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Kapi`olani Nurtures Hawaii’s Tiniest Babies Saving premature infants takes medical expertise and technology, and the right touch MADISON CHARLES CELEBRATED her 5th birthday this year, which for her parents, Yavette and Glenn, marked more than just a milestone in their daughter’s life: It marked a miracle. That’s because birth, Madison weighed only 1.69 pounds and struggled for the first six months of her life in the neonatal intensive care unit (NICU) at Kapi`olani Medical Center for Women & Children. “If it hadn’t been for the doctors and nurses at Kapi`olani, we couldn’t have celebrated this miracle,” says Madison’s mother, Yavette Charles. Yavette’s pregnancy was going fine until her 20-week prenatal checkup. Her blood pressure and protein levels were high — an indicator of preeclampsia, a life-threatening complication that prevents the placenta from adequately supplying nutrients to the fetus. Yavette’s doctor referred her to Kapi`olani’s Fetal Diagnostic Center for further testing. The Center is the first comprehensive obstetrical clinic in Hawaii, and offers highly specialized tests and consultation for pregnant women. An ultrasound exam revealed that Yavette had almost no amniotic fluid, a result of the preeclampsia. She was admitted to Kapi`olani that day and Madison was delivered a few weeks later by C-section at 26 weeks. Highest level of medical care for newborns Born more than 10 weeks early, Madison was immediately taken to the NICU where she was cared for by a highly trained team of neonatologists. These doctors specialize in caring for pre-term babies, and are on-site 24 hours a day to attend to newborns at delivery and in the weeks and months that follow. In some cases, babies are transferred from other Hawaii hospitals to Kapi`olani’s NICU. Moving these frail infants from another facility is no small task. It’s a complex process, requiring a dedicated team of specialists to ensure baby’s safety. The pediatric transport team at Kapi`olani manages facility-to-facility transfers for the entire state. The NICU sees about 850 babies each year. Its multidisciplinary team of physicians, nurses, respiratory and rehabilitation therapists and social workers excels at nurturing these little babies, encouraging their development and supporting their families through this difficult time. The right touch While today’s medical technology gives babies who are born as early as 23 weeks a chance at survival, it is critical that premature babies have all of their needs met. Beyond medical attention, the caring team at Kapi`olani helps to foster babies’ development so they can go home with their families sooner. The team offers what the medical community calls, “developmentally supportive care,” which is designed to provide a softer touch to their babies and the family members who visit and care for them. The goal of the initiative is to provide babies the intensive care required in a more babyfriendly and family-friendly environment by reducing noise and light, keeping new additions to the family swaddled, and talking to babies in soothing voices. Kangaroo Care As part of its developmentally supportive care program, the staff helps parents bond with their babies using a technique called Kangaroo Care (KC). Like a mother kangaroo that carries her baby inside her warm pouch, the nurses help parents position baby between their breasts so that baby can receive skin-to-skin contact from a “human incubator.” Research indicates that KC has multiple benefits for premature infants, including improvement in sleep, greater weight gain and earlier discharge from the hospital. The “softer” techniques implemented in the unit first gained notice in a 1994 article in the Journal of the American Medical Association and began to be adopted at Kapi`olani in the late 1990s. “The changes we’ve made to the NICU are a natural evolution,” says Venkataraman Balaraman, M.D., Kapi`olani neonatologist. The developmentally supportive care concept is meant to calm babies’ families, too, since the families spend many hours, days, and possibly months in the NICU encouraging their babies’ development. “The parents are such an important part of the progress of these infants because they’ll be caring for their babies long after they leave the unit,” says Dr. Balaraman. “We realize that having a baby in the intensive care unit can be a traumatic and scary experience.” The unit even has a “practice” room, a transitional space in which parents can be alone with their babies with the comfort of knowing that nurses and physicians are close by if they need help. Family support program Kapi`olani Medical Center has teamed up with the March of Dimes to provide information, resources and support to parents and family members of newborns admitted to the NICU. Services are available to families throughout hospitalization and during baby’s transition home. The March of Dimes tailors the support program to hospitals across the country according to the specific needs of the families and staff at each facility, complementing the services already offered by Kapi`olani. The program includes a dedicated family support specialist who works with the families of babies in the unit, as well as the families of past NICU graduates, providing a supportive network for everyone involved. Going home While the NICU staff readied Madison to live at home with her parents, she was still in need of extra care. Kapi`olani’s Mobile Therapy Team of specialists — including speech, occupational and physical therapists — provided services at the Charles’s home until she was 3. The therapy was essential to Madison’s continued development and closed the loop on the continuum of care she received at Kapi`olani’s NICU. “They were always there for us no matter what,” says Yavette about the physicians, nurses and social workers in the NICU. She even keeps in touch with some of the nurses and shares Madison’s successes with them. Madison has had pneumonia twice and she catches colds easily, but her biggest developmental challenge was difficulty eating. She had a feeding tube for nourishment during her first 18 months, which her parents learned to use. She only began chewing and eating regular food when she was 3 years old. What was her incentive? Bubble gum! Madison always saw people chewing gum and blowing bubbles and she wanted to do those things, too. Today, Madison is doing well. She just started kindergarten and recently joined a soccer league. For more information on having a baby and the specialized care for newborns only available at Kapi`olani, call 808-535-7000. Premature Births: On the Rise in Hawaii According to the March of Dimes, pre-term birth is the nation’s No. 1 obstetric challenge. “It’s a common problem for everyone,” says Scott Berns, M.D., National March of Dimes vice president of chapter programs. In an average week, 46 babies are born premature (before 37 weeks gestation) in Hawaii Between 1992 and 2002, the rate of infants born pre-term in Hawaii increased 33 percent What can we do about it? While we know the risk factors, the exact cause is still unknown, making all pregnant women potential candidates for early delivery. It’s critical that we raise awareness and educate couples so that they can recognize the signs of pre-term labor. Kapi`olani Kids is printed by Kapi`olani Medical Center for Women & Children. This is the November 2005 issue. Kapi`olani Kids is published twice a year as a service to parents in the community served by Kapi`olani Medical Center for Women & Children, 1319 Punahou, Honolulu, HI 96826. The information is provided as education about physical, mental and psychosocial health. It is not intended as a substitute for consultation with a physician. If you have questions or concerns about specific items that appear in Kapi`olani Kids, please contact your child’s doctor. To advise us of changes to your mailing address, please contact us at 808-535-7554.