Baby Randolph Smith

Over four decades ago, the chances of survival for preemies born in the Cayman Islands were exceedingly rare, the Health Services Authority (HSA) Paediatrician Dr Marilyn McIntyre recounted. But that all changed with the establishment of the Neonatal Intensive Care Unit (NICU), a journey that began with a single act of courage, resourcefulness and compassion.

In November, which observed World Prematurity Day (17 November), the NICU reflected on its remarkable legacy of providing life-saving care to the most vulnerable infants in the Cayman community. Dr McIntyre, who had spearheaded the formation of the unit, noted that its inception was marked by a sense of urgency to save more lives and a mother’s decision to fight the odds by having her premature baby receive care on island.

In the late 70s, preterm infants often faced transfer to Jamaica under challenging conditions. “There was no designated area in the hospital for NICU. At that time, babies delivered prematurely were airlifted to Jamaica by the Jamaica Defence Force helicopter, which was sparsely equipped with only a basic transport incubator and a small oxygen cylinder,” explained Dr McIntyre. “The cylinder was not fitted with an oxygen regulator, so the babies either received 100% oxygen or nothing. Sadly, this cylinder could not last the journey to Jamaica, so the babies often died en route to the Bustamante Children’s Hospital or shortly thereafter.”

She continued, “Around 1981, a staff member went into premature labour and was faced with the options of either sending her baby to Jamaica or keeping the baby here at HSA and managing it on a makeshift Continuous Positive Airway Pressure (CPAP) machine. She decided to have the baby here on island, where even if it didn’t survive, she would be with her baby.”

Paediatrician Dr Marilyn McIntyre

Dr McIntyre recalled how the maternity staff created the makeshift CPAP using just an oxygen regulator underwater seal made with a bottle, tape measure, a tongue depressor and a plastic tubing attached to a face mask, which was applied to the face. “Three staff took turns around the clock holding the face mask in place for three days. The outcome was the baby survived,” she said proudly. 

Now 43 and a dedicated Caymanian professional, Randolph Smith, the infant whose survival marked a turning point in neonatal care for the Cayman Islands, still praises the NICU team and shared about being known as the first premature baby to receive this type of care on the island. “I am incredibly grateful to have been one of the first babies to benefit from the HSA’s pioneering efforts in neonatal care. I’ve always known that I was a fighter because being born prematurely at just one pound two ounces was an uphill battle, but the dedication and care of the NICU team made all the difference—I wouldn’t be here today without them. I’ve learned how much the nurses gave of themselves to keep me safe and cared for. One nurse, Julie, even refused to leave my side, and I’ve been fortunate to reconnect with her recently. 

“I heard how they went to Public Works to get nuts and bolts to make the CPAP machine for me, which shows the extraordinary lengths they were willing to go to. Sadly, I also learned of another baby born around the same time in the Brac who didn’t make it, which reminds me of how hard and uncertain this work can be. That’s why I’m proud of my mother’s brave decision to trust the HSA team, despite the challenges at the time, and it reminds me of how vital this type of personal and compassionate care is to our community. I’m glad they are still here saving lives and it’s a legacy I’m honoured to be part of,” Randolph expressed. 

Randolph Smith’s (43) survival as an infant marked a turning point in neonatal care for the Cayman Islands.

The miracle birth was a defining moment that led to the establishment of the island’s first NICU with the commitment to go to extraordinary lengths to save lives, especially those of our most vulnerable patients.

Following the successful case, Dr McIntyre and the staff at the HSA began advocating for the creation of a NICU. Their efforts gained momentum in 1985 when then-Chief Medical Officer Dr Ken Grant allocated funds to construct an addition to the Maternity Unit to care for critically ill newborns. 

This initiative further galvanised community support, inspiring generous contributions from charitable organisations such as the Pink Ladies, Lions Club, and Rotary Clubs, as well as local banks. Then-Governor Allan Scott and his wife took a personal interest in the project, with Mrs Scott becoming a primary sponsor. The Governor also hosted a black-tie dinner, donating all proceeds to the Neonatal Unit. 

These combined efforts allowed the purchase of vital equipment, including five radiant warmers, a resuscitaire, two oxygen analysers, and a bili light. This essential infrastructure became the foundation of the Cayman Islands NICU, which officially opened its doors in 1986. 

“Dr McIntyre’s pioneering spirit, our staff’s resourcefulness and dedication and our local community’s inspiring support helped build the foundations of the Level 3 neonatal care unit, which continues to provide life-saving treatment to hundreds of families today,” noted HSA’s Chief Executive Officer (CEO) Lizzette Yearwood. 

HSA Chairman, Osbourne Bodden stated, “From its humble beginnings, HSA’s NICU has grown into a cornerstone of neonatal care in the Cayman Islands. Since its establishment in the 1980s, it has been saving lives, strengthening families and, as of 2019, it achieved an impressive preemie survival rate of nearly 100%.”

The unit has continued to grow, adapting to advancements in neonatal technology. Presently, it offers a comprehensive range of advanced services, including advanced ventilation systems, bubble CPAP machines, and the Tecotherm Infant Cooling System—all on island at the George Town Hospital. Such technology makes it possible for HSA to serve the Cayman community better, offering families a safe and supportive option locally, even for complex cases. For neonates needing specialised care abroad, the NICU is equipped to provide stabilising treatments before transfer, ensuring the safest possible journey for these delicate patients. 

Recently, the NICU managed the care of Jaquan Scott, its youngest premature baby to date. He was born at 25 weeks and 4 days gestation – almost 15 weeks early. He weighed just 765g or 1lb 11oz. 

The NICU’s high standard of care results from the collaboration between HSA’s paediatricians, neonatologists, respiratory therapists, pharmacists, laboratory services, imaging services, occupational therapists, physiotherapists and a team of nine specialised NICU-trained nurses, all of whom undergo regular training in neonatal resuscitation and critical care. 

“Establishing the NICU was a labour of love, born from a deep desire to give every newborn the fighting chance they deserve. Watching it grow and evolve over the years has been one of the greatest joys of my life,” said Dr McIntyre. 

HSA’s Medical Director Dr Delroy Jefferson noted, “As Cayman’s first and longest-standing NICU, HSA remains committed to delivering the highest standard of care to our tiniest residents, offering families a legacy of compassion, expertise, and continued advancement in this field.”

For more information about HSA’s Maternity and NICU services, please call 949-8600 or visit www.hsa.ky/medical-services/maternity.