A new way to help preemies breathe

Dr. Bernadette Levesque introduced the Bubble CPAP technique for babies at St. Elizabeth's. (Jonathan Wiggs/Globe Staff)

There are many who see Dr. Bernadette Levesque's work as controversial. That's something she can live with, because as she walks among the tiniest of patients in the neonatal intensive care unit at Caritas St. Elizabeth's Medical Center, what Levesque sees is results.

"The greatest reward is to go around here and see babies who would have been sicker," Levesque, 42, a neonatologist at St. Elizabeth's, said as she roamed the ward, stopping to gently adjust a miniature hat on a miniature head. "It's worth any negative feedback that I may have received from trying to push."

Levesque, who has the polished good looks of a well-heeled suburban mom and the soft, soothing voice of someone who works with the most fragile of humans, has raised her voice to successfully push for a revamp in the way the hospital handles lung support for premature babies. To prevent the underdeveloped lungs from collapsing and reopening with each breath, the traditional approach has been to use a mechanical ventilator and administer surfactin, a mix of proteins and lipids that line the airways.

But back in 2000, Levesque went to a conference and learned another treatment method she was convinced would lead to less chronic lung disease. Called Bubble CPAP (continuous positive airway pressure), a flow of warm humidified oxygen stabilizes and opens the airway and keeps the lungs inflated while allowing the baby to retain the surfactin it has already produced.

The system has been used with great statistical success for more than two decades at Columbia University Medical Center in New York, Levesque said, but has remained in medical limbo because it has not gone through the randomized clinical trials that are considered necessary before a treatment receives widespread adoption.

Seven years ago, when she tried to introduce it at St. Elizabeth's, the unfamiliar idea met resistance from many doctors and nurses. She dropped the idea and ultimately left St. Elizabeth's for Children's. Then in 2006, St. Elizabeth's contracted with Children's to staff its neonatal unit, and Levesque returned to the unit with a sense that the restructuring might provide the right atmosphere for a renewed Bubble CPAP push.

"There was an expectation that things would change, but I couldn't come in and say, 'Everyone has to do this,' " she said. "This is a big change. We're questioning what we've been doing for the last 20 years, and people don't like to hear that what we've been doing has not been the best. So I had to build a consensus."

A year ago today, St. Elizabeth's became the first Boston-area hospital to switch to Bubble CPAP.

The results have been impressive. Compared to data from 2006, Levesque said the unit has had to perform 75 percent fewer intubations (where a tube is inserted into the windpipe to improve breathing) on babies born at less than 33 weeks gestation, seen a 60 percent decrease in the number of babies requiring blood pressure support, and diagnosed fewer babies with chronic lung disease at 36 weeks gestation. Survival rates have remained the same, and she said there has been no increase in complications.

"The babies are feeding earlier, they're getting less blood products, and they're getting to go home earlier," she said. "Our respirators are gathering dust. It's such a dramatic change that the nurses here ask me all the time, 'Why isn't everyone doing this?' " Levesque said, even though she acknowledged that keeping the bubbling system working and the nasal tubes in place on fussy infants is more work for the nurses and respiratory therapists.

There's also an added bonus that is music to a hospital administrator's ears: Bubble CPAP is cheaper than the surfactin approach.

Donald Ingber, a professor of pathology at Harvard Medical School and Children's Hospital who has done lab research with Levesque, said that she was able to make difficult changes because she believes passionately in what she does.

"People tend to be cautious in medicine, and with good reason, but she saw something with her own eyes that she thought could help these kids, and she was willing to take a chance," Ingber said. "That's what makes a great clinician - someone who can takes risks but is careful not to take it beyond the limit. The first rule is 'do no harm.' She's following that, and the preliminary data show that she may be doing better."

On Wednesday, as Levesque prepared to scrub in for a caesarean section on a mother who was having complications, she said she has never felt better about the care she is able to give the premature baby as it takes its first troubled breaths in the world.

As a mother of two, Levesque said she understands how frightening a premature birth is for the parents. But with the new technology, she said she's glad those children are being born at St. Elizabeth's.

"I don't think I'd want to go into a delivery room that didn't have Bubble CPAP," she said. "I really feel like we have more to offer. And I hope the rest of the units will take a serious look at the results we're getting here.

"You feel responsible for these babies, and you don't want to take chances. But if people's experience says another way is better. . ."

Fact sheet

Hometown: Williston Park, N.Y.; lives in Easton.

Education: Levesque graduated from St. John's University in 1987 with a double major in biology and philosophy, and earned her MD from Albany Medical College in 1991.

Family: Her husband, Peter, is a urologist at Morton Hospital in Taunton; their daughter Emily is 13 and son Noah is 9.

Hobbies: "My hobbies are whatever the kids want to do," she says. "Maybe in my retirement I'll have hobbies." (Correction: Because of a reporting error, the benefits of introducing a new technology in the neonatal unit of Caritas St. Elizabeth's Medical Center were understated in a profile of Dr. Bernadette Levesque in yesterday's Health/Science section. Since the Bubble CPAP lung support technique was introduced a year ago, the unit has had to perform 75 percent fewer intubations, where a tube is inserted into the windpipe to improve breathing, on babies born at less than 33 weeks gestation, and has seen a 60 percent decrease in the number of babies requiring blood pressure support.)