature babies.The earlier a baby is born the less developed its lungs will be and in turn, the more severe the case of RDS will tend to be.According to Dr Outerbridge, back in the 60s this was “the single largest reason for premature baby death” but he said today the problem is easily and effectively managed by either: giving the mother steroids before she delivers — this will cause an enzyme in the cells to turn on the surfactant, administering oxygen in continuous positive airway pressure (CPAP) to the baby, or giving the baby an artificial surfactant.In the KEMH SCBU, babies are often managed with a CPAP machine. Dr Outerbridge said the machine is in the delivery room and greatly reduces the severity and duration of RDS in a baby.CPAP machines are also in the SCBU and each newborn using one has a dedicated nurse monitoring his/her condition.While RDS is expected in premature babies, it’s also quite common in babies born by Cesarean section.“Babies are in a total fluid environment in the uterus,” said Dr Outerbridge. “ During vaginal delivery much of the fluid is squeezed from the lungs.”Because this squeezing of the lungs does not take place in Cesarean sections the babies are born with some fluid in their lungs and also require CPAP in order to get sufficient oxygen.According to Dr Outerbridge about 30 percent of babies born this way in Bermuda, have this problem. It’s a main reason Cesarean section babies are kept in SCBU.“We also do it because mum has had an anaesthetic and is not able to provide initial care for baby,” said Dr Outerbridge.And the numbers are significant. While the actual figures differ from year-to-year about 29 percent of babies are born by Cesarean section at KEMH. Last year that accounted for 207 babies.Each year between 50 and 100 babies are born at KEMH prematurely. A hospital spokesperson said the prematurity rate is about eight percent. In the US it averages 20 percent. The low KEMH figure is positive and indicates that women in Bermuda receive a high standard of prenatal care.While the SCBU offers intensive treatment and observation for babies Dr Outerbridge pointed out that it is not equipped to care for those younger than 34 weeks. Forty weeks is considered full term.“If delivering less than 34 weeks, we try to transfer the mother to a centre overseas,” said Dr Outerbridge. “We feel that the outcome for the baby is better. “About four to ten pregnant women are transferred annually for this reason.Dr Outerbridge said the type of specialist care such a young baby may require is not feasible in a community hospital such as KEMH. “It’s a function of the complexity of illness and the array of paediatric services that you need to provide expert care,” he continued.He said that there have been 700 and 800 gram babies born at KEMH. “This has happened when we cannot stop labour,” he said. “Our team is fine to provide expert first care but such a baby may require respiratory therapists as well paediatric sub specialists like a paediatric endocrinologist, so we transfer them overseas,” he added.Between five and 15 infants are transferred each year to overseas hospitals.The SCBU also accepts premature babies born overseas coming home to Bermuda. Dr Outerbridge said the amount of time such babies need to spend in SCBU differs from case to case and can be a few days to several weeks.He said: “We cannot make them grow faster and mature more quickly than their mom would have!”