NWA hospitals expand NICU services

NWA hosptials expand NICU options

NWA Democrat-Gazette/DAVID GOTTSCHALK Lori Guffey, a speech therapist, works with a new born baby in the Neo Natal Intensive Care Unit at Willow Creek Women’s Hospital in Johnson. The highest level of care for infants in the state is still only offered in Little Rock, and that’s unlikely to change soon, officials said.
NWA Democrat-Gazette/DAVID GOTTSCHALK Lori Guffey, a speech therapist, works with a new born baby in the Neo Natal Intensive Care Unit at Willow Creek Women’s Hospital in Johnson. The highest level of care for infants in the state is still only offered in Little Rock, and that’s unlikely to change soon, officials said.

Expanded services are allowing more Northwest Arkansas women to give birth to high-risk babies close to home and hopefully saving more lives.

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Courtesy Photo

Jenny Schisler (right) gave birth to twin girls at Willow Creek Women’s Hospital on Jan. 25. The twins were in the NICU until Feb. 17. Schisler is pictured with husband James and 2-year-old daughter, Eden. Schisler is holding Evelyn and her husband is holding Elizabeth.

Hospitals across the two counties have added medical personnel, services and equipment to help babies born prematurely or with other medical conditions.

Neonatal Intensive Care Unit Classifications

Level I (low risk; 35-plus weeks gestation)

• Basic neonatal care

• Supervised by a family practice specialist or pediatrician

Level II (medium risk; 32-plus weeks gestation)

• Provide care to infants who are moderately ill with problems that are expected to resolve rapidly

• Supervised by pediatrician or neonatologist

Level III-A (high risk; birth weight of more than 2.2 pounds and gestational age of more than 26 weeks)

• More than 25 annual admissions of babies born before 32 weeks

• Neonatologist able to be in house within 30 minutes

• Ability to provide life support including assisted ventilation for a more than 24 hours

Level III-B (high risk; newborn infants of any weight or gestational age)

• Ability to perform major surgery on site or at a closely related institution

• More than 75 annual admission of babies born before 32 weeks

• Personnel and equipment to provide life support for as long as needed

Level IV (critical)

• Immediate and on-site access to pediatric medical and surgical subspecialty consultants

• Provide surgical repair of serious congenital cardiac malformations that require cardiopulmonary bypass

Source: Arkansas Department of Health

The highest level of care for infants in the state is still only offered in Little Rock, and that's unlikely to change soon, officials said. Offering the second-highest level of care in this region may take a while, because newborns are delivered at several area hospitals, said Carol Gore, chief nursing officer Willow Creek Women's Hospital in Johnson.

Jenny Schisler is one of those who not long ago would have had to give birth to her twin daughters in Little Rock. The Springdale woman's pregnancy became high risk when she was in her 25th week because her water broke. She rushed to Mercy's emergency room in Rogers and was moved to the labor and delivery floor. Doctors were able to stop her from going into labor, but she required specialized care not offered here.

A helicopter flew her and her husband, James, to the University of Arkansas for Medical Sciences hospital where she spent the next 31 days on bed rest.

As her condition stabilized and the fetuses grew stronger, she began exploring options to return home. The couple had a toddler, Eden, at home and didn't want to deliver three hours away.

The doctors agreed to transfer her to Willow Creek when she reached 30 weeks. The facility employs Dr. Bernard Canzoneri, a doctor who specializes in high-risk pregnancies.

"It was so hard to be so far away from home," Schisler said. "It was so nice being just 15 minutes away and to have family and friends nearby."

Willow Creek also has a neonatal intensive care unit and would be able to care for her daughters. She went into labor in her 32nd week. A pregnancy is considered full term at 39 weeks and preterm between 32 and 37 weeks.

