VIDEO: With new doctors, tiniest babies can stay closer to home

By Karin Grunden
The Tribune-Star

March 29, 2006 09:15 am

— Dr. Ronette Chua warmed her small stethoscope before slipping it onto Gabrielle’s doll-sized chest.
Inside the incubator, the tiny baby squirmed as Chua listened to her heart, breathing and abdominal sounds. Eyes still closed, the newborn opened her mouth, but made no sound.
On this morning, Chua was making her rounds in Union Hospital’s neonatal intensive care unit.
The Lafayette doctor, whose specialty is caring for newborns, is one of three neonatologists who share a weekly rotation at the Terre Haute hospital.
On the job since June, the trio has allowed Union’s neonatal intensive care unit to accept the tiniest of newborns — some as small as 2 pounds.
“It’s a different level of care,” said Dr. William Scully, a retired Terre Haute pediatrician who was instrumental in founding Union Hospital’s neonatal intensive care unit in January 1968.
“All pediatricians have been trained in neonatology, but the neonatologist takes extra time doing nothing but taking care of newborns. That’s an advancement,” Scully said.
A year ago, the protocol for preterm medical care was much different. Wabash Valley women whose labor couldn’t be postponed were rushed to Indianapolis if their pregnancies had not yet reached 32 weeks gestation. Doctors consider full-term 40 weeks. If the babies arrived before transfer to a larger hospital, they were moved immediately after birth.
No local hospital had a neonatologist on staff, something the American Academy of Pediatrics recommends for care of any infant born more than eight weeks early or weighing less than 3.3 pounds.
Joanne Goldbort, Union Hospital’s director of maternal and child services, was among hospital administrators who believed families should not have to leave the community for such care.
“Having a baby is just an amazing transition for a family,” said Goldbort, who worked as a labor and delivery nurse for 24 years. “Then you top that off with a preterm delivery. It’s a very stressful time.”
About a year ago, Union Hospital began a search for a neonatologist. The quest led to Chua at Home Hospital in Lafayette.
While remaining on staff there, Chua now serves Union Hospital on a revolving weekly basis. Two other neonatologists also share the local rounds: Dr. Russel Coutinho, who relocated his practice to Terre Haute from Chicago, and Dr. Zenaida Reyes, who recently completed a post-residency fellowship at the University of Miami.
Union Hospital’s enhanced neonatal intensive care unit is considered a subspecialty unit — one of about a dozen in the state. Barring the need for surgery or cardiac care, the earliest of preemies now can remain in intensive care locally before they’re ready to head home.
Julia Brillhart, executive director of the Indiana Perinatal Network, said the benefits of the change are twofold. A high-risk infant usually can stay in the birth hospital, something studies show reduces the risk of death. In addition, the parents and newborn aren’t separated, she said.
“It’s really hard to live in Terre Haute and have your baby rushed to Indy and you’ve just had a C-section,” said Brillhart, who heads a statewide coalition that provides guidelines on levels of neonatal hospital care.
In the past 10 months, at least 20 babies have remained at Union Hospital who otherwise would have been born in or transferred to Indianapolis, Chua said.
Terre Haute Regional Hospital, which does not have a neonatologist on staff, transfers about 20 babies each year in need of more specialized services, a nurse manager said. Primarily, those include newborns who are on a ventilator for more than 24 hours.
Shane and Holly Mullenix’s son, Evan, spent three months in Indianapolis hospitals after he was born nearly 14 weeks before his due date. He arrived two years ago today, weighing just 1 pound, 7 ounces, after Holly was taken by ambulance to Indianapolis in preterm labor.
The couple view the availability of full-time neonatologists as added security, especially as they eventually plan to have another child.
‘Nick-you’ — for the most fragile
At the end of a first-floor hallway, past the nursery, is the door to Union Hospital’s neonatal intensive care unit. Inside is a room outfitted in plastic incubators, where supplies range from sophisticated ventilators to diapers barely the size of a cell phone.
This is where the most fragile of newborns are treated and protected. Usually, they’re premature, weigh too little or experienced complications at birth. Full-term babies with respiratory problems, congenital anomalies and infection also are treated here.
In this unit, nurses monitor oxygen levels, insert miniature IVs, bottle-feed or tube feed their patients, change dozens of diapers and accommodate the wails that accompany bath time and daily weigh-ins.
Moms and dads often make a trip to NICU — pronounced “Nick-you” by staff and parents — each day, sometimes more than once, just for a few minutes to hold, feed or simply watch their little ones.
Mike Miller leaned back in a chair near a corner of the room, titling a bottle into his newborn son’s mouth.
Little Brayden gulped for awhile. Then the crying began. His message was clear: He was full.
Dad patted the infant on the back. Out slipped a tiny burp.
“I know you’ve got a more manly one than that,” Mike said, chuckling about the substantial belch his son produced earlier in the feeding.
Brayden arrived a month before his due date after his mother experienced complications from preeclampsia, a disorder marked by high blood pressure, swelling of the extremities, sudden weight gain, headaches and changes in vision.
