Local care for low-birth-weight Infants

By Srisatish Devapatla, MD, FAAP

On May 24, 2007, the Ithaca Journal ran an Associated Press article entitled, “Study: Closing small neonatal ICUs could save more preemies.” The article attempted to briefly summarize a large study of infant and fetal deaths in California hospitals that was published in the New England Journal of Medicine. The article was confusing for local readers, however, because it did not include information specific to local neonatal services at Cayuga Medical Center, and, as a result, it raised more questions than it answered.

What level of neonatal care is available locally?

Cayuga Medical Center is certified by the NYS Department of Health to provide Level 2 nursery services. In accordance with the American Academy of Pediatrics, our Special Care Nursery is classified as a Level 2B nursery because we are qualified to provide mechanical ventilation for brief duration or continuous positive airway pressure, which are both designed to help babies who need assistance breathing. To offer this level of care, we have specialized equipment and personnel available around the clock to provide ongoing care and to handle emergency situations as they arise.

What’s the definition of a low-birth-weight baby?

The study summarized in the May 24 article analyzed mortality rates among “very-low-birth-weight infants.” By definition, these are infants who weigh less than 3 lbs, 3 oz. at birth (less than 1,500 grams). Researchers in the study focused on babies weighing between 1 to 3 pounds.

At Cayuga Medical Center, our Special Care Nursery is certified to care for “low-birth-weight infants,” which encompasses babies who weigh between 3 lbs, 3 oz and 5 lbs, 5 oz., and who have had at least a 32-week gestation period. The average gestation period for humans is 40 weeks, which means that we can care for babies up to eight weeks premature, provided they weigh over 3 pounds.

When there is an impending delivery of a baby of less than 32 weeks gestation, we transfer the mother to the closest tertiary-care center. However, if the baby is already on the way, we deliver and quickly stabilize the infant at Cayuga Medical Center, and then transfer him or her to the nearest tertiary-care center.

What role do obstetrical services play?

The May 24 article noted that hospitals with better neonatal units also had round-the-clock anesthesiology and obstetrical coverage to handle emergency deliveries: mortality rate of premature and low-birth-weight infants does correlate with the level of obstetrical care available. The Maternal-Child Care staff and neonatologist at Cayuga Medical Center have worked closely with our obstetricians and anesthesiologists to meet this requirement. We have streamlined our processes in providing emergency care to obstetrical patients, including emergency Cesarean section

On average, how many low-birth-weight babies are born and receive care at Cayuga Medical Center?

The Special Care Nursery has been a designated Level 2 for over four years. Last year 45 low-birth-weight babies received care in our Special Care Nursery, which is less than 6 percent of the babies born here.

Will the study published in the New England Journal of Medicine have any impact locally?

The study is interesting and certainly helpful to those hospitals providing care to very-low-birth-weight babies. However, the study is less helpful to Tompkins County because it didn’t focus on the exact level of care and service we offer and the specific size and age of premature babies for which we provide care. Additionally, Cayuga Medical Center is the only acute care provider in this rural region. Without a certified Special Care Nursery here, the community would experience an increase in infant mortality and morbidity. Finally, our infant mortality rate for low-birth-weight babies is excellent: since becoming certified more than four years ago as a Level 2 nursery with 24-hour coverage by a board-certified neonatologist, we have not lost a low-birth-weight baby who would otherwise have survived in a tertiary care facility.

Since coming on staff at Cayuga Medical Center five years ago, I have been continually impressed with this medical center’s physician specialists, nursing staff, respiratory therapists, medical technologists, echocardiology technicians, and imaging technologists in their commitment to meet a very high standard of care for newborns. Our team is very experienced, highly trained, and very compassionate as we strive to provide local care that enables families to remain together, which is crucial for the wellbeing of premature and low-birth-weight babies.

Dr. Devapatla is board certified in neonatal-perinatal medicine and pediatrics and is medical director of the Special Care Nursery at Cayuga Medical Center. He completed a fellowship in neonatal-perinatal medicine at Case Western Reserve University after finishing his residency in pediatrics at Metropolitan Hospital Center, New York Medical College.

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