West Tower Rising: Level II Nursery means we can keep more premature babies in Casper, close to family and home
By Kristy Bleizeffer Sep 17, 2014
When Pediatric Hospitalist Anne Scholl Moore, M.D., came to Wyoming Medical Center last year, she wanted to be able to care for more premature babies in Casper, closer to their families and homes. The start of the Pediatric Hospitalist Service in September 2013 provided 24-hour coverage allowing doctors to closely monitor babies with more intensive needs.
Now, the opening of the McMurry West Tower means Wyoming Medical Center will have the facilities required for a Level II Nursery. We sat down with Dr. Moore to discuss what this means for families.
One feature of the new Ruth R. Ellbogen Family, Mother and Baby Center is a nursery equipped to provide Level II Nursery care. Explain what this means.
The nursery in the new tower can accommodate more of what we call Level II Nursery babies which require a little bit more than your routine newborn care. It’s not the highest level of care, like you’d see in a Level III or a Level IV nursery, but it allows us to take care of our premature and sick newborns a little more efficiently and effectively.
We will have more ability to support babies who have respiratory difficulties. Level II allows us to give oxygen, have a baby on a ventilator or CPAP (continuous positive airway pressure), administer antibiotics, keep him in isolation if we need to. In the past, those babies have been flown to Denver which is very disruptive to families. We are happy with our new Pediatric Hospitalist Service to be able to take more of those babies here in Casper and only send the really sick ones out if we have to.
We do know from national studies that if babies are transferred out, it is a risk to their life and health. If they don’t have to fly into Denver, there is a better chance that they will do well.
What is a pediatric hospitalist?
Our Pediatric Hospitalist Service was started a year ago at the request of local pediatricians. We have five pediatricians who are dedicated to inpatient care of our babies and children when they are in the hospital. That means we have coverage 24 hours a day, seven days a week.
In the past, the local pediatricians had to manage their offices and take care of the children in the hospital at the same time, which is a difficult and sometimes almost impossible job to do. We now have a dedicated staff that will take care of all the children in the hospital. That way, when you have a baby who’s sick and needs continuous care for hours, and often in the middle of the night, someone is available to make sure all of their needs are met and their evaluations are happening on an hourly basis, which is sometime necessary for a Level II baby.
How does a Pediatric Hospitalist Service help in the care of Level II babies?
We’re getting more consistency in our care. I’m not for a minute saying our level of care was not good before this service, it’s just that most of those premature or sick babies were transferred out because the local pediatricians could not stay up all night with a sick baby and then see a bunch of kids in the office the next day.
We are happy and thrilled to be doing this job, and it is continuing to grow and improve. The nurses are getting more and more ongoing experience taking care of the sicker babies. They know how to do it, but it’s a matter of having day-to-day experience in care of babies that are a little bit sicker.
What are the differences in care we are able to provide now, as opposed to what we were able to provide before?
We’re keeping a little bit of a younger baby in Casper. For sure, 34-week preemies and some down to 32 weeks. We’re not caring for babies younger than that. Going younger than that in gestational age, you often run into surgical concerns, and we don’t have a pediatric surgeon on staff who is expert at working with premature babies. When there is a risk of needing surgery, we need to transfer those babies.
Before, I would say our limit for caring for premature babies was 35 or 36 weeks. It is a significant amount of babies that we will now be able to care for that we weren’t able to in the past. Some 36 or 37 weekers can also really misbehave, so it often isn’t just gestational age alone. It’s how sick baby is. Some 32 weekers don’t need any care at all except for feed them and some 37 weekers have to be on the ventilator for several days. So it’s really the level of illness and not necessarily the gestational age of the baby.
Later in the fall, we will be adding a neonatologist to our staff which will continue to improve the level of intensive care that we are giving our babies.
What features of the new tower will help provide Level II care?
The new nursery has three separate rooms instead of one large room like we have now. That means mothers and families of the babies that must stay in the nursery will have a little more privacy. It also is a quieter environment. We have better storage facilities, which I know sounds silly, but you have a lot of equipment which is related to the care of these babies. There’s a new waiting room for the families also, so everyone will be more comfortable.
You’ve worked with a lot of premature babies in your career?
Since I was in residency, I’ve always enjoyed working with the little preemies. It’s just a passion of mine. Fortunately, I’ve been able to continue to do it even though I’m not a neonatologist per se. But through my work in Denver (working for many years alongside neonatologists at St. Joseph’s and as a locums tenens at Children’s Hospital Colorado) and continuing in Wyoming, I’ve been able to continue my joy of working with the little preemies and helping the staff here to expand our role.
I think the biggest plus for this system is the fact that families are not disrupted when they have a premature baby and it doesn’t have to be transferred to Denver when it’s hours old. It’s really disheartening when that happens for all of us. We are thrilled, and I think families are also thrilled, when they can keep their little ones here.
A Level II Nursery is more than the physical facilities, but is a comprehensive system of care. Explain some of the protocols adopted here for this level of care.
Besides the respiratory support and close monitoring, we are also providing a form of total nutrition for the babies which has also been shown to be extremely helpful in brain development and helps them tolerate oral feedings. Often, premature babies don’t tolerate oral feedings early on, so you have to start them on IV. The feedings is No. 2 on the premature baby list because if you can’t feed them and get them to grow, they’re not going home anytime soon.
We also now can administer Curosurf, which is an artificial surfactant which helps expand the lungs and promotes the exchange of oxygen.
That’s right. This spring Wyoming Medical Center delivered a set of 27-week-old twins who were the first to get Curosurf here after you implemented its use in the hospital. Tell us about that.
Curosurf is a wonderful drug and is one of the best products available now. Instead of having a baby on a ventilator for four to six weeks, often they can be off the ventilator within a day or two or sooner because they respond just so brilliantly to this medication.
I had been working on the protocols to get it here for several weeks. It just so happened that a day after our clinical pharmacists got it shipped to our pharmacy, a mom who didn’t know she was in labor came in with 27-week-old twins. We gave them the Curosurf and ended up transferring them to Denver, but within a day or two, neither needed significant respiratory support. It was thrilling to see that work so well.