He spent 10 days in neonatal intensive care before heading home.
His mom, Amanda Reynolds, said she appreciated the nurturing her son received.
“But I’ll be glad not to be coming here,” she said.
Heather Shanes of Linton shared those sentiments as she sat at her son’s bedside last week. The 22-year-old first-time mother gave birth a month early after her high blood pressure led her obstetrician to induce labor.
While grateful for the care Aaron is receiving in Union’s NICU, Heather was more than ready for him to come home. “It’s really hard to leave him,” she said.
For two weeks, she has been making the 45-minute trip from Linton to visit Aaron, who was born a month early. Problems with apnea and a low heart rate have kept him in intensive care.
“He’s a miracle,” she said, watching Aaron last week as he slept under a blue-colored billirubin light, which is used to treat jaundice. “He’s my miracle.”
It takes a team
to tend the tiny
As Dr. Chua finished her morning rounds, she glanced at one of her patients.
“If I could give them a kiss, I would, but I can’t,” the doctor said.
A native of the Philippines, Chua knew early in her career she would focus on women or children.
A friend discouraged her from obstetrics, because of the high risk for malpractice suits.
Chua decided on neonatology, which offered the mix of interacting with both moms and babies. After a medical degree from Philippines, Chua later completed a post-residency fellowship at Riley Hospital for Children. She spent the next 14 years as the only physician for newborns at Home Hospital in Lafayette.
“It was a sacrifice,” she acknowledged of being on-call 24 hours a day, seven days a week for so many years.
Now, she and the two other neonatologists share the rounds at Home and Union.
Chua views the opportunity to practice in another community as a gift, she said, something she simply couldn’t do alone.
Union Hospital’s NICU, she made clear, is not “my neonatology show.”
Nurses, respiratory therapists and other physicians all are essential to the care of the at-risk newborns, she said.
In fact, the changes last year in Union’s NICU went far beyond the addition of three neonatologists.
Nurses on staff — many of whom had past experience caring for babies born more than eight weeks early — received updated training. The hospital also added seven nurses to the staff, said Pat Martin, a NICU nurse who has kept track of statistical details of the changes.
Tens of thousands of dollars of new equipment, ranging from new cardiac monitors to a high-tech incubator, also was necessary to upgrade the unit, said Goldbort, the former obstetrics nurse who oversees the hospital’s maternal and child services.
Among the acquisitions was a transport incubator designed to move newborns from surrounding hospitals that lack subspecialty levels of care.
“I think we’re building up the confidence of the outlying hospitals,” said Mari Gaskins, a neonatology nurse who helped form the transport team. The hospital’s latest records show eight babies had been shuttled from other hospitals for care in Union’s NICU since June.
The hospital’s services also go beyond the time a preemie spends in the NICU.
A developmental clinic is available to children born at least six weeks early. The purpose: to evaluate and promote growth and development.
“It’s a concerted effort to identify children at risk for developmental delays,” Chua said.
Clinics are conducted once a month, with patients screened every three to five months by a neonatologist and experts in speech, audiology, occupational therapy, physical therapy and nutrition.
Infants and toddlers with developmental delays are channeled to therapy services, Chua said.
Getting dressed
to go home
Back in NICU, Amanda Reynolds held a little coordinating shirt and pant set in her lap.
She scooped up son Brayden, placing him in his crib for a final diaper change in the hospital.
“Are you ready to go home?” she said, as she unfastened the disposable diaper.
Brayden wailed. The crying grew louder as his mom snapped him into his going-home outfit. Brayden quieted down.
Amanda and Brayden’s father, Mike Miller, placed their son in a car seat. It had been fitted with rolled-up blankets, to ensure a safe ride for its tiny cargo. Still, the seat seemed to swallow the baby.
“My God, this is as big as a house for you,” Mike told his son as Amanda struggled to get the belts fastened.
Sue Tinchy, one of the neonatal nurses, walked past. “He looks so little in there,” she said.
For the nurses, a baby’s trip home can be a time of mixed emotions. It’s hard to say goodbye, but “when you see a healthy baby go home, it’s very rewarding,” nurse Pat Martin explained.
A twist in one of the straps slowed down Brayden’s exit. As Amanda took Brayden back out of the seat, Mike struggled to fix the problem.
Mari Gaskins, another nurse, pitched in, helping Mike feed the strap through the back of the car seat. About five minutes into the process, Brayden was back in his seat, for his first ride in an automobile.
“You are ready to travel young man,” Gaskins said.
Before they could make it out the door, Mike’s cell phone rang.
“Not yet,” he told the person inquiring whether they were headed home.
He made the first of two trips to his pickup, carrying a box of formula and plastic shopping bag topped off with a blue blanket crocheted by a family friend.
Amanda waited with Brayden, rocking his car seat with her foot.
“I’m nervous,” she acknowledged, but knew they would manage.
“Just remember,” Gaskins said. “Call us anytime.”
Karin Grunden can be reached at (812) 231-4257 or karin.grunden@tribstar.com.

