HELPING SICK NEWBORNS

Women who experience difficulties during pregnancy or delivery will have more options when making the decision to stay in Cape Girardeau to receive care instead of being transferred to St. Louis or Memphis, Tenn.

But whether the patients and their newborns are transferred still will depend on the severity of their problems.

Currently, only Southeast Missouri Hospital offers obstetrics and a neonatal intensive-care unit. When St. Francis Medical Center opens its new birthing center next fall, both hospitals in Cape Girardeau will offer obstetrics and neonatal intensive-care services.

A neonatal intensive-care unit (NICU) allows doctors to treat ill newborn babies who might have complications, need around-the-clock monitoring or emergency surgery.

The ultimate goal is to have specialists so that patients can remain close to home and be spared added trauma. Doctors also want to keep the parents and babies together. Studies show it is easier to transport the mother before delivery than a newborn infant.

"Anybody can have problems with their newborn," said Dr. Karlyle Christian-Ritter, who will join the St. Francis staff in July to help build the neonatal program. "Being pregnant is a high-risk situation."

A newborn with health care issues is an added stress, Christian-Ritter said.

Having a neonatologist or neonatal specialist available will mean that newborns could have better chances of survival and recovery from the beginning, she said.

Few sick newborns

The number of critical care infants born in Cape Girardeau is a small percentage. Of the 1,547 births at Southeast Hospital last year, only 25 infants were transported to St. Louis for care after their birth. Another 32 mothers were transported prior to delivery. In all, 100 babies were cared for in the NICU.

St. Francis, when conducting its feasibility studies and interviews about an obstetrics ward, concluded that there are 700 babies born each year who are transported to St. Louis or Memphis for care.

That figure is based on data collected by the Missouri Hospitals Association and includes transport numbers for a 25-county area served by St. Francis.

The number is probably higher, and 700 is a conservative figure, said Dr. John Mackel, vice president of medical affairs.

Both hospitals say that the new birthing center at St. Francis and obstetrics renovations at Southeast are means of providing better health care to women.

The health care benefits are going to be having doctors educated in the latest care for newborns and having neonatologists on staff who can diagnose problems early, St. Francis president and chief executive officer Steven C. Bjelich said.

The birthing center is another element of the hospital's woman care program.

"We're blessed to have this level of care where we don't have to go to St. Louis or Memphis," Bjelich said.

The American Academy of Pediatrics establishes the rating system for NICUs. The ranking ranges from Level I, a status given to most hospitals that service normal, healthy deliveries, to Level III, where hospitals can handle newborn surgeries and specialized care, said Dr. Elizabeth James, a child health and obstetrics professor at the University of Missouri-Columbia School of Medicine.

Level III status requires a NICU to have mechanical ventilation for patients, a neonatologist or physician staffing around the clock and availability of cardiothoracic surgeons and pediatric surgeons. Neonatologists are pediatricians who have an extra three years of training and certification for infant care.

Some medical centers can get around the staffing requirements by having neonatal nurse practitioners or neonatal nurse clinicians.

"You can't just leave your babies with the nurses," said James, who works at a Level III center.

When St. Francis opens its NICU, the center will have a Level III rating. Southeast has a Level II-plus rating.

But the rating at Southeast is more likely based on the availability of surgical specialists in Cape Girardeau than on whether the hospital has neonatologists, said Dr. Scott Weiner, who heads the NICU at the hospital.

"We have kept and taken care of babies for short periods of time, and have shipped them to St. Louis because they needed a heart surgeon or a pediatric surgeon, not because the hospital didn't have neonatologists," Weiner said.

St. Francis hires doctors

St. Francis hired two neonatologists from Nebraska to head up its birthing center and neonatal intensive-care unit, which includes both maternity and delivery suites and postpartum care.

The nursery will be able to care for babies born as early as 20 to 24 weeks.

Drs. Lynne Willett and Christian-Ritter will join the staff in July to help build the neonatal program. Christian-Ritter is a native of Poplar Bluff, Mo.

Both women are working at the University of Nebraska Medical Center in Omaha and teach at Creighton University School of Medicine.

It is unusual to hire two new doctors from the same medical center but there is also an advantage, said Bjelich.

"They have a strong working relationship over these many years and are nationally recognized. To have them here gives our new program a substantial advantage in getting started," he said.

Both will work with other doctors, pediatricians and obstetricians in the region to improve the caliber of care available, Bjelich said.

Both doctors realize that educating the area's doctors about the program is their greatest challenge.

"Like everything else, your reputation grows as you demonstrate skills and do what you say you can do," Willett said.

St. Francis, the city's oldest hospital, announced last year that it would again offer obstetrics services. The hospital closed its maternity program in 1966.

Southeast Hospital is undergoing a $4.3 million redesign of its obstetrics unit to include birthing suites, triage rooms and operating suites.

Nurse shortage problem

The key to either program's success could hinge on finding qualified nurses to help run the unit. With nursing shortages at the national level, both Cape Girardeau hospitals could face a problem.

"You would think the doctors are the most important part of that, but you need experience in newborn nursing and nurses you can count on," Weiner said. The nurses at Southeast have a combined 875 years of newborn care experience.

Finding and recruiting nurses shouldn't be a problem at St. Francis, Willett said. "It will be a critical issue to have enough staff," she said, but added applications from qualified nurses are arriving.

Many nurses and staff members she works with in Omaha, Neb., have been interested in hearing about the program, Willett said.

Willett and Christian-Ritter admit there might be some patient cases they won't have the staff or medical equipment to handle, but those cases likely will only involve surgeries.

"We won't be able to do everything. There will be some that have to go for special procedures like birth defects or heart surgeries," Willett said.

"We don't want to do anything other than excellent" care, said Christian-Ritter.