Elizabeth and Evelyn were born during a routine Cesarean section on Jan. 25, weighing 5 pounds, 6 ounces and 4 pounds, 3 ounces respectively. The girls were early and low birth weight, but had no major medical conditions. Any baby born weighing less than 5 pounds, 8 ounces is considered low birth weight. The twins spent three weeks in the NICU before being discharged Feb. 17.

Willow Creek is one of three Northwest Arkansas hospitals with a neonatal intensive care unit. It is part of Northwest Health System, which also owns hospitals in Springdale, Bentonville and Siloam Springs. Northwest Medical Center-Springdale opened the state's first advanced neonatal intensive care outside of Little Rock in 1998. The medical system purchased Willow Creek in 2002 and moved the unit in 2008. The Springdale hospital no longer delivers babies.

Willow Creek has 24 neonatal intensive care beds for babies: 15 in private rooms, which allow the family to have around-the-clock contact with the newborn, and seven in an open room for more critical patients.

Northwest is also creating a six-bed neonatal intensive care unit at its Bentonville hospital that will be run by the Willow Creek unit, said Sharif Omar, Northwest CEO. He anticipates the unit will open in November.

"It's important to keep moms with their babies," he said, adding there will always be some babies that need to be transferred to a facility offering more advanced services.

Mercy Northwest Arkansas expanded its neonatal services in Rogers last summer after hiring two neonatologists and adding four ventilator units. A neonatologist is a pediatrician who specializes in medical care for newborn infants with critical illness or premature birth. The unit has eight beds and can go up to 10; two are isolation beds.

Washington Regional added a neonatologist recently and is expanding its NICU from 12 to 34 beds, Bill Bradley, hospital president and CEO wrote in an email.

Classification system

The Arkansas Department of Health spent the last several years developing a classification system that shows which hospitals can take care of the sickest newborns. The Perinatal Regionalization Advisory Committee created a voluntary review process that began this year.

"The goal of the committee and the Arkansas Health Department is to improve the care provided to babies and birthing mothers in collaboration with the physicians and hospitals in each community," Dr. Jay Deshpande said in an email. He is Arkansas Children's Hospital chief medical officer and chairman of the advisory committee.

"On a national level, states with NICU classification systems have been able to demonstrate improvement in infant mortality and morbidity," he said.

The Health Department estimates that if all pregnant women less than 32 weeks delivered in a Level III hospital, the classification system could save the lives of 20-25 babies annually.

Arkansas was one of only three states nationwide that did not have a classification process in place when the review process began.

Statistics show Arkansas has higher rates of low birth weight babies and preterm births than the national average. The National Center for Health Statistics reports 8.8 percent of Arkansas births and 8 percent of national were low birth weight in 2013. The March of Dimes' 2014 report card showed 12.7 percent of Arkansas and 11 percent of the nation's babies were born early.

Northwest Arkansas is doing a bit better than the national average, with 12.5 percent of the 6,425 babies born in the two counties in 2013 being preterm and 7.7 percent having low birth weight, according to the state Health Department.

Hospitals are placed in four categories from basic neonatal care from Level I to the surgical and specialty services of Level IV.

The state's sickest and smallest newborns are still sent to Arkansas Children's Hospital, the only facility in the state earning the highest rating of Level IV. The hospital does not provide delivery services, but is affiliated with the University of Arkansas for Medical Sciences.

Deshpande said the hospital can treat infants who were born very early, have congenital anomalies, require surgery or were injured during complicated deliveries. No hospital in Northwest Arkansas offers full neonatal surgery options.

Level III is divided into two categories, with B facilities offering the next highest level of care. These hospitals include the University of Arkansas for Medical Sciences and Baptist Hospital, both in Little Rock. These facilities take newborns of any weight or gestational age and should have the ability to perform major surgery on site or at a nearby facility.

Willow Creek is going through the review process and is on track to earn a Level III A rating, Gore said. Health Department officials were on site last week as part of the voluntary classification process. Gore said Willow Creek hopes to eventually earn a B rating and offer some surgeries.

