NICU Practices Put Babies and Families First
For about 550 Staten Island babies a year, many weighing less than three and a half pounds, Richmond University Medical Center’s Neonatal Intensive Care Unit (NICU) is a lifesaver — literally. In 2012, the NICU, once again, had one of the highest survival rates in the region: 99.6 percent.
Behind the Numbers
Part of the secret of the unit’s success lies in the continuity of care: Doctors and nurses hired there tend to stay for many years. “We have a staff that has a lot of longevity with that unit; some of them are here their whole professional career,” says RUMC’s Assistant Vice President Women and Children’s Services and Nursing Education, Kathleen DiMauro, RN-BC, MS, IBCLC. “Neonatal nursing is really their passion.”
“A solid group leads to continuity,” adds RUMC NICU Director Dr. Anthony Barone, D.O. “Everybody starts thinking in the same way, and I feel it provides better care for the babies.”
The statistics prove his point. RUMC is a member of the Vermont Oxford group, which gathers data from 900 NICUs in the U.S. and Europe. Statistics from 2012 show that, in addition to an unmatched survival rate, RUMC’s average length of stay is consistently shorter compared to other NICUs: 62.2 days, compared with the Vermont Oxford average of 64.4 days.
The statistics revealed many other successes for RUMC, including a low rate of chronic lung disease, an ever-present threat for premature babies with lifelong consequences. “When premature babies have been on support for a long time, you can damage lungs to the point where they’ll never recover. We have a very low incidence of that,” says Dr. Barone. “That’s a big accomplishment, because if you have damage to the lungs, that leads to a lot of other issues, including more infections and prolonged stays in the NICU.” The incidence of overall infections in RUMC’s NICU is also very low, Dr. Barone says.
A History of Success
The NICU’s success story began with Dr. Ananthan Harin, who established the unit, says RUMC’s Associate Program Director of Pediatrics, Teresa Lemma, MD, FAAP. “He was the one who initiated the protocols about 30 years ago. He was such a a great clinician — he would foresee issues before they happened. Dr. Barone came in and continued those practices.”
Today, Dr. Barone continues them together with his associate, Dr. Santosh Parab, M.D.; they are still the primary people managing the babies’ ventilators. “So you’re looking at two people,” he says. “When you go to a big center, they’ll have respiratory therapists dealing with the ventilator and the neonatologist making the rounds. We maintain the old philosophy. You could say it’s micromanaging, but you have to you have to be available and hands on.”
The other part of their hands-on philosophy is maintaining a low-tech approach that emphasizes human interaction, not equipment. “That forces the nurses to be very visual and not rely on monitors — not putting a baby on a feeding pump and walking away. They do everything by hand. That makes them better nurses,” Dr. Barone says. “The constant observation helps them pick up cues: ‘This baby’s belly is full, so I don’t think we should progress with feeding,’ or, ‘This baby’s activity is not good; there may be a growing infection, so let’s do a culture before the baby gets overwhelmed.’”
“They are spending an inordinate amount of time at the bedside,” DiMauro adds. “There’s a lot of touch. They subscribe to knowing the cues and using their senses.”
Lemma agrees that the NICU nurses deserve considerable credit for the unit’s success. “They never leave. They come and stay in the job until they retire. My feeling is that they must get such a great reward seeing those babies leave the hospital and when a 13-ounce patient comes back, now 17 years old,” Lemma says.
Such outcomes are the NICU’s real story, which statistics alone cannot tell. “When you look at the numbers, it’s too clinical,” Lemma says. “You need to see the kids come into your office, now grown and in college.”
Then you understand why the staff of the NICU work so hard and see the results they do. “Besides having great outcomes, we care,” Lemma says. “That’s such an important aspect at the NICU — and at RUMC in general.”
Chronic Lung Disease, 2012: Vermont Oxford: 25.4%. RUMC: 5.9%.
Nosocomial Infection, 2012: Vermont Oxford: 2.8%. RUMC: 1%.
Mortality: 2012: Vermont Oxford: 3.5%. RUMC: 0.4%.