What to know
n Union Hospital houses the Wabash Valley’s only subspecialty neonatal intensive-care unit.
n The NICU provides care for premature infants and newborns with respiratory problems, congenital anomalies and infections.
n Three neonatologists, dozens of nurses and respiratory therapists provide 24-hour care.
n The service allows the tiniest of patients to remain closer to home.
n For more information, call the hospital at (812) 238-7000 or visit online at www.uhhg.org/
union.

On the net
American Academy of
Pediatrics: www.aap.org
The Web site provides a parenting corner on a variety of topics. Links on prematurity include an explanation of what a neonatologist is and information on the academy’s policies for various neonatal-related topics.
Premature Baby Premature Child: www.prematurity.org
This parent-run site includes articles on everything from the emotional roller-coaster ride of having a preemie to the newborn’s first bath. It also provides a support group for parents.
Indiana First Steps: www.in.gov/fssa/first_step
Find out more about this program for Indiana families, which provides intervention services for infants and toddlers experiencing developmental delays or disabilities.
March of Dimes:
www.marchofdimes.com
With a $75 million prematurity research, awareness and education campaign under way, the March of Dimes provides facts on prematurity, as well as personal stories.
Parents of Premature Babies Inc.: www.preemie-L.org
This not-for-profit organization offers a discussion forum, e-mail list and a list of medical abbreviations.
Premature-Infant.com: www.premature-infant.com
Dianne Maroney, an NICU nurse and founder of the site, shares the story of her premature daughter, explains the neonatal intensive-care unit, and provides a list of resources.
Zero To Three:
www.zerotothree.org
The Web site for this national not-for-profit organization brings together the fields of medicine, child development, research science and human behavior, to focus exclusively on the first three years of life.

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