Admission numbers are a barrier. A NICU must have more than 75 admissions of babies born before very prematurely, or less than 32 weeks, to earn Level III B status. She said about 50 of Willow Creek's nearly 300 annual NICU patients were born before 32 weeks.

Gore said there are enough patients in Northwest Arkansas to support a Level III B unit, but the newborns are spread across several hospitals.

The state's classification report says Northwest Arkansas has enough patients to support either one Level IIIB and two Level IIIA facilities or three Level IIIA hospitals.

Washington Regional Medical Center in Fayetteville is a Level IIIA facility. Hospitals rated A can treat newborns with a weight of more than 2.2 pounds who are more than 26 weeks.

Mercy Northwest Arkansas is a Level II, but hospital leaders hope improvements will allow it to reach Level IIIA in the next six to eight months. The new Northwest Medical Center-Bentonville neonatal unit will be a Level II, and Siloam Springs Memorial Hospital is a Level I.

Rankin said the classification system means the hospitals are holding each other to a set standard of care.

Local care

Courtney Reeves, Willow Creek NICU director, said the hospital cannot provide all surgical options newborns. Infants requiring surgery are usually sent to Arkansas Children's Hospital unless the parents opt to send to an out-of-state Level IV facility.

Dr. Sameer Wagle is one of Willow Creeks two neonatologists. He pointed to a newborn receiving speech therapy during a recent tour of the hospital's neonatal unit.

"Speech therapy is very unique to our facility," he said, claiming Willow Creek is the only area facility with a full-time speech therapist on staff. He said the hospital began speech therapy on newborns two years ago. An $80,000 machine stimulates the baby's facial muscles and teaches him to feed. Wagle said premature babies often don't know how to suck.

Willow Creek also employs a physical and occupational therapist dedicated to the unit, he said.

The doctor said about 80 percent of the units nearly 300 admissions each year are born premature. Between 3,500 and 4,000 babies are born at Willow Creek and Northwest Medical Center-Bentonville each year.

Babies from the unit are also enrolled in the Northwest Neonatal Graduate Clinic, which provides a team of clinical professionals who work together to make sure the baby hits his developmental milestones, Reeves said. The team meets with the child at three-month intervals and makes recommendations in cognitive and problem solving skills, communication skills, motor skills, feeding and swallowing and medical status resulting from premature birth.

Rankin said Mercy can keep sicker babies since hiring the neonatologists last year, and the patient count has nearly doubled. The hospital has delivered nearly 1,500 babies in the past year and recorded 175 NICU admissions.

Mercy can deliver babies after they reach 32 weeks, and Rankin said they plan to expand that service later this year to include delivery as early as 28 weeks.

"We are looking at how we can grow our women's and children's services," said Charlotte Ranking, Mercy's chief nursing officer. She added the growth would likely include both space and services.

She said the NICU is more of a ward-type setting and hospital administrators are looking for ways to create private rooms.

Washington Regional Medical Center delivered 1,196 babies last year and 260 were admitted into the NICU.

Working together

Outlying hospitals without a neonatal intensive care unit can transfer babies to one of the area's existing units. Northwest has developed a dedicated neonatal transfer team and is looking at expanding the service as far out as Harrison, Reeves said.

Mercy Fort Smith and Sparks Regional Medical Center in Fort Smith have neonatal units.

Omar said Northwest is also doing an increasing number of back transfers, which includes bringing patients back to Willow Creek or sending those that came for care back to their referring hospitals.

Deshpande said Arkansas Children's Hospital works closely with families and medical facilities to return infants to the referring hospitals as often as possible. The decision to transfer is based on several factors including an ongoing need for specialty services, bed space availability, insurance approval and the desires of the families.

There were 64 infants transferred to children's hospital from Northwest Arkansas' five delivery hospitals last year.

"We want to keep the families here and not send them down to Little Rock whenever possible," Rankin said. "We try to work collaboratively with other hospitals and here in our community."

NW News on 06/21/2015

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