Pregnancy : Hospital Program Boosts Preemies' Survival

Misti Crane Nearly 90 percent of babies born before 27 weeks gestation -- the sickest, smallest infants in intensive care at Nationwide Children's Hospital -- are surviving.

The success rate is one of the best in the nation, and an 8-year-old effort to standardize and improve care is getting the credit.

A new study reported in the Journal of Neonatal-Perinatal Medicine highlights the hospital's success in caring for extremely premature babies, and the protocols here are getting attention from other hospitals, said Dr. Edward Shepherd, the chief of neonatology at Nationwide Children's.

When the hospital started the "Small Baby Program" in late 2004, it brought together doctors, therapists, nurses and others and aimed to create an atmosphere in which everyone was united in following protocols likely to help the babies develop normally and go home with their parents, Shepherd said. The guidelines have evolved but have consistently improved the likelihood of survival for infants born as early as 22 weeks of gestation, or four months early.

In 2009 -- the end of the study period highlighted in the article -- 78 percent of the babies were surviving. Now, it's almost 90 percent, according to the hospital. Survival is highest for those born later.

Other recent studies have shown survival rates for these infants at 39 to 70 percent, according to the study from Nationwide Children's.

Before the small-baby guidelines, there was a considerable amount of variation in how extremely premature infants were cared for, Shepherd said.

"If you have a culture of optimism, of a really solid process, of really careful uniform care, then your babies do better," he said.

One thing that has become routine is known as "kangaroo care": Parents hold their babies skin-to-skin. That is done for several reasons, including to encourage healthy neurological development.

"Their neuro development, at the end of the day, is the most important part of their care," Shepherd said.

The hospital also routinely limits medical care that could harm delicate skin and increase risks of infection and other complications. That includes minimizing the amount of tape applied to the skin, using gentler tape and thoroughly checking the skin for signs of damage.

"The way we take care of their skin now is much better than the way we used to," Shepherd said.

Standardization of care is "a potentially very important area that we all need to learn more about that would be very important for the public," said Dr. Ed Bell, a professor of pediatrics at the University of Iowa and an expert in extremely premature infants.

"I don't think we understand very well all the factors that influence survival rates in those babies," he said.

Melissa DeGraw Metz of Grandview Heights remembers vividly the terrifying and hopeful times during the three months her son Nicholas stayed at Nationwide Children's, as well as the reassurance it gave her to know that his team was focused on extremely premature babies and had a concrete plan for his care.

It also was a comfort to DeGraw Metz and her husband, Mark, that Nicholas was cared for in the hospital's "small-baby pod," where they were with other families going through similar circumstances and could count on a high level of care from the medical team, she said.

Nicholas, who is now 19 months old, was born at 24 weeks and weighed 1 pound, 11 ounces. DeGraw Metz had contracted an infection that spread to the fetus and placenta following an emergency appendectomy.

Nicholas had to be delivered so quickly he didn't get the benefit of steroid shots given before birth to improve preemies' lung health.

"He had everything against him," DeGraw Metz said.

"Through the whole progression, it's like one step forward and two steps back. He'd have a really good couple days, and he'd crash and they'd intubate him again," she said.

"As a parent, you're just helpless, and you have to rely on and put your trust and faith in these doctors and nurses. And the whole time they had a plan, and they knew what it was."

mcrane@dispatch